developing web-based heatlh information systems in new jersey katherine hempstead center for health...
TRANSCRIPT
Developing web-based heatlh information systems in New Jersey
Katherine HempsteadCenter for Health StatisticsNew Jersey Department of Health and Senior Services
From paper to the web….
Transition to electronic records occurring throughout the health care system
Benefits to patients, physicians, and government
But many challenges to overcome
Three examples
1. Child Health Registry2. Trauma Registry/Pediatric Critical
Care Registry3. Electronic Death Registration
System
Child Health Registry
Background Since @ 1999, HRSA and partners have
been working to foster development of integrated child health systems
Identified key elements Developed principles and core functions Disseminated to states Grant funding
Current situation in many states
Separate child health information systems Birth registration Newborn screening Hearing screening Immunizations Birth defects registry Eligibility screenings
Problem with current system
Physicians do not receive timely information in many cases
Patients lost to follow up Leads to under- or over-
immunization Missed opportunities for appropriate
care
Integration of child health information systems
Goal – To prevent problems arising from
lack of timely, accurate, and complete information
To reinforce concept of a “medical home” for children that contains all information about the child
Facilitate assessment and prompt provision of appropriate services
National activities
HRSA and partners Proposed systematic approach Developed user requirements Comprehensive evaluation plan Communications plan to include all
stakeholders Document and disseminate best
practices
Priority areas for integration
Vital registration Newborn dried blood spot screening Newborn hearing detection Immunization Other areas:
WIC, lead screening, special needs registries, billing systems, birth defects surveillance, early interventions
Example: Utah
Child Health Advanced Records Management (CHARM)
Provides real-time access to data Reduce duplicate data entry Support coordinated service
delivery
CHARM
Does not replace existing data systems
Serves as an electronic broker Participating programs can link to
CHARM; share data they choose to share
Participating programs retain stewardship of their data
CHARM
CHARM Core Council Program managers, UDOH senior
management, technical staff and consultants
Mechanism for developing a consensus on what is to be shared
Provide input on potential uses of integrated data
Primarily supported by federal grants
Where are we in New Jersey?
Vital Registration Newborn screening Newborn hearing Immunization
Birth Registration
EBC – DOS-based 1995 Genesis Systems PCs using modems enter data from
labor and delivery centers Transmit to local registrars - BVS
New Jersey Immunization Information System
Developed in 1997 http://njiis.doh.state.nj.us/njiis/index.htm
Contains over 500,000 records 2004 law requires participation,
unless refusal Located in Communicable Disease
Service Accessible by physicians and other
providers
Early Hearing Detection and Intervention
Established in 2002 with CDC funding
Developed internally Has been updated and improved Monitors hospital compliance Does not include out of state
transfers
Newborn Biochemical Screening
NBS lab located in DHSS (PHEL) Mandated to screen for 20 disorders Actually screens for somewhat more Notifies hospitals of results Also notifies NBS Follow-up program Follow-up program notifies
pediatricians, parents, tracks outcomes
Newborn Biochemical Screening
Required by law, unless parents object
Began in 1964 Has expanded considerably since
then Results mailed from lab via USPS
Current level of integration
EHDI and NJIIS have signed MOA, so that hearing data is available to physicians accessing NJIIS
EHDI and NJIIS receive information from EBC – weekly files accessed via FTP
NBS not currently integrated with EBC
Vision for the future
Integration of all systems in a web-based “data mart”
Authorized users can obtain information in real time
EBC information is integrated with screening and immunization information
Pediatricians can access in real time
Progress toward goals
Have received HRSA funding to create integrated child health registry
Formed working group Drafted RFP In process of preparing for bids
Trauma Registry
Definition Uses of a trauma registry
Evaluate treatment; outcomes Proper triage/transfer procedures Injury surveillance, prevention activities
Trauma registry
Background Has legislation to establish state
trauma registry; no rules Current status
Central Nervous System injury registry Transition to statewide trauma registry Trauma centers Other acute care hospitals
Pediatric critical care registry
Developed by Governor’s Emergency Medical Services for Children Advisory Council
Purpose: Develop a registry of critically ill or injured pediatric patients
Track outcomes; evaluate treatment Develop best practices
Plans for Development
Web-based registry minimizing duplication
Will be implemented as part of New Jersey Trauma Registry
Hospitals should begin piloting by Fall 2008
Challenges
Electronic Death Registration System
Electronic Death Registration System
Benefits of EDRS Background Current status Challenges
What is EDRS?
Electronic filing of death certificates On-line collaboration among multiple death
registration system users User-friendly death record data entry screens
Fact-of-Death data Cause-of-Death data
Built-in instructions and on-line/telephone helpdesk Internet accessibility 24/7 Electronic authentication
User IDs/passwords
Adapted from Electronic Death Registration Systems in the United States
Accessed 3/08 from www.naphsis.org
Who benefits from an EDRS?
Physicians and medical examiners Institutions
Hospitals Nursing Homes Hospice Long Term Care
Funeral directors State and Local registrars Federal, state and local agencies Public health researchers Families
Adapted from Electronic Death Registration Systems in the United States
Accessed 3/08 from www.naphsis.org
Benefits of NJ-EDRS
Sends timely email alerts when an electronic signature is needed to certify a death
Staff can quickly and easily enter decedent information for physician review and certification
Empowers facilities with reporting features
Alaska
California
Idaho
Oregon
Washington
Montana
Wyoming
Utah
Colorado
ArizonaNew Mexico
Texas
Oklahoma
Kansas
Nebraska
South Dakota
North Dakota Minnesota
Wisconsin
Iowa
Illinois
OhioIndiana
Kentucky
WV
Virginia
N. Carolina
Georgia
Florida
AlabamaMS
Missouri
Arkansas
LA
Nevada
Hawaii
Michigan
PennsylvaniaNJ
New YorkCT
MA
VT
NH
Maine
Tennessee
MD
DE
RI
DC
S. Carolina
United States Electronic Death Registration Systems, by Jurisdiction, With SSA Funding Indicator, July 2007
New York City
StatusDeployed In Development Planning/Requirements Stage
Received SSA Funding
*
**
*
*
***
**
*
**
*
** *
**
**
*
*
*
**
*
*
*
*
*
*
New Jersey Mandatory EDRS
Physician use of the EDRS is required by law:
26:8-24.1 New Jersey Electronic Death Registration System (NJ-EDRS); establishment
“…All participants in the death registration process, including, but not limited to, the State registrar, local registrars, deputy registrars, alternate deputy registrars, subregistrars, the State medical examiner, county medical examiners, funeral directors, attending physicians and resident physicians, licensed health care facilities, and other public or private institutions providing medical care, treatment or confinement to persons, shall be required to utilize the NJ-EDRS to provide the information that is required of them by statute or regulation.”
The State Registrar will send official notice identifying the date for mandatory compliance with this law, but all persons are
encouraged to begin using the system now.
Phased Approach to EDRS TrainingPhase I
Pilot – Completed May 2007 Training of Registrars, Funeral Directors and 3 medical
facilities in the pilot county (Mercer) Medical Examiners statewide were trained during the pilot
Phase I – June 2007 to Present, Concurrent training of: 566 Local Registrar Offices
Completion Oct 2007 800 + Funeral Homes
Target completion by early 2009 To date, Funeral Directors have been trained in Mercer,
Hunterdon, Warren, Sussex, Middlesex, Monmouth, Ocean, Burlington, Somerset and Passaic counties
Phased Approach to EDRS Training Phase II-III
Phase II – Training of Medical Facilities Hospitals, Long Term Care, Nursing Homes, Hospice
943 Medical facilities to be trained Medical Facilities, staff and affiliated physicians will
receive training beginning Spring of 2008
Phase III – Training of Private Practice Physicians Training to commence upon the conclusion of Phase II Physicians can self-register and utilize on-line tutorials
Additional Training Tools
CD-ROM Tutorial Medical Certifier Quick
Reference Guide EDRS powerpoint
presentation Posters, fliers, magnets 24-hour Help Desk Reference Guides for:
Medical Facility Administrators
Long Term Care Hospice Nursing Homes
Simple Physician Self-Registration Go to EDRS Homepage - https://edrs.nj.gov
Complete Initial Registration Page
The Medical Facility Administrator EDRS requires each facility to identify a
person to serve as an administrator Set up and monitor EDRS for the facility Affiliate users and manage who is
allowed to access the facility’s cases Serve as an on-site point person for
EDRS training
EDRS User Accounts for the Medical Facility
New Jersey Health Information Technology Commission
Established under P.L. 2007, c.330 “New Jersey Health Information
Technology Act” To work with Office of e-HIT (DOBI) Responsible for approving state
health information technology plan Development of electronic medical
records
New Jersey Health Information .,..
Background Authorizing legislation Current status
RHIOS
Current status
Private Sector initiatives
Federal government initiatives
Overview
What we can expect