The Wisconsin EHDI Tracking Referral and Coordination System

February 19, 2004

Elizabeth Seeliger, Lilah Katcher

Wisconsin Department of Health and Family Services

Births ~ 69,000/year

Birthing Hospitals = 102

Population ~ 5.4 million cheeseheads

Welcome to Wisconsin! A few facts to get us started:

Home of the Wisconsin Sound Beginnings (WSB) EHDI program and WE-TRAC

WE-TRAC, the Wisconsin EHDI Tracking Referral and Coordination System,

•supports the goals of the WSB program and the national EHDI algorithm

•provides a mechanism for the tracking and reporting of individual, hospital, and statewide aggregate hearing screening data.

•allows electronic referrals to appropriate organizations, and denotes a clear transfer of responsibility for follow-up activities.

•acts as a safety net assuring timely and appropriate coordination of care throughout the EHDI continuum.

• is a part of the Wisconsin Public Health Information Network (WI PHIN)

• is designed to be compatible with the NEDSS base system

•has a common interface with other Wisconsin Program Area Modules (PAMs)

– Is the portal into applications supporting public health in Wisconsin, including WE-TRAC, West Nile Virus, SPHERE (public health records), and Birth Defects Surveillance PAMs.

– hosts a centralized directory of users and organizations

– brings together:

• The WI Health Alert Network (HAN),

• PAMs

• Wisconsin State Lab of Hygiene (SLH) Electronic Laboratory Reporting, and

• The NEDSS base system.

– Will be the platform for integrated public health data in Wisconsin

WE-TRAC is a part of the WI PHIN, which

WE-TRAC uses data collected on the SLH newborn blood card.

•Hearing screening data added to the blood card beginning April 30, 2002.

•SLH staff does initial followup on missing blood card information

WE-TRAC hearing screening data is entered at the SLH.

•Blood card data used by WE-TRAC is sent from the SLH by secure messaging to the WE-TRAC server at the University of Wisconsin Division of Information Technology (UW-DoIT)

•Records with complete hearing screening information are sent nightly

•Records with incomplete hearing screening information are held for up to 10 days for more information from the blood card hearing screening “pullout”

•Records for babies passing the hearing screening are archived in WE-TRAC

•Babies who refer or were not screened are placed in the WE-TRAC birth hospital “queue” for follow-up

•At this point, only the birth hospital can view or manage records for babies born at their organization

WE-TRAC “queues” ensure secure case management.

• A queue is a secure record list viewable only by users at that organization

• From the queue, users can view and enter hearing-related care information

• Case management options depend on the organization type. For example, only a birthing unit can enter a NICU transfer, and an audiology clinic can enter diagnostic audiology results.

WE-TRAC Queue and Case Management Options (Birthing Unit)

Three roles: User, Local Administrator, WE-TRAC Administrator:

•Users can view site news, modify their individual profile and preference information, view records and manage care for babies associated with their organization, manage hearing-related care of these babies, and enter other information about the baby.

•Local Administrators can, in addition, modify organization profile, modify organization preferences, manage organization user information and roles, and approve or reject requests for secondary authorization to the organization.

•WE-TRAC Administrators can, in addition manage site news, site forms, role-based system access, and and user feedback; create, manage, and “map” organizations; manage cases needing additional followup.

WE-TRAC also uses role-based security to restrict access.

WE-TRAC Login Screen Detail

•The State of Wisconsin's Web Access Management System provides a single user ID for user authentication to all state sites for which the user has authorization.

•The HAN stores user information in a central directory and gives users an option to select public health alert notifications.

WE-TRAC users must obtain a WAMS ID and register for the WI HAN.

•WE-TRAC recently completed a 1 year pilot, and has 25 active user organizations. Almost 25% of WI births occur at WE-TRAC hospitals.

•WE-TRAC allows entry of sequential events along the EHDI continuum.

•A common intuitive interface is shared by nursery staff, NICU staff, primary care physicians, audiologists, and Birth to Three providers.

•Based on pilot feedback, we developed additional workflow elements to support tracking of NICU babies--transfers and inpatient screening entry

•Electronic referrals denote clear transfers of responsibility.

•Organizations have “look-back, look-ahead” capability to see the status of a baby for which they have provided care

•Users can monitor that timely and appropriate hearing-related care is provided to all babies associated with their organization

WE-TRAC is a workflow system that allows hearing care coordination.

WE-TRAC Screening Form

•NICU organizations can enter repeat inpatient screening results, other organizations enter outpatient re-screening results

WE-TRAC allows users to enter screening results.

WE-TRAC Referral Screen

•Birthing Units and NICU organizations can cross-transfer, all other organizations enter referrals

•Transfers and referrals show a clear transfer of responsibility

WE-TRAC allows easy transfers and referrals to follow-up organizations.

WE-TRAC Audiology Report

WE-TRAC allows entry of diagnostic audiology results.

WE-TRAC allows completion of the Confirmed Hearing Loss form (CHL).

• The CHL Report is the first place WI collects Risk Factors

• At this point, audiologists will enter a referral to Early Intervention and, with parental consent, notify others, including the

– Birth Hospital

– Guide-By-Your-Side Program

– and Primary Care Physician

WE-TRAC “Last Action, Next Suggested Action” Display

•System prompts guide users to complete the next step (referrals, CHL form) immediately after test results are entered.

WE-TRAC supports timely and appropriate hearing follow-up.

WE-TRAC “time-outs” promote timely and appropriate care.

•A next recommended procedure and date appear by each baby’s name in the queue.

•If the procedure does not occur by the “time-out date,” the baby’s

name and the date will turn red.

•On time-out, an E-mail is sent to providers, and a copy of the baby’s

record is placed in the WE-TRAC “timed-out queue” for follow-up.

WE-TRAC Timed-out Queue Item Detail

Welcome to WE-TRAC!

WE-TRAC System Demonstration--a few words before we begin:

• Visible site features vary based on user role. We will demonstrate from the WE-TRAC administrator role to show the full range of user and administrative options. This will also allow us to see information about multiple organizations, where another user role would view information on only one organization.

• The demonstration site differs from the live site in a few ways:

– mock babies, users, and organizations

– non-representative results (30 babies screened, none passed)

– live report data not available in training site

Demonstration Notes:Child’s Chart

Includes:

• Parent Information

– adoption (hides birth parent information)

– foster care (allows addition of guardian information)

• Hearing screening & follow-up history

• Address and Medical Home information

• Blood Card Information

– Includes graphic representation

• Frequent system prompts remind users to enter PCP/Medical Home information.

• Email notification is sent to the Medical Home upon refusal of care.

Demonstration Notes: PCP/Medical Home

WE-TRAC Future Directions

•Continue integration with the PHIN, PAMS and NEDSS base system

•Continue outreach and training--bringing more organizations onto the system. Develop training video that can be accessed from WE-TRAC.

•Conduct PCP focus groups co-facilitated by the EHDI WI- Chapter Champion to further define physician requirements for WE-TRAC

•Develop a robust Early Intervention module for use by Birth to Three providers

•Develop an interface to be used by the Guide-By-Your-Side Program

•Expand collection of lost-to-followup data

•Continue to develop SAS reporting capabilities

WSB Contacts

WI CSHCN Toll Free Number 1-800-441-4576

Sharon Fleischfresser, MD, MPH, CSHCN Medical Director fleissa@dhfs.state.wi.us

Elizabeth Seeliger, MA, CCC-A, WSB Program Coordinator seeliel@dhfs.state.wi.us

Lilah Katcher, WE-TRAC Project Manager katchlm@dhfs.state.wi.us