Transcript Hearing Merged with Metabolic: A Marriage Made in Heaven?

Hearing Merged with Metabolic:
A Marriage Made in Heaven?
James G. Schmaelzle, M.C.D., CCC-A
Pam King, M.P.A., RN
Oklahoma State Department of Health
Oklahoma City
2005 Early Hearing Detection and Intervention Conference
Renaissance Atlanta Downtown
March 4, 2005
Oklahoma Newborn Screening
+
Newborn Metabolic Screening
Newborn Hearing Screening
Oklahoma Newborn Screening
=
a marriage made in heaven?
Oklahoma Newborn Screening
Well…….
Oklahoma Newborn Screening
GATES of
HEAVEN
DETOUR
In the beginning…
Newborn Hearing
Screening Program
(NHSP)
Newborn Hearing Screening
• Risk-register hearing screening began
in 1983
• Physiologic hearing screening was
added in 1998
• Birth sites recorded results and
demographics on a newborn hearing
screening hospital questionnaire
Newborn Hearing Screening
• Completed forms were mailed to the
state health department
• NHSP office staff checked and “coded”
each form
• Coded questionnaires were sent to
agency keypunch (contractor after
1990) for conversion into a data file
Newborn Hearing Screening
• The hearing data file was then uploaded
to the health department’s mainframe
computer
• A mainframe “software” program
generated physician notification “cards”
for infants needing follow-up when the
baby was 3½ months of age
Newborn Hearing Screening
• When the baby was 4 months of age,
the software program also generated
parent notification “cards” for infants
needing follow-up hearing evaluation
• If no response was received from the
first mailing, a second notification was
generated at 8 months
Newborn Hearing Screening
• When NHSP staff received follow-up
hearing evaluation results or a change
of address for an infant, the new
information was added to the database
via keypunch
• The system software generated a
“standardized” yearly statistical report
Newborn Hearing Screening
Challenges
1. “Coding” 50,000 forms a year was tine
consuming and tedious for staff
2. Because “hearing data” was not yet in
the system, follow-up didn’t begin until
the baby was over 3 months old
3. Information about the infant’s health
care provider was often outdated,
inaccurate, or missing
Newborn Hearing Screening
Challenges, continued
4. No way to customize correspondence
to physicians and parents on the preprinted 8½” by 3½” notification cards
5. Printing of notification cards was often
delayed because agency’s only
tractor-feed printer was being used by
other programs
Newborn Hearing Screening
Challenges, continued
6. Program staff was unable to easily
correct errors in database
7. Computer programmer needed to
produce even the simplest data
summary reports
8. The Health Department planned to
phase out the mainframe computer
system by 2002
Newborn Metabolic
Disorder
Screening Program
(NMDSP)
Newborn Metabolic Screening
• Metabolic screening began in 1965
• Records were maintained in a
laboratory “paper” file
• Follow-up was provided through
telephone calls and typed letters to
physicians and parents
Newborn Metabolic Screening
• An agency “metabolic” database was
established in the mid-1970s
• Laboratory personnel entered
demographics and screening results
• This newer system was capable of
generating correspondence to physicians
and families when follow-up was needed
Newborn Metabolic Screening
• A Neometrics designed DOS based
system capable of generating
appropriate correspondence
automatically based on laboratory
results was installed in 1989
• The system allowed for the creation of
customized and personalized letters to
parents and physicians
Newborn Metabolic Screening
• Reports of screening percentages,
results by disorder, etc. could be
generated by program staff
• A “Windows” version of the Neometrics
software was installed in 1999
• The newer version allowed staff to
operate all features of the program from
their desktop computer rather than a
stand-alone system
Hearing Screening
combined with
Metabolic Disorder
Screening
Combined Newborn Screening
• The NHSP and the NMDSP were placed
under the same service chief in 1998
• The NHSP was now collecting
physiologic hearing results, but because
of its tracking system, was unable to
correspond with parents and physicians
in a timely manner
Combined Newborn Screening
• To remedy the NHSP tracking difficulties,
the service chief and both program
managers began to look for ways to link
the follow-up programs
• The NHSP applied for and was awarded
a HRSA/MCHB grant in 2001
• These funds were used to combine the
databases and provide the NHSP with
an enhanced tracking system
Combined Newborn Screening
• The public health laboratory agreed to
enter hearing results at the same time
they entered the demographic
information into the lab database
• In 2001, the NHSP, the NMDSP, and the
lab worked diligently to combine the
hearing screening questionnaire and the
blood-spot form
Combined Newborn Screening
•
•
The resulting new form included an area
to record hearing screening results as
well as hearing risk status
It also included:
1. A “chart copy” hospital pull-out
2. A metabolic educational parent pull-out
3. A hearing results/educational parent pullout
Combined Newborn Screening
Hearing Screening Pull-out - (pink)
Metabolic Screening Pull-out - (blue)
Hospital Chart Copy Pull-out - (yellow)
Combined Newborn Screening
Hearing Screening Results:
Right Ear
 Pass
 Refer
Left Ear
 Pass
 Refer
If not screened, reason:
 Technical problem
 Caregiver refused
Screen Method
 ABR Other (Specify)____
 OAE
 No equipment
 Baby discharged
 Delayed
 Other______
Combined Newborn Screening
Hearing risk status
Blood relatives of the infant have a permanent
hearing loss that began at birth or in early childhood.
Question refers to congenital childhood hearing loss -- NOT
hearing loss due to accidents, illness (i.e., ear infections, fevers,
meningitis) or the aging process.
Infant is suspected of having a congenital infection
(neonatal herpes, cmv, rubella, syphilis,
toxoplasmosis).
Question addresses whether the infant has experienced any
of the above conditions.
Combined Newborn Screening
Risk status, cont.
Infant has craniofacial anomalies (pinna/ear canal
abnormality, cleft lip/palate, hydrocephalus).
Infant had exchange transfusion.
Infant has serum bilirubin level ≥ 15 mg/dL.
Infant was placed in a Level II or III nursery for more
than 24 hours.
Combined Newborn Screening
• Neometrics designed and installed a
“hearing-screening” module in mid-2002
at a cost of $85,000
• The NHSP developed appropriate parent
and physician “hearing” letters as well as
follow-up result forms
Combined Newborn Screening
• Cross-training was provided for the
NHSP and NMDSP support personnel
allowing staff from either program to
generate correspondence for either
program
• Hospitals were provided information
regarding the use of the new forms via
correspondence and in-service training
starting in June, 2002
Combined Newborn Screening
• The Voice Response System (used by
providers to access screening results) was
upgraded to include hearing results along
with metabolic results
• Hospitals were encouraged to report
hearing results on the combined bloodspot form beginning August 1, 2002
Combined Newborn Screening
• The program accepted hearing results on
either the the new blood-spot form or the
old NHSP hospital questionnaire through
2002
• Since January 1, 2003 all birthing sites
have been reporting hearing screening
results on the combined form
Combined Newborn Screening
Advantages
• Hospital staff complete only one form
to supply demographics for both hearing
and metabolic disorder screening
• Education of hospital staff is simplified
since personnel from either program
can provide the appropriate training
Combined Newborn Screening
Advantages
• Demographics/data for both programs are
entered by the same laboratory staff
• Hearing results and metabolic results are
available in the tracking system at the
same time – usually within a week of birth
• Both NHSP and NMDSP staff can
generate appropriate correspondence for
either program
Combined Newborn Screening
Advantages
• Support staff from both programs have
access to the same database and can field
telephone calls from providers and parents
about either program
• Physicians providing follow-up for infants
receive both hearing results and metabolic
results on the same laboratory mailer
Combined Newborn Screening
Advantages
• Appropriately credentialed providers
obtain both hearing and metabolic results
through the same voice response system
• Current program statistics by disorder,
hospital, county of birth, etc. can be
generated by program support staff
• Follow-up results for either program are
entered easily into the combined database
Combined Newborn Screening
Advantages
• Updating demographics for one program
updates them for both programs
• Both programs are able to track and
provide individualized follow-up for infants
and their families in a timely manner
Is combining newborn hearing
screening with newborn
metabolic disorder screening
really a marriage made in
heaven?
In Oklahoma………
We know so!
Oklahoma Newborn Screening
Hearing Merged with Metabolic:
A Marriage Made in Heaven?
2005 Early Hearing Detection and Intervention Conference
Renaissance Atlanta Downtown
March 4, 2005
Contact Information
Jim Schmaelzle ([email protected])
Pam King ([email protected])
Oklahoma State Department of Health
1000 NE 10th Street
Oklahoma City, OK 73117-1299
405-271-6617