John Eichwald, Team Lead
Early Hearing Detection and Intervention (EHDI)
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention (CDC)
Public Health Data Standards Consortium
2012 Annual Business Meeting
November 9, 2012
Hyattsville MD

• U.S. Preventive Services Task Force (USPSTF) recommends screening for hearing loss in all newborn infants (Grade B - July 2008)
• Hearing loss is one of the core newborn conditions on the Recommended Uniform
Screening Panel (RUSP) of the Secretary’s
Advisory Committee on Heritable Disorders in
Newborns and Children (SACHDNC)

About 12,500 infants are diagnosed with the core conditions each year with the current RUSP
• Estimated annual numbers (the most common)
– Hearing Loss: 5,064
– Primary Congenital Hypothyroidism: 2,156
– Sickle Cell Disease: 1,775
– Cystic Fibrosis: 1,248
– MCADD : 239
CDC Grand Rounds - Newborn Screening and Improved Outcomes
Morbidity and Mortality Weekly Report (MMWR) June 1, 2012

1 3 6
Screen no later
Diagnose no later
Intervene no later than 1 than 3 than 6 month months months
Healthy People 2020
Hearing and Other Sensory or Communication Disorders

Two types of screening technologies
• Otoacoustic Emissions (OAE)
• Auditory Brainstem Response (ABR)
Photographs courtesy of the National Center for Hearing Assessment and Management (NCHAM)

CMS Electronic Health Record (EHR) Incentive Program: Stage 2
Final Rule published August 23, 2012

OBR|17|128993^ST ELSEWHERE
HOSPITAL^9999999999^NPI|999555^TNSPHLAB^77D7777777^CLIA |54111-0
^Newborn hearing loss panel^LN|||201010141853|||^VH||||201010151121||1111111111^Smiles^
Minnie^^^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^^^^^^^^MD||||||
201010160918|||F
OBX|1|TX|57700-7^Hearing loss newborn screening comment/discussion^LN||Any baby with clinical features suggestive of hearing loss requires clinical and diagnostic follow-up regardless of whether the NMS result is normal or abnormal.|||N|||F
OBX|2|CE|54109-4^Newborn hearing screen – right
^LN||LA103921^Pass^LN|||N|||F
OBX|3|CE|54108-6^Newborn hearing screen – left
^LN||LA103921^Pass^LN|||N|||F
OBX|4|CE|54106-0^Newborn hearing screen method
^LN||LA10388-9^Auditory brain stem response^LN|||N|||F
Implementation Guide for Laboratory Results, U.S. Realm, HL7 Version 2.5.1

• The HIT Standards Federal Advisory Committee has recommended the use of the HL7 CDA standard as a future direction for electronic data exchanges between clinical and public health information systems for public health reporting
• The Public Health Data Standards Consortium (PHDSC) is demonstrating electronic data exchange between clinical
EHR Systems and public health EHDI using the HL7 Clinical
Document Architecture (CDA) standard

Goal: demonstrate the ability to receive a CDA-based
EHDI Report by a Public Health Information System in two jurisdictions will focus on reporting of:
• Newborn hearing screening results and basic patient demographics from the birthing facility’s
EHR to the State EHDI Program or
• Early Hearing Care Plan (EHCP) - based on jurisdictional plans

Proposed Public Health Reporting Schema: Screening Report
Birthing
Facility
EHR
Screening
Results
Document
Health
Information
Exchange
(HIE)
Or
Screening
Results
Document
Public
Health
Gateway
State EHDI
Information
System
CDA-based Actor Diagram

Proposed Public Health Reporting Schema: Care Plan
State EHDI
Information
System
Early
Hearing
Care
Plan
Health
Information
Exchange
(HIE)
Early
Hearing
Care Plan
Or
Public
Health
Gateway
Primary Care
Provider EHR
CDA-based Actor Diagram

TEAM
•
2 States Participants: (to be determined)
Maryland, Massachusetts, Michigan, North
Dakota, Oregon, Rhode Island
States Observers
•
• Florida, Missouri, Ohio, Pennsylvania, South
Carolina, Texas, Washington
PHDSC Team:
Alla Fridman, Anna Orlova, Lisa Nelson, Lori
Fourquet, Maiko Minami, Sarah Quaynor

•
•
•
•
•
• Aug - Sept – Recruitment
• 2 State participants (To be determined)
• X State observers
November 2012 – Pilot Design
December 2012 – Implementation
January 10, 2012 – Testing
February, 2013 – Draft Project Report
May 2013 – Final Project Report

CDA EHDI Pilot Project information
PHDSC Project Wiki pages at: https://wiki.phdsc.org/index.php/EHDI
The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position or policy of the Centers for Disease Control and Prevention.