MOAC Use Case Summary - DRAFT
Name of UC:
Submit Newborn Screening – Hearing Test
Sponsor(s):
Michigan Department of Health and Human Services
Date:
February 20, 2015
The purpose of the MOAC Use Case Summary Form is to allow the Sponsor of a proposed Use Case
(UC) to provide the MOAC Use Case Work Group information needed to evaluate and provide
feedback to the Sponsor and eventually the MiHIN Board. The feedback will assist the HIE
Community with understanding where this UC fits within the overall Strategic Priority Plans.
The MOAC UC Summary Form is split into several sections to allow the Sponsor to speak to the
impact of the proposed UC in the following areas: Health Outcomes, Regulation, Cost and Revenue,
Implementation Challenges, Vendor Community, and Support.
Executive Oversight
Early detection of and intervention for hearing loss in babies is key to treatment and improving
quality of life. The newborn screening mandate in Michigan Public Health code section 333.5431
requires hospitals to screen newborn babies for hearing loss and report the hearing test and
screening results to the Early Hearing Detection & Intervention (EHDI) program at the Michigan
Department of Health and Human Services (MDHHS).
With a large percentage of the births in Michigan covered by Medicaid, the receipt of newborn
hearing test and screening results in near real-time from the state’s birthing hospitals is an essential
public health function. This Use Case pertains to transmission of newborn hearing test results from
maternity facilities to EHDI. These transmissions will assist with the agency’s goal of improving
beneficiary patient health and reducing patient health care costs through early detection. Hearing
test and screening results are currently entered into hospital EHR systems, and most Michigan
hospitals have already established their connection to the Michigan Health Information Network
Shared Services (MiHIN).
This Use Case enables electronic messages that contain newborn hearing test results to be
transported from the hospital Electronic Health Records (EHRs) to MDHHS using Health Level 7 (HL7)
message transmission through MiHIN. Eliminating paper forms reduces the risk of error and
streamlines the reporting workflow which lowers the burden on hospital staff. MDHHS also benefits
from more timely and complete reporting.
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Diagram
In this section, provide a diagram of the information flow for this UC. The diagram should
include the major senders and receivers involved and types of information being shared.
Submit Newborn Hearing Screening Results (EHDI)
Health Provider’s
EHR
EHR submits the
EHDI HL7 (ORU^R01)
message
Data Sharing
Organization(DSO)
DSO routes the
message to MiHIN
Michigan Health
Information
Network (MiHIN)
MDCH Data Hub
MiHIN receives the
EHDI HL7 (ORU^R01)
message and sends
to MDCH Data Hub
MDCH Data Hub
receives the EHDI
HL7 (ORU^R01)
message
EHDI Web Service
MSH-11
T
YES
P
EHDI Test
EHDI Production
Valid HL7
message?
Error from XML?
NO
YES
AR or AE
Reject Message
MSA = AR
NO
AA
AR
EHR receives the
acknowledgement
Acknowledgement
Acknowledgement
Acknowledgement back to MiHIN
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Format XML
Response
Regulation
In this section, provide information as to this UC being in response to a mandate by the
federal regulation, state legislation or state level administrative rule or directive.
Additionally, provide information if this UC will allow Eligible Professionals/Providers (EP) or
Eligible Hospitals (EH) to meet an attestation requirement for Meaningful Use.
Michigan Public Health Code
333.5432 Hearing test and screening.
Sec. 5432. If a health professional in charge of the care of a newborn infant or, if none, the health
professional in charge at the birth of an infant, the hospital, the health department, or other facility
administers or causes to be administered to the infant a hearing test and screening, then that person
or facility shall report to the department, on a form as prescribed by the department, the results of all
hearing tests and screens conducted on infants who are less than 12 months of age and on children
who have been diagnosed with hearing loss and are less than 3 years of age. The report shall include
the type, degree, and symmetry of the diagnosis, along with where and when the diagnosis was
made.
History: Add. 2006, Act 31, Imd. Eff. Feb. 23, 2006.
Federal
S.3199 Early Hearing Detection Act 2010
Early Hearing Detection and Intervention Act of 2010 - Amends the Public Health Service Act to
expand the newborns and infants hearing loss program to include diagnostic services among the
services provided.
Requires the Secretary of Health and Human Services (HHS), acting through the Administrator of the
Health Resources and Services Administration (HRSA), to assist in the recruitment, retention,
education, and training of qualified personnel and health care providers.
Includes within the purposes of such program: (1) prompt evaluation and diagnosis of children
referred from screening programs; (2) appropriate education, audiological, and medical interventions
for children identified with hearing loss; and (3) other activities, which may include developing
efficient models to ensure that newborns and infants who are identified with a hearing loss through
screening receive follow-up by a qualified health care provider.
Amends the definition of "early intervention" to require that families be given the opportunity to
obtain the full range of appropriate early intervention services, educational and program placements,
and other options for their child from highly qualified providers.
Authorizes appropriations for FY2011-FY2015 for hearing screening programs and research.
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Cost and Revenue
In this section, provide information relevant to the understanding of the investment needed
or currently secured for this UC. Be sure to address if there are Payer Incentives, Provider
Incentives or cost savings that could be realized (i.e. reduction of administrative burden).
As information is known or available, provide information on the resources and
infrastructure needed to move this UC into production.
Cost and Revenue Summary:
The MDHHS Data Hub has secured the financing needed for State of Michigan (SOM) development of
this UC interface in its 2015 Health Information Technology (HIT) Advanced Planning Document
(APD), Activity 21, and DCH Division of Family and Community Health/Infant Health Unit. MDHHS and
MiHIN are contributing to staffing the project, thus project resources have also been secured and
include business and technical support resources.
The project financially covers the following components:
 HL7 Message Development, based off the National Standard
 Development of the Implementation Guide
 Technical development and maintenance at MDHHS Data Hub, and destination system
 Piloting of the new message
 EHDI support for development, implementation and piloting activities
Existing infrastructure can be leveraged for implementation of this UC.
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Implementation Challenges
In this section, as information is known or available, speak to any challenges that may be
faced to implement this UC. Be sure to address if the UC leverages existing infrastructure,
policy or procedures, ease of technical implementation, and impacts on the current workflow
(short term and long term).
Challenges Summary:
This Use Case requires enhancements to the existing MDHHS Data Hub and to the EHDI systems to
consume the EHDI HL7 messages.
The newborn hearing test results message requires the EHR to include both the infant’s and birth
mother’s demographics. This might be an issue for some EHRs.
Open issue(s) requiring elaboration:
None
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Vendor Community Preparedness
In this section, address the vendor community preparedness to readily participate in the
implementation of this UC. Speak to whether this UC will utilize current or future technical
capabilities of the vendor products. If this UC requires new functionality at the vendor level
provide information as known to the timeliness of when product updates may be available
and any potential costs to the HIE community.
Vendor Summary:
EHR Related Items:
 The EHDI message is based on the very common HL7 Observational Results
Unsolicited (ORU) message.
 There is a National Reference Implementation Guide published by HL71 for this
message. MI’s Implementation Guide is based on this National Reference
Implementation Guide.
 The EHDI message is very similar to in many cases simpler than the Newborn Pulse Ox
for Critical Congenital Heart Defect (CCHD) message.
HIE Related Items:
 The EHDI message is a standard HL7 message just like the vast majority of the other
public health reporting messages.
 The message routing is identical to the Newborn Pulse Ox for CCHD message.
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HL7 Version 2.6 Implementation Guide: Early Hearing Detection and Intervention (EHDI) Results, Release 1
February 2014
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Support Information
In this section, provide known information on the support for this UC.
Support can come from multiple levels (Governor, Federal or State Legislative, MI HIT
Commission, Michigan State Departments, CMS/ONC/CDC, MiHIN Board, Qualified
Organizations, Payer Community, Interest Group [ex: MSMS, MHA], or Citizen support).
Support Summary:
This Use Case is supported by the State of Michigan Department of Community Health Office of
Medicaid Health IT and the MDHHS Division of Family and Community Health/Infant Health Unit.
Political Support:
☐Governor
☐Michigan Legislature
☐HIT Commission
☒MDHHS or other SOM Department
☐CMS/ONC
☐CDC
☐MiHIN Board
Other:
Concerns/Oppositions:
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Sponsor(s) of Use Case
Who are the major sponsors of the use case?
Sponsor Information Summary:
The MDHHS Medical Service Administration’s Office of Medicaid Health IT and MDHHS
Division of Family and Community Health/Infant Health Unit.
Metrics of Use Case
In this section, define metrics for the Use Case to be successful.


Number of sites submitting to the EHDI using HL7
Number of hearing test and screening results sent to the EHDI program at MDHHS through
HL7 messaging
Other Information
This section is to afford the sponsor(s) an opportunity to address any additional information
with regard to this UC that may be pertinent to assessing its potential impact.
Additional Summary Information not contained in the above sections:
No additional information is being submitted at this time.
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