EHDI and Vital Records Collaborations at the State Level.

1
EHDI and Vital Records Collaborations at the
State Level.
Utah Department of Health

• NAPHSIS Annual Meeting
• Salt Lake City
• JUNE 2007

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Proposed EHDI Motion

• NAPHSIS is encouraged to continue its ongoing
  coordination and cooperation with CDC-EHDI and
  other federal agencies to identify means and
  methods by which states can proceed with planning
  and implementation of EHDI/ vital records
  integration/linkage.

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Utah VR-EHDI CollaborationA Long History

• Births screened with family history of hearing
  loss item since 1979 Birth Certificate Revision.
• High-Risk algorithm developed in 1980s and
  applied to electronic birth data.
• Several publications showing ability of birth
  certificate items to predict sensorineural
  hearing loss.
• Universal hearing screening called for new forms
  of collaboration between EHDI and VR.

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Child Health Advance Records Management (CHARM)

• Universal newborn screening registries covered
  the same population as the birth registry
  (theoretically).
• Managers saw obvious benefits of linkage (death
  purge, coverage validation).
• CHARM middleware proposed to integrate
• Birth and infant death
• Newborn Hearing Screening
• Newborn Heelstick Screening
• Immunization Registry (USIIS)
• Early Intervention

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VR-EHDI Study Application
Births
VR Point of Service Application
CHARM Query Module
VR CHARM Agent
 
Study Data
CHARM Server
VR-EHDI Study Application
Phone Calls
Letters
EHDI CHARM Agent
Follow-up
EHDI
Reporting
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Initial CHARM Project Birth Record Number

• Newborn heelstick kit number determined to be
  assigned earliest in Utah hospitals.
• Research on alternative means of populating the
  BRN yielded bar coded label distribution.
• Labels pilot tested in 3 Utah hospitals focus
  groups suggested enthusiasm for this method.
• Vital records field staff, EHDI staff and Newborn
  Heelstick staff collaborated to introduce system.

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Resource Needs For ImplementationBirth Record
Number Labels
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Resource Needs For VR ImplementationRevised
Newborn Care Information Worksheets
A representative from Vital Records provided
birthing facilities and midwives with a supply of
revised New Newborn Care worksheet with a set
location for the new heelstick kit label.
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Resource Needs For CHARM ImplementationVideo
Message and Letter Provided to All Birth
Facilitators

• A Guide to the
• Birth Record
• Number Process.

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Population of the Birth Record NumberVital
Records Data For 2002

• Roll out October 2002
• 12,054 Live Birth Occurrences (OCT, NOV, DEC)
• 11,895 Hospital Occurrences
• 159 Home Birth Occurrences
• 2 Refused Newborn Screening
• 1,682 Birth Certificates Without Newborn Number
• 86 Hospital Compliance
• 21 Home Birth Compliance
• 85 Compliance Rate Overall

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Population of the Birth Record NumberVital
Records Data

• 2003 Population
• 50,527 Live Birth Occurrences
• 95 Compliance Rate Overall
• 2004 Population
• 51,853 Live Birth Occurrences
• 96 Compliance Rate Overall

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Population of the Birth Record NumberVital
Records Data

• 2005 Population
• 52,272 Live Birth Occurrences
• 98 Compliance Rate Overall
• 2006 Population
• 54,529 Live Birth Occurrences
• 99 Compliance Rate Overall

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2006 Births Identified At-Risk By EDHI Tracking

• 54,529 births
• 1,198 alerts set for 2006 births
• 458 did not return for outpatient screening
• 402 have alerts set in EDHI
• 356 recommended for evaluation
• 175 have not completed outpatient evaluation and
  have alerts set in EDHI
• 936 infants missed initial screening
• 621 have alerts set in EDHI

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2006 Births With Contact Alerts Made By VR/CHARM

• 8 alerts made since March 2007
• All are infants under 2 years of age
• 4 missed initial screening
• 3 missed outpatient follow up screening
• 1 infant deceased
• 1 parent made follow up call and appointment
  within 24 hours of receiving notification letter
  with certified copy of infants birth certificate.

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Sample
Letter Given to Parents Along With Certified
Birth CertificateMelodi Robinson-Reynoso01/21/2
0062006 03935 Dear parent/guardian This
letter is to remind you that your child did not
pass the newborn hearing screening at birth, and
should have an additional hearing test. Newborn
hearing screening is usually completed before
your baby is discharged from the hospital, but
occasionally some children need to have a hearing
test done after they leave the hospital. It is
very important that your child complete this
testing. For help finding hearing screening
follow-up services for your child, or if you have
already taken your child for a second hearing
screening, please call Utahs Newborn Hearing
Screening program at  [phone] 
or toll free  1 [phone]
option 5 You may also call if you have any
other questions about newborn hearing
screening. Sincerely, Richard S. Harward,
DirectorEarly Hearing Detection and Intervention
ProgramUtah Department of Health
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Social Marketing Implications of Birth
Certificate Sales

• Parents of 25,000 infants and toddlers contact us
  for Birth Certificates annually
• Child Health programs see a missed opportunity
  for outreach to families
• Applications for Integrated Information Systems
• Potential to reach infants lost to follow-up for
  newborn hearing screening
• Immunization reminders

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Utah Birth Certificate Customers

• 50 of birth certificates sold within
  10 years of birth
• Almost ¼ of all birth certificates sold within 5
  years of birth

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Certificates Issue to Y2K Birth Cohort

• 20 birth certificates were issued within 2
  months after birth
• 40 were issued in first year after birth
• By mid 2004, 53 of Y2K births had been issued
  birth certificates

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VR-EHDI Follow-up Study Population

• Utah Births Since 2004
• Requesting Certified Copies of Birth Certificates
  via
• Mail
• In-person
• On-line
• Through the State Office (first year)
• Actually issued through Online Issuance of Vital
  Event Records (OLIVER), a Point of Service
  Application

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VR/EHDI collaboration is proven public
health service success story!
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Thank you!

• Marie Aschliman
• Information Analyst
• Office of Vital Records Statistics
• Utah Department of Health
• maschlim_at_utah.gov