HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

JILL BRIGGS: Good afternoon and for those of you who are sitting here wondering if we were ever going to start this we really are. I’m Jill Briggs from the wonderful state of Minnesota where the mosquitoes are gone and we love Fall. The theme of my presentation today is really going to be something that was mentioned and it’s really about the program interfaces. I tend to talk pretty fast but I’m going to start by just introducing you to all the types of program interfaces that we have worked in in Minnesota. I’m the upstate section manager. I go and try to explain this to my boss who is the division director and she sees me coming and she just goes, “Don’t tell me another interface is happening or partnership”.

In the Department of Health the work I’m going to explain involves a number of divisions. I’m in the division of Community and Family Health. We work with the division of Public Health Labs. I also have to cross over and work with our folks in the Environmental Health Division and certainly last but not least we have a division that houses our Center for Health Statistics. So with an MDH we’re all working at what I’m going to describe related to our grant.

Then we add the grants that we have and several of you will know that Minnesota has an integrated Child Health Information System Grant. We also have an Early Childhood Comprehensive System Grant that works and going to be weaved into what I talk about. We have a Medical Home Grant. Our Universal Newborn Hearing Screening Grant is wound in this work and we have CDC supports two grants in the work I’m going to describe today. One of them supports our birth defects information registry that we are just creating and then the MCH section we are also fortunate enough to have a CDC grant that supports our prevention work in Fetal Alcohol Spectrum Disorder. I haven’t lost yet, we also have key partnerships, we’ve been here with our families. We are fortunate to have The Mayo Clinic and believe it or not the Mayo Clinic can work with the Department of Health establish a memorandum of understanding and we have that with our biochemical labs at the Mayo Clinic. They are a key partner to what I’m going to describe. We also have staff at the University of Minnesota in the metabolic clinic. We actually fund two positions at that metabolic clinic. It comes through the grants we have in the MCH section and we support our colleagues at the University of Minnesota. I’m not going to repeat every one of those grants and all these partners every time. That’s why I did it up front for you.

So let’s talk about a little bit of background. We are in our third year of our grant. Before we had our integrated grant, we had a two-year planning grant. When we got done with the planning grant where we were at is that we had managed to accomplish taking our dry blood spot folks. They had worked with our hearing screening folks which are in the Maternal Child Health section and they had come together to have all their information recorded on the dry blood spot form with hearing done on the little corner and they were using the oracle data base.

This was at the end of our planning grant. I’m going to come back to this because with this crew the identifier, the unique identifier was the bar code on the dry blood spot form. You’ll hear why that is important later. Last but not least our blood spot information is mandated and the hearing screening is not mandated so imagine being an integrated system when half of your form is missing the data because some hospitals won’t report to the Minnesota Department of Health. They are screening but they are not mandated to report to the health department but you want to create an integrated data system.

Secondly, I mentioned earlier, last year our legislature created statutory language that allows us to have a birth defects information registry. That planning design is under way, the programming. Those folks have met with our newborn screening folks and they are going to use the oracle database and connect to that information in vital records. As I mentioned our FAS work is a subset of what we are doing with our birth defects registry.

Let’s move to our grant then. The Integrated Grant I call it. Our first objective was really to take that newborn screening information and link it to birth records. It is actually birth and death records. We started out in year one. It took us a year to get a memorandum of understanding with our vital statistics place housed at MDH because we didn’t give them any money to do this work and they were already very busy folks but they did it. It was a lot of work and they worked on it well. Year one we started to get weekly downloads of the vital records information. Here to we started working on our matching algorithms. What we found when we did that we were only able to match about eighty percent. So the big um hmm went and why is this happening. So we did a historical look. We looked two years back with our blood spot information and our birth certificates. What we learned that didn’t make us very happy is that we know in Minnesota that 3.4 infants every day we have birth certificates for them but we have no blood spot information.

The good news here is we now know who those little people are and what hospitals they are being born at so it really allows us, every six months our folks in the labs send a report out to hospitals with their data and so we are able to say, hey you missed this many kids. Can you help us learn what’s that about and what’s happening? A key piece. The other part of matching is that on occasion parents will change the name of their little babies before they leave. We also have some culture challenges. Is it Lee Ving or Ving Lee and so we are having transposed names happen. Misspellings, missing data, all those kinds of things. So, the 3.4 is also a learning for us to look even deeper. Was that child really missed or do we have a misspelled name. Seems like key data but it happens. You probably know that.

Our second objective then is to really take that newborn screening database and we wanted to move it to web-based newborn screening database. This really involved some of the meetings that we’ve gone with our Medical Home folks. Our primary care physicians are very interested in getting the information faster. Our hospitals, we report back to the hospitals on all of our kids who have a normal result. MDH has staff; those staff I mentioned earlier that do then our tests that come back that are abnormal. But even the docs want to know faster, understandably so. This web base was what we envisioned to be a tool to really help us move that along. Some of our primary care physicians have very sophisticated databases.

The third piece is we want to use your web base and download our information into what your sending us so we have all kinds of challenges related to connectivity related to their electronic medical records. Those are some of the things we are working on currently. This is slow go, I’ll just tell you that. We want to create a web base internally to the Department of Health and every one of those wonderful division I mentioned have their own rules about how to do that so we keep smiling and working but not easy work.

Our third objective was really long term, all contracting for identified infants. Kind of what’s the long view here? How do we work with the kids? It’s fine to have them and screen him but we also want to do that longer piece. Where are they? What happened to the referrals? Primary care providers also enter in here in the communication link. Where has this kid been referred? How’s it going? Who’s doing what piece? One of the good news pieces is we are still on paper we realize but believe it or not we have everyone of our programs, our metabolic folks, hearing screening and our birth defects folks are all using a piece of paper that tracks every referral any of them are making. This is a very basic referral sheet but I can tell you something as basic as this, they all love it. They are sharing it. It talks about what information was given, did you make a referral? They already were involved with that, they’re not eligible and we put the coordinator’s name. Who talked to the family about this? This is a key piece of paper that we are trying to get it electronic. A key piece to what we are doing and it really has helped with our ability to do some of this long-term tracking. We want to put this on a database. That was the piece here. A long-term outcome tracking on a database. So we are working on it.

The benefits to what we think we are doing; our grant was really about program and data integration. I’m going to talk about the program integration part now. If you ask staff, this is the most tangible thing they can get their hands on. They are very excited about these three pieces. First of all, our friends at Mayo Clinic said we want on our second tier testing, we want that information to move back and forth between MDH and Mayo very quickly. Mayo does our second tier testing. So Mayo stepped up to the plate and said fine, we’ll develop a secure email system. MDH will use it with us and we said you betcha, we’re there. So Mayo Clinic has been a key to that data transfer of second tier testing.

Second thing that has come along is Quick Place. At our Medical Home learning labs we got several smiles around the room when we were talking about Quick Place. Again our friends at Mayo created, they purchased an IBM product and what we’ve developed is a secure email communication between MDH, the biochemical lab and the specialty care providers. So now we have all three players. If you work primary care provider you would go to Quick Place. You would see the child’s folder, Johnnie John’s folder. Everyone communicates in the same folder. What we hear from the folks using this is that they are checking it twice a day. They can tell what specialty clinics they’ve been to; they can see test results coming through, so a really speedy and seamless way to integrate some of our program activities.

Care coordination is, if you talk to our family partners they would tell you this is their favorite part. We actually have care coordinators at the Metabolic Clinic at the University of Minnesota. They are on site. Those care coordinators know where that kid is at all time. They are also the key piece in communicating back to the primary care provider and to the specialty providers. What’s everybody doing? When these little folks go back to their communities in Minnesota the primary care doc will see them and this is what we learned from our Medical Home discussions. Why I didn’t know they saw five specialists when they went up to the U. How is it that I was supposed to know about that? We’ve made great progress and it is successful for those kids that are receiving care coordination. I could tell you two FTE’s isn’t going to do it but it is a wonderful model that is being used. This simple little referral form we have used has made a difference so we are excited about these three pieces of integrating our program. Challenges just out here; I did have handouts but they disappeared. No one quite knows where they are so we will try to find them.

The lack of a single identifier. Birth certificates use a birth certificate number for their unique identifier. Our blood spot folks and hearing folks are using a bar code. Their system has been around. I’m not changing my system; you’re going to change your system. Those challenging discussions we have. We are making progress but it is a challenge. I’d say it also relates to our third bullet where we talk about some systems aren’t interested in linking. People want to do, I don’t know if interest is the right word but they have a history of using the same identifiers and it is painful to change and think differently and so we haven’t given up yet. The second challenge I’ve listed is that we are just taking on folks who will work with us. It’s fun to work with those folks who are interested and willing. I wouldn’t say it’s always fun but it’s possible. We don’t have an overarching plan but we need to get one to have everybody come along. Oh good I have two minutes left. Next steps, well we are going to keep integrating.

We are going to work hard to find some more systems to bring folks along. My colleague in WIC, Betsy Clark, every time she sees me coming she just says, “Jill, I’ll get there someday”. We smile and keep our conversations going. I’ll tell you that part of these effects to integrate are about the relationships that you form with people. Our lab folks think very differently than my brain. I have great appreciation for their brains. We were looking out a window in the winter and the programmer said, “Jill, we’re going to get to your data, your projects when the snow melts outside”. This is in the winter and so I looked up and said, “this is really great” I said to Craig, “there is hardly any snow left”. He very seriously looked at me and said “No, I’m looking at the pile of snow across the street that has been piled up all winter”. He was serious, he was thinking that snow pile. My point is just the relationships. We say that over and over but it is key to this really tough work. On the business case we are interested in that Quick Place. What might we create about a business case and the efficiencies that has created. The seamlessness that we really are hearing and we really have to keep working at finding that matching alga rhythm and moving to the database.

Slow but steady wins the race. I will tell you a big piece of this is the coordinator for our grant who is Nancy Vanderberg. She is a tireless champion. Nancy goes to any meeting anybody will invite her too. Lisbeth Shorr talked yesterday about having someone who is flexible, who can think out of the box and who’s been around and Nancy definitely is our champion so I would tell you she is a fabulous person to have out there. She went to a immunization web-based training last week and told me about five more things we need to do with the immunization connectivity. Thank you all.