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  Case Study: Newborn Hearing Screening and Referral  
 


Summary
The Center for Disease Control (CDC) has mandated that all newborn infants should be screened for hearing loss no later than one month of age. The Montana Child Health Referral Information System provides a newborn hearing screening component to assist with population based reporting, as well as tracking unscreened infants and providing referral for services of children who have diagnosed hearing loss.

Clients
The Montana State Newborn Hearing Screening Program is responsible to conform to the State mandate to ensure that newborn hearing screening and reporting is completed, as well as the reporting of audiologic assessments conducted on babies who have not passed their newborn hearing screening. The Montana School for the Deaf and Blind (MSDB) is a residential and day school which provides educational opportunities to students, preschool through high school, at our Great Falls campus. MSDB is also a statewide resource center. Information and technical support is provided through our Outreach Program to students attending school in their local districts.

Challenge
The newborn hearing screening program was faced with managing the multiple aspects of their federal and state mandates: capturing the initial screening data, filtering for children who need follow-up, determining how to identify unscreened children and interfacing with various software systems. MSDB personnel were completely unfamiliar with the process of automating business requirements and struggled to identify how they needed the system to work. Our intent was to provide these clients with a seamless, highly automated process but we were challenged in our attempts to capture requirements, ensure that valid data was being collected throughout the process and help the clients identify metrics and output.

Approach:
We determined that the most cost effective solution involved integrating with the (Child Health Referral Information System (CHRIS), an integrated client management system initially built for the Montana Children's Special Health Services program. Because the system provided both a mechanism for downloading and processing birth data, as well as an internal referral module, it provided our clients with ready-built functionality that could be easily replicated. The existing birth certificate download was modified to incorporate an algorithm that would match the birth data against data from the hearing screening equipment and software. Additional data management tools were provided, including reports, to identify children who were not screened and to notify the birth facility. An existing process to migrate these temporary records into the tracking system was customized to facilitate the transfer of records for children with hearing loss to the MSDB. In addition, the MSDB users can enter data about children whose onset of hearing loss occurs later in childhood.

Outcome
Both the newborn hearing screening module and the MSDB tracking system are currently in use and the Hearing Screening program has been able to provide reliable reports on screening outcomes since 2006. Plans to link with Part C data are under way. In August 2008, the Hearing Screening program received an Early Hearing Detection and Intervention (EHDI) grant to automate the follow up process. In September 2008, Gold Systems began working with Children's Special Health Services, MSDB, the Hearing Screening Program and the Metabolic Screening Program to web-enable a community outreach system that will allow MSDB outreach workers and others secure access to hearing data. This three-year grant will allow us to continue to web enable the CHRIS system as funds allow.