By: Kelly Luchini, Mark Belanger, and Jennifer Monahan
The Massachusetts statewide health information exchange (Mass HIway) and the Massachusetts Department of Public Health (DPH) are making it easier for healthcare providers to report required childhood lead data.
The agencies recently completed connecting all direct-reporting pediatric primary care practice locations in Massachusetts to the Mass HIway to provide real-time reporting of childhood lead data to the Childhood Lead Poisoning Prevention Program (CLPPP). The primary goal of the DPH's CLPPP is the prevention of lead exposure in children, which is associated with irreversible neurological and behavioral impacts.
By providing increased efficiency, greater accuracy, and real-time communication, the Mass HIway is helping support the DPH to detect exposed children, quickly enroll children in case management services, identify high-risk populations, and target outreach and resources to better treat, and ultimately to prevent, childhood lead poisoning in Massachusetts.
The DPH conducts lead screening surveillance, analysis, education, and outreach with various organizations that serve children. Pediatricians are a crucial part of detection and follow up care for children exposed to high levels of lead. Pediatric primary care providers perform annual screenings of all young children as part of required periodic monitoring, plus additional screenings when they suspect lead poisoning.
Mass HIway enables secure, electronic data submission to increase the speed of collection, enable rapid validation, and provide direct real-time feedback to users.
Reporting through the Mass HIway promotes greater uniformity of reporting, and a reduction of errors and missing information for children's addresses and other key variables, including race and ethnicity. Since implementation of the new reporting system in January 2016, race reporting has increased from 1.4% to 6.5% and ethnicity reporting has increased from 12% to 20%. This information is critical to DPH efforts at identifying and reducing health disparities.
Healthcare providers are experiencing increased efficiencies by using the Mass HIway for data submission to CLPPP. The pediatric practice of Howard M. Zinman, MD recently began submitting lead data reports through the Mass HIway.
Dr. Zinman's practice is in Worcester, one of the Commonwealth's high-risk communities for lead poisoning. In Worcester, the 5-year incidence of children with confirmed blood lead levels at or above 10 μg/dL is 3.8 children (age 9 to 47 months) per 1,000 screened, compared to the overall state level of 2.8.1
For Dr. Zinman and his staff, lead detection is part of providing high quality pediatric care; however, the administrative processing of data captured from screening has been burdensome for the clinical staff. Cindy Ferraiuolo is responsible for submitting all lead tests to the DPH on behalf of the practice. When asked about CLPPP reporting through the Mass HIway Cindy stated "I love the new process - It is so efficient and so easy to use."
Before transitioning to the new submission process, Cindy had to wait to hear from DPH by phone or fax to know if there were errors in non-urgent cases and, once received, would have to refer back to paper copies of the actual lead test results to troubleshoot issues. Now with the use of the Mass HIway, Cindy receives immediate feedback. By the end of the day all submissions are confirmed and any outstanding issues are resolved.
"My favorite feature is the real-time feedback when I submit. I not only know when something is accepted, but more importantly, I now know within minutes if there are any errors, along with details of the actual problem. This gives me great peace of mind and I feel much more confident with the process," says Cindy.
DPH staff have also experienced the benefits of the new system. Alicia Fraser, Assistant Director of the Environmental Epidemiology Program at DPH says, "By automating the electronic file delivery, adding data validation and direct error reporting, Mass HIway has greatly reduced the amount of staff time needed to import, process, correct, and update the more than 250,000 childhood blood lead reports that we receive annually. These time savings have provided increased capacity for surveillance and evaluation, allowing us to better target high risk communities and vulnerable populations to reduce lead poisoning."
Pediatricians and DPH work closely together to prevent and treat childhood lead poisoning in Massachusetts. The new Mass HIway and CLPPP reporting are helping pediatricians and DPH personnel do their work with greater accuracy, speed, and efficiency.
About the Mass HIway
The Mass HIway is a secure health information exchange that is accessible to all healthcare systems Commonwealth wide, regardless of affiliation, location, or differences in technology. Mass HIway is a tool for the Commonwealth's healthcare community to improve coordination, quality, patient satisfaction, and public health reporting. The Mass HIway is operated by the Commonwealth of Massachusetts' Executive Office of Health and Human Services with input from the Health Information Technology Council and its multi-stakeholder advisory groups. More on the Mass HIway may be found at www.masshiway.net
The Childhood Lead Poisoning Prevention Program at the Massachusetts Department of Public Health provides a range of both primary and secondary prevention services to the children of the Commonwealth and their families, and to others with an interest in the prevention of lead poisoning. In order to accomplish the fundamental goals of identifying lead poisoned children and ensuring that they receive medical and environmental services as well as preventing further cases of lead poisoning, CLPPP has developed linkages with a wide array of professionals and programs that provide services to children. CLPPP also provides coordinated and comprehensive nursing case management. More on CLPPP may be found at http://www.mass.gov/eohhs/gov/departments/dph/programs/environmental-health/exposure-topics/lead/
The mission of the Massachusetts eHealth Collaborative is to improve healthcare delivery through meaningful adoption of health information technology. MAeHC was selected by EOHHS through an open bid process to serve as the Mass HIway's Account Management team to deliver outreach, education and onsite user support services with a goal of increasing adoption and effective utilization of the Mass HIway across the Commonwealth. The Account Management team assisted with the outreach and onboarding of providers onto the Mass HIway for CLPPP reporting.
1 High Risk Community Incidence Rate Statistics 2011-2015 Calendar Year Data, Massachusetts Department of Public Health