Technology Assessment: Moving Rhode Island s KIDNET Forward
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1 Technology Assessment: Moving Rhode Island s KIDNET Forward Noam H. Arzt, Ph.D. President, HLN Consulting, LLC Amy Zimmerman, MPH Chief Children s Preventive Services Rhode Island Department of Health
2 KIDSNET The KIDSNET Concept: Assure all RI children receive comprehensive screening and follow-up for preventive services Public health computerized information management and follow-up system that tracks children s preventive health services Links health and service care providers to Department of Health Promotes sharing of information between providers Promotes comprehensive contacts with families
3 KIDSNET Affiliated Programs 6 Universal: 4 Targeted: Newborn Developmental Risk Newborn Bloodspot Screening Newborn Hearing Assessment Immunization Childhood Lead Poisoning Vital Records WIC Early Intervention Family Outreach (Home Visiting) Birth Defects KIDSNET
4 Vital Records Newborn Developmental Risk Newborn Blood Spot Home Visiting Lead Prevention Pediatric Providers KIDSNET Early Intervention WIC: Special Supplemental Nutrition Program for Women, Infants and Children Immunizations Rhode Island Department of Health RIHAP: Rhode Island Hearing Assessment Program Birth Defects
5 KIDSNET System Features and Design Records initiated at birth Includes all RI births from Jan 1, 1997 (84,000 children) Remote online access by users,- older technology Data Capture: Only immunization data comes directly from providers
6 KIDSNET Follow-up/Outreach Features Generates well child reminders Generates recall letters (lead) Provider monthly feedback reports - Lead screening - Immunizations Home Visiting/Risk Response Program
7 KIDSNET Who uses KIDSNET? Current Users: Health department staff Health care providers Contracted home visiting agencies Headstart Agencies Potential New Users (requesting access): Audiologists MCO s School Nurse Teachers Other Community Based Organizations
8 KIDSNET Progress to date 50% of Primary Care Provider sites are operational 70% of children in KIDSNET have some immunization history (beyond Hep B at birth)
9 Ongoing Challenges KIDSNET is terminal based and antiquated technically Users find the system difficult to use their standard is graphical user interface Matching and de-duplication Chronic problem of double data entry billing system extracts have been problematic from a data quality standpoint Difficult to run ad hoc reports
10 Project Objectives Identify an updated architecture for the registry product that modernizes it and makes it more user-friendly Identify strategies to match and de-duplicate records as part of the larger integrated system Define appropriate strategies for data capture for this system KIDSNET
11 KIDSNET Project Plan Organize Project Research Analysis Develop Options Choose Option(s) Finalize and Approve Plan Build Consensus Traditional analytical approach Centered around three visits which triggered off-site research agenda Conducted survey of all pediatric practices Met with many different stakeholders Project website for collaboration Limited budget
12 KIDSNET Underlying Methodology Technical Architecture Development Methodology guides research in four areas: Documentation and validation of functional requirements Development of IT principles Documentation of current architecture Research of selected industry trends
13 Project Activities: Visits First Visit: March 2002 System overview; system demonstration; technical discussion; review of other initiatives Second Visit: April 2002 Stakeholder meetings (affiliated programs; KIDSNET staff; senior management) Third Visit: June 2002 Present survey results; review strategic options
14 KIDSNET Project Activities: Deliverables Detailed meeting notes Current Architecture diagram Draft principles vetted with senior management group and revised Online, web-based survey with written analysis and analytical website Research notes: bar coding; HIPAA; de-duplication Strategic technology options Selected Option Work plan elements
15 KIDSNET Survey Results 87 of 148 practices responded (25% via web) High interest in participating Concerns about cost and confidentiality 89% had at least one computer 74% had web access (those without are equally interested in participating) 38% using handhelds (mostly doctors)
16 Strategic Technology Options Four options: #1: Stay the Course #2: Series of Marginal Improvements #3: Commercial Off-the-shelf Replacement #4: Complete System Re-write KIDSNET
17 Strategic Technology Options Option #1: Stay the Course Strengths Allows time for state-wide architectures and strategies to develop more fully Allows more time for emerging technologies to mature Allows more time for NEDSS and HAN strategies to develop Weaknesses Loss of staff and provider enthusiasm Continuing buildup of new records held in suspense KIDSNET processes may not be HIPAA compliant.
18 Strategic Technology Options Option #2: Series of Marginal Improvements Strengths Incremental improvement consistent with KIDSNET goals. Many strategies can be implemented independent of one another. Moves key provider functions to the web quickly. Does not require detailed, multi-program requirements analysis and discussion at this time. Preserves the solid technical and functional foundation of KIDSNET. Weaknesses Strategies fall short of complete web enablement of current KIDSNET application screens. Funding requirement still substantial
19 Strategic Technology Options Option #3: COTS Replacement Strengths Resulting application is a fully webenabled product for all KIDSNET functions. Quicker to implement than other options. Weaknesses KIDSNET will have to accept the business process implementation of the selected package. Funding requirement still substantial >$500,000) May require replacement of some components of KIDSNET that are considered successful and desirable. Substantial customization of packaged application required to accommodate KIDSNET data set and system interfaces.
20 Strategic Technology Options Strengths Preserves as much of the technical and functional foundation of the existing KIDSNET system as the analytical stage determines. Resulting system will come closest to meeting negotiated requirements of KIDSNET programs. Option #4: System Re-write Weaknesses Requires a detailed, multi-program requirements analysis. Will take the longest to implement. Funding requirement still substantial (@$500,000- $1 million+). Possible loss of user enthusiasm. Continuing buildup of new records held in suspense.
21 Plans for Technology Improvements: Option #2 Create web application for accessing data (patient and practice reports) Improve matching and de-duplication, create a merge tool, allow online adds Develop/pilot PDA data collection tool Implement ad hoc query reporting tool Improve scanning capabilities KIDSNET
22 Contact Information Amy Zimmerman MPH Rhode Island Department of Health Noam Arzt,PhD President, HLN consulting, LCC KIDSNET
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