BUILDING BLOCKS STATE CASE STUDY #2: Quantifying the Impact of Electronic Test Orders and Results (ETOR) with Quality Assurance Metrics

Wisconsin Newborn Screening Program

BACKGROUND

The Wisconsin Newborn Screening program piloted the exchange of electronic test orders and results (ETOR) with two birthing hospitals. The electronic order was configured to include all data fields on the newborn screening card that are entered into the newborn screening laboratory information system (LIS), pulling demographic information directly from the electronic health records of the mother and baby, as well as specimen collection information from the hospital LIS.

PROBLEM

Establishing and maintaining the pilot exchange of ETOR required a significant investment from both partners in the relationship, including changes in workflows at both the hospitals and the NBS laboratory. We needed a means of quantifying the positive impact of ETOR to justify that effort as well as the effort that will be required to expand ETOR to additional partners going forward. 

SOLUTION

With the implementation of ETOR, the Wisconsin NBS program anticipated a decrease in the instances of missing or inaccurate key demographic information, and therefore, also a decrease in amended result reports due to erroneous demographics. In the immediate post-live validation phase of the pilot, NBS cards continued to be filled in completely by hospital staff, even though all fields were intended to be included in the electronic order. During the validation phase, the NBS lab compared all fields included in each electronic order to that provided on the associated card. They tallied all discrepancies and instances of information omitted from the order and provided the information to hospital staff for investigation. The hospital made modifications to workflows and/or the queries pulling the information into the order until it was confirmed that the electronic orders were routinely including complete and accurate information. The monthly quality assurance reports provided to submitters by the NBS lab showed a dramatic decrease in the instances of missing key demographic information for the ETOR partners. Internal tracking of amended result reports also showed the elimination of amended reports for demographic changes requested by ETOR partners.