Within most of Title V’s programs, there are efforts related to the surveillance, analysis and dissemination of data related to the State’s maternal and child health and CYSHCN population, either statewide or from contractors.
Statewide
A large undertaking has been the almost four-year deliberative process going into the search, selection, draft and implementation of an integrated data management system designed to provide a secure web-based application for the entirety of the Newborn Screening Program including early hearing detection and intervention (funded by HRSA and CDC), newborn blood spot screening and critical congenital heart disease (CCHD) (self-funded by the cost of filter papers), and birth conditions (Title V funded). The newborn screening and hearing programs currently have separate data management systems with CCHD and birth conditions having none. After a request for proposals and then applicant review, the OZ Systems was approved to go into contract.
The OZ System has a “canned” database, which will allow for the manual entry of data beginning July 1st, 2021. On that date, MCH will begin collecting CCHD data, followed by early hearing screening sometime in the fall of 2021. Blood spot screening will be last since it additionally entails interacting with the current laboratory’s (University of Massachusetts Medical School) data program. Since the passage of RSA 132:10aa in August of 2012, screening for CCHD for all newborns in the State has been mandated. In 2016, it was added to the State’s newborn screening panel with approval from the Newborn Screening Program’s Advisory Committee and the DHHS Commissioner. However, there has been no mechanism for hospitals and birthing centers to communicate this information. When the OZ System goes live in July, this will be the first time that MCH will be able to conduct surveillance on CCHD, which will be integrated into the responsibilities of birth conditions staff.
Four birthing hospitals have agreed to work with the OZ System as pilots to determine how the data can be migrated through the pulse oximeter and hearing machines as well as the electronic medical records into the data system. The rest of the birthing hospitals will continue adding data manually until those four come “on-line”, at this time expected to be late fall of 2021. MCH has worked with the NH Hospital Association throughout the past several years, which has been vital in getting the input of all of the birthing hospitals’ directors of information systems. Starting in June, staff from hospitals and birthing centers will be trained on how to manually enter data into the new system. Eventually, the OZ System will serve in the role of application host as well as ongoing maintenance and technical support provider.
Some Title V staff have access to DHHS’s Enterprise Business Intelligence (EBI) platform which is a scalable enterprise data analytics platform that serves as a comprehensive data repository across multiple systems, providing analytic capabilities that address NH health priorities, including the COVID‑19 pandemic. The EBI platform leverages Oracle for database management; Informatica PowerCenter for data extracts, modeling and transformations; and Tableau for web-based visualizations of data. The data sources in EBI include but are not limited to Medicaid eligibility; Automated Emergency Department Syndromic Surveillance (AHEDD); Commercial Healthcare Claims and Membership; Drug and Alcohol Treatment Related Data; Vital Records Birth Certificate and Death Certificate Data; COVID‑19 Contact Tracing, Patient Investigation, Case Monitoring and Testing; NH Electronic Disease Surveillance System; Hospital Discharge Data; Immunization Information System; and population estimates. Since the EBI platform is scalable, it is expected to integrate more health related datasets into the system. Most of the data sources have person linkage integrated into the Person Dimension Table in EBI. The information systems will, in the future, provide a platform for all of DHHS to use for enterprise reporting, analytics and visualizations.
The CDC’s Overdose to Action grant (OD2A) enables the Injury Prevention Program to fund ten different strategies, five prevention and five surveillance, with ten non-MCH partners. The surveillance strategies (in addition to the CDC’s National Violent Death Reporting System [NVDRS] grant) enables data analysts within MCH and the Office of the Chief Medical Examiner to work on NVDRS and the State Unintentional Drug Overdose Reporting System (SUDORS). NVDRS is the only state-based surveillance system that pools more than 600 unique data elements from multiple sources into a usable, anonymous database. NVDRS covers all types of violent deaths including homicides and suicides. SUDORS helps to increase the timeliness and comprehensiveness of reporting fatal opioid overdoes by capturing detailed information on toxicology, death scene investigations, route of administration, and other factors that may be associated with a fatal overdose. Data is shared with the NH Drug Monitoring Initiative (DMI), a consortium of statewide colleagues, who post reports on the DHHS website (http://www.dhhs.nh.gov/dcbcs/bdas/data.htm).
OD2A also enables work with colleagues from the Bureau of Infectious Diseases on the Automated Hospital Emergency Department Data system (AHEDD), which collects and disseminates real-time data on suspected drug, opioid, heroin, and stimulant overdoses, again released through the DMI.
The fourth strategy in OD2A supports the Comprehensive Opioid Response Business Intelligence (CORbi) system, which is an innovative surveillance tool that enhances multiple data sources into an interactive online data display for both public access of aggregated data, and password protected-access for data queries by NH state staff. This strategy in particular has been beneficial for MCH staff in that they are working and getting to know colleagues across DHHS including the Bureau for Information Services and the Office of Data Analytics and Reporting, outside of DPHS. The CORbi Project was developed originally to create dashboards with data related to the opioid overdose crisis in NH. Eventually, all of the dashboards currently on WISDOM (DPHS’ online data portal containing its wide variety of stewarded data) will be migrated to DHHS’ Enterprise Business Intelligence (EBI), which is the database of all DHHS stewarded data. Currently, both CORbi and EBI are only available for internal DHHS use.
The fifth surveillance strategy includes the funding of a toxicologist from DPHS’s laboratory who does overflow opioid testing from samples that cannot be done at the OCME’s laboratory or the Department of Safety’s Crime Lab.
The Community Collaborations to Strengthen and Preserve Families (CCSPF) grant, funded by the Children’s Bureau and sitting within MCH’s Early Childhood Comprehensive Systems Program, is a coordinated community response to children and families’ service needs in three high risk areas of the State. Outcomes include a reduction of child maltreatment, entry into foster care, and an increase in parental protective factors. The program uses the Predict Align Prevent (PAP) method of place- and population-based data analytics for data decision-making support.
PAP, funded by Casey Family Programs, provides geospatial risk and protective factor analysis identifying high-risk places where child maltreatment may occur in the future by taking an inventory of resources that currently exist, and risk behaviors currently seen in the three CCSPF locations: the city of Manchester, Coos County and the Winnipesauke Public Health Region. Some of the data sources mapped at the address level for the Predict phase were information on where child maltreatment has occurred, crime data and assaults, as well as locations of bars, gas stations, laundromats, crisis shelters, child care centers, churches, police departments, schools and fire stations. Because MCH staff work collaboratively with the Division of Children, Youth and Families (DCYF and the child welfare section of DHHS) on this project, access is given for many databases that are stewarded there. This mapping was recently completed for all three service areas and the oversight team finalized a communication plan for dissemination that summarizes the population health and safety mapping work. All three site locations have had technical assistance support through data presentations by DCYF and DPHS data analysts using the population health mapping as well as technical assistance to support next steps in the utilization of the maps. At this time, each of the sites has been provided with implementation resources to support next steps in sharing the visualizations[1] with each community team. The partnership with DCYF has also lead to additional localized data sets to help inform strategies in each site. Below is the city of Manchester’s map.
One of the first uses of the PAP data in the city of Manchester was the development and targeted outreach of a community wellness van, signing people up for programs like WIC and Medicaid.
MCH staff are also very involved in the selection and analysis of questions for the statewide Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Surveillance System (YRBS), both supported by the CDC and stakeholder dollars, and stewarded by DPHS’s Health Statistics and Data Management Section in conjunction with the State’s Department of Education for the latter. MCH has supported (through general funds) the addition of the complete ACEs module to the BRFSS on an every five-year rotating schedule (2016 and 2021). MCH staff will be working on the 2021 data in the years to come, similar to their report from 2016 (https://www.dhhs.nh.gov/dphs/bchs/mch/documents/nh-aces-report.pdf. This complements the parent-reported data on the National Survey of Children’s Health (NSCH).
MCH staff also help to refine and select questions on the YRBS. This survey is the major source on guiding MCH’s prevention activities in the areas of adolescent driving, family planning, violence (sexual assault) and mental health as shown in the analyses of two questions below.
The BFCS uses a database that is a web-based application, maintained and supported by the NH Department of Information Technology (DoIT). The application can be accessed through a Citrix portal by contracted staff and via a network logon/desktop icon for state staff.
Coordinators (both BFCS state employees and contracted) use the application to collect information for each child/family being served including, but not limited to demographics, primary care provider and insurance information, programs enrollment, health information/diagnoses, financial eligibility, referrals, consultations, encounter details, care plans, authorizations, information and referral, and outreach efforts. Program staff and supervisors/program managers conduct quality assurance and continuous quality improvement activities using Crystal Reports.
BFCS’s Data Analyst is working closely with the Division of Long Term Supports & Services and DoIT staff to address the Bureau’s data capacity shortfalls. With help from the Project Management Office, BFCS has identified a team to conduct an operational review to make decisions about resources and develop contingency plans. There is very little Information Technology (IT) knowledge transfer and no current written Continuity of Operations Plan for the Data System. Through a Lean Six Sigma review, the team will identify inefficiencies to develop and sustain improvements.
Contractors
MCH’s MIECHV (funded by HRSA) within the home visiting program, continued to increase data quality by conducting tailored training for its’ home visiting contract agencies on how to access reports and interpret the data. Training and site-specific technical assistance about using the web-based data system, Efforts to Outcomes (ETO), and increasing understanding of the data system was the focus of these trainings. The Data Coordinator has worked closely with contractor staff to improve functionality of several ETO reports in continuous quality improvement (CQI) activities, helping to support the Healthy Families America re-accreditation at several of the sites. The Data Coordinator, Gary Titus, has continued his series of brief videos, “Gary’s Tricks and Tips,” on the how-to’s of data entry and reporting. The most recent one is featured on YouTube and can be accessed at https://youtu.be/Gr3PiZMNau8. Each video focuses on topics such as demonstrating how to access and run reports, where the data points come from in ETO, and tips on data entry. These have been very well received and have increased to monthly to make up for the lack of on-site technical assistance due to the COVID‑19 pandemic.
Bi-weekly meetings continue to be held with the Social Solutions Advanced Support Consultant (data system contractor) to address ongoing and emergent issues of functionality within ETO. While NH’s data within the ETO system remains a work in progress, the amount of missing data has continued to decline over the reporting period due in large part to these changes.
MIECHV’s focus on improving performance in federal performance measures has provided an opportunity to dig deeper into the data to determine if areas of low performance and high missing data are issues of data capture, entry into the system, challenges with program practice, or issues with the data reports themselves. Building on the videos and one-on-one technical assistance, MCH staff have worked on mapping ETO touchpoints to data collection, input and report generation, in order to help identify areas that may contribute to the missing data.
This method has enabled regular monitoring of measures selected by the contractors based on higher levels of missing data and lower performance rates. The selection of targeted measures allowed for a deeper focus and understanding of how agencies approached their CQI efforts and the impact on their data as shown below.
Percentage of Missing Data for Selected Performance Measures over Time:
State Aggregate
MCH’s Family Planning Program (funded by general state funds and the Federal Office of Population Affairs’ Title X grant) contracts with BOWLink Technology for the handling of family planning data. The use of the data system is essential for the collection of data required for the Title X Family Planning Annual Report (FPAR) and for overall programmatic evaluation and improvement. The data base system will be updated this coming year, increasing the number of data elements collected from 20 to 51.
[1] https://wisdom.dhhs.nh.gov/wisdom/#Topic_8004F922AA3D495E8942ED18FBC18D9F_DEV retrieved on May 25, 2021.
[2] Ibid.
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