MCH EPI has access to timely and linked MCH data systems. Except where otherwise indicated, MCH EPI has at least annual access to each data source via an electronic data source. Below is a summary of the status of the relevant data sources:

1. Vital Records Birth: MCH EPI maintains annual access to “final” vital records data and live access to the vital records data management system (Genesis). Except for Induced Termination of Pregnancy certificates, the “final” vital records data is internally linked, as are data sets derived from the live data.
2. Vital Records Death: MCH EPI maintains annual access to “final” vital records data and live access to the vital records data management system (Genesis). Except for Induced Termination of Pregnancy certificates, the “final” vital records data is internally linked, as are data sets derived from the live data.
3. Medicaid: MCH EPI maintains access to Medicaid data for some notifiable conditions. Maternal death data is linked to the Medicaid data to identify if and when a woman had Medicaid coverage and, if so, services received. This data is then used by Georgia’s Maternal Mortality Review Committee (MMRC).
4. WIC: Broadly, MCH Programs has access to WIC data in aggregate and as requested. WIC data that can be linked to other data sources (e.g., identifiable) is not available at this time.
5. Newborn Bloodspot Screening: All Newborn Screening data are available without lag, aside from the time spent to process and/or enter data. Genetic testing, performed by an external vendor, is available at least annually and by request. These data are linked to vital records’ birth certificates upon intake within the State Electronic Notifiable Disease Surveillance System (SendSS).
6. Newborn Hearing Screening: All Newborn Screening data are available without lag, aside from the time spent to process and/or enter data. Genetic testing, performed by an external vendor, is available at least annually and by request. These data are linked to vital records’ birth certificates upon intake within SendSS.
7. Hospital Discharge: MCH EPI obtains quarterly hospital discharge files from the Georgia Hospital Association. The lag in the receipt of these files is four to six months. A final hospital discharge file is available around nine or ten months after the end of a calendar year. As needed or requested, these data may be linked to birth certificate data using a unique identifier.
8. PRAMS: MCH EPI, the entity responsible for the implementation of PRAMS, has received data representative of women with a recent live birth each year since 2017 and anticipates receiving the most recent year (2020 birth cohort) in September 2021. PRAMS data are inherently linked to birth certificates.
9. Vital Records Fetal Death Certificate: MCH EPI maintains annual access to “final” vital records data and live access to the vital records data management system (Genesis). Except for Induced Termination of Pregnancy certificates, the “final” vital records data is internally linked, as are data sets derived from the live data.
10. Vital Records Induced Termination of Pregnancy: MCH EPI maintains annual access to “final” vital records data and live access to the vital records data management system (Genesis). Except for Induced Termination of Pregnancy certificates, the “final” vital records data is internally linked, as are data sets derived from the live data.
11. Family Planning Program: MCH EPI developed and maintains ongoing access to Family Planning Program (FPP) data via the Family Planning Portal housed in SendSS. Data is generally provided by the 18 public health districts ten days after the end of each month. These data are encounter-based and may be aggregated for analyses.
12. Maternal Mortality: As a lead partner in Georgia’s Maternal Mortality Review Committee (MMRC), MCH EPI maintains ongoing access to final MMRC data. To date, this includes deaths occurring from 2012 to 2016.

Role of SSDI in Title V

MCH EPI works closely with Paige Jones, Title V Deputy Director, and Linda Tran, Title V Analyst. During the most recent Five-Year Needs Assessment and for subsequent establishing of priorities and national and state outcome measures, MCH EPI was responsible for a large part of the quantitative component. SSDI funding allows MCH EPI to maintain ongoing access to key metrics, including access to women’s health services and infant morbidity and mortality (described in more detail in Section b.iii below). Specifically, the SSDI-funded epidemiologist is responsible for the breadth of surveillance activities necessary to monitor National Outcome Measure (NOM) 11 (rate of infants born with Neonatal Abstinence Syndrome (NAS) per 1,000 hospital births) and for assisting in the calculation of vital records-related NOMs and State Performance Measures (SPMs). SSDI funds supporting ongoing maintenance and modification of the Family Planning Portal permit the calculation of ESM 1.2 (percentage of women (ages 15-44 years) served in Georgia Family Planning Program who use long-acting reversible contraceptives (LARCS)).

Key SSDI Program Activities

During the current budget year, SSDI funding supported several projects to include funding allowed for the continued development and maintenance of a Family Planning Portal and to support an epidemiologist position to fill a critical gap in infant surveillance. Progress has been made on the SSDI Performance Indicator of increasing state access to maternal and child health data sources (e.g., hospital discharge, Special Supplemental Nutrition Program for Women, Infant, and Children  Program (WIC), and the Pregnancy Risk Assessment Monitoring System (PRAMS).

Family Planning Portal

The Family Planning Portal (“Portal”) stores Family Planning Program (FPP) data and performs on-the-fly analyses. Though initial development of this portal was completed during a previous budget period, there remains an ongoing need for technical maintenance of the Portal (e.g., ensuring data files are being processed correctly), as well as minor modifications (e.g., updating of federal poverty guidelines within the coding). Before the development of the Portal, there was a significant lag in both obtaining and analyzing FPP data as this data was housed externally by multiple third-party vendors and had to be amalgamated upon receipt of data. This hindered access to usable data. The Portal allows all Family Planning data from ten days after the prior month to be available on an ongoing basis to MCH EPI and Women’s Health programmatic staff (WH). The Portal is currently being used by WH and MCH EPI to produce readily available analyses and to export data to perform analyses as requested. The Portal incorporates several on-the-fly reports of FP data. These reports allow MCHP to have access to the FP results on both immediate point-in-time and ongoing bases. One of the priorities that was successfully met during the current budget year was the creation and modification of an on-the-fly TANF report. In this report, FP data results specific to TANF are provided. This greatly reduces the time to create quarterly and annual TANF reports. Additionally, on-the-fly analyses enhanced access and flexibility to the data utilized by WH. For example, date ranges may be changed and specific demographics, such as race/ethnicity, geography, income level, may be selected for each of the analyses.

Infant Epidemiologist II (Infant EPI) Position

The Infant EPI drastically increases MCH EPI’s capacity to perform surveillance of critical infant health outcomes- NAS and birth defects. This position has been filled since October 16, 2018, by A. Elise Barnes. The Infant EPI works on multiple projects, but primarily focuses on the surveillance of birth defects and NAS. Because of the high priority of NAS in Georgia, she performed several analyses to help meet the NAS data needs of Title V-related programs, including providing results for the annual Title V Block Grant, performing analysis for the Title V Five-Year Needs Assessment, assessing the burden of NAS in Georgia for multiple presentations, responding to several media requests, several trainings of hospital reporters, and disseminating best practices for reporting suspected cases of NAS. As part of the Georgia Perinatal Quality Collaborative (GaPQC), The Infant EPI has given multiple presentations or webinars on the burden of NAS in Georgia and on NAS surveillance that allowed hospital staff responsible for reporting NAS to DPH to learn how to report and to ask questions on reporting practices. Through her service on the GaPQC’s Neonatal Committee, The Infant EPI provides facility-specific data to hospitals participating in the neonatal initiative, which is currently focused on improving care outcomes for infants with NAS and fulfills data requests as needed. With the support of the SSDI grant, we have achieved several improvements related to data capacity, as well as have many goals we would like to accomplish. Georgia was one of the first states to begin receiving infant toxicology results from national reference laboratories as part of Georgia’s mandatory NAS reporting requirements. This was accomplished by leveraging existing electronic laboratory reporting (ELR) infrastructure and established relationships with external reference laboratory contacts. The toxicology results received via ELR can be linked to existing cases submitted by hospital staff via the SendSS NAS reporting module or, if no existing report exists in SendSS, the ELR data can be used to generate a report by linking the laboratory data to the infants’ birth certificate to obtain the necessary demographic fields to create a case in the NAS reporting module.

The Infant EPI has also participated in the ongoing development of Georgia’s Birth Defect Registry (BDR) and participated in weekly meetings to discuss the technical development of the BDR and has regular meetings with Technical Developers to clarify and assist in decision making around the BDR infrastructure. The MCH EPI also assisted in the creation of multiple components of the BDR. The Tracking Form module in SendSS allows DPH epidemiologists to track the case status of reported cases and expedites medical record requests. The SendSS Case Management module allows epidemiologists to disposition suspected cases following medical record review and abstraction. Each of these modules allows for comments between the two roles (medical record requestor and medical record reviewer) involved in case requesting and reviewing. In June 2019, Ms. Barnes received the Best Poster award for the Maternal and Child Health, Chronic Disease, and Oral Health Section at the annual Council of State and Territorial Epidemiologists (CSTE) Conference for a poster entitled, “Validity of Facility-Reported ICD-10-CM Codes Captured Through an Existing Birth Defects Surveillance System to Identify Zika-Associated Birth Defects, Georgia, 2016-2017”.