2003 C.I.P.A. Winners

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Health Accountability Division of Alberta Health and Wellness

Newborn Metabolic Screening (NMS)

Overview

A preventive health activity, which allows the early detection in newborns, of a number of metabolic conditions before they manifest clinically. Early detection and treatment improve the quality of life for the family.

Objectives

The objectives are as follows:

• Ensure 100% of newborns receive metabolic screenings within the first 7 days of life.
• Ensure all registered births and screening activity are tracked by provincial health care providers and laboratory service providers.
• Ensure timely notification, exchange of information, and monitoring of screening abnormalities.
• Enable the transfer of follow-up responsibility between all health regions.
• Monitor Non-Sufficient Quantity (NSQ) in order to reduce NSQ occurrences.
• Measure and improve the end-to-end delivery time for metabolic test and results reporting.
• Ensure consistent delivery of the program provincially, regardless of regional technology disparities

Summary Description

Newborn Metabolic Screening [NMS] is a population based preventive health activity, which allows the early detection of a number of inherited and congenital conditions before they manifest clinically. If effective treatment is started early, the impact of the disorder can essentially be avoided. Although the volume of these conditions is low, if left untreated, the cost to the individual and the health care system is substantial.

The NMS application, developed under a partnership of Alberta Wellnet and Alberta Health & Wellness, reconciles Birth and Metabolic Screening laboratory records to identify missing metabolic screening samples for newborns. It provides Alerts on test results that require repeat samples, or samples that show an abnormal or suspicious test result. It allows the Metabolic Screening laboratory to oversee the follow-up taken by the Health Region on an Alert and to check for repeat metabolic screening samples. It also provides a mechanism for the formal transfer of accountability from one Health Region to another with respect to obtaining screening samples and follow-up of alert conditions.

This application implements processes used in the Alberta NMS Standards/Guidelines that outline program goals, roles, and responsibilities of stakeholders in the delivery of the Newborn Metabolic Screening program. The Standards/Guidelines are used by the following stakeholders:

• Regional Health Authorities [RHA],
• Metabolic Screening Laboratory [MS Lab],
• Alberta Health & Wellness [AH&W],
• Medical Officers of Health [MOH],
• Registered midwives,
• Public Health,
• Physicians, and
• Parents of newborns.

Performance Measurement statistics are captured from birth to screening test result. These statistics include:

• Non-sufficient Quantity [NSQ] incidents to address the problems by Health Region, location, and person,
• The number of Births versus Completed screening events to ensure all newborns are screened,
• Tracking the efficiency of follow-ups and responsibility transfers.

Innovative Use of Technology

The NMS application, using IBM's e-business Application Framework, built and employed a "Generic Screening Engine" or GSE.

The GSE isolates common functionality, shared by all screening programs, into a set of components that can be reused in the development of future screening applications.

The long-term benefits provided by the GSE are the reductions in both the development and maintenance costs, and the implementation time for new screening applications.

The GSE provides the following functions:

• Population Management
  • Automatic identification of screening candidates for a screening program within a population (i.e. the Province of Alberta),
  • Entry of partiC.I.P.A.nts into a screening program (i.e. qualifying candidates),
  • Management of both voluntary and involuntary partiC.I.P.A.nts in a screening program
  • Automatic deactivation of partiC.I.P.A.tion when partiC.I.P.A.nts no longer meet the business rules for partiC.I.P.A.tion in a given screening program (e.g. exceed the maximum age rule for partiC.I.P.A.tion)
• State Transition Determination
  • The flow of a candidate through various state transitions for partiC.I.P.A.nts (i.e. invitation, screening, follow-up, etc.).
• Program Management
  • Parameter driven configuration of screening program attributes (e.g. frequency of screenings, elapsed time between follow-up and reminders for follow-up, etc.),
  • Screening program entry and partiC.I.P.A.tion rules.

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