NEWBORN SCREENING
Using Continuous Quality Improvement to Improve
Newborn Screening Systems
By Chenelle Norman, MPH, manager, Newborn Screening Quality Improvement
Continuous quality improvement (CQI)
is an organizational philosophy rooted
in the automotive and manufacturing
industry that, beginning in the early
nineties, expanded into the fields of
healthcare and public health. Today CQI
is credited with promoting innovations in
healthcare delivery by introducing system
changes that have led to improvements
such as the reduction in hospital-acquired
infections, reduction in mother-to-child
HIV transmission and advances in patient
safety. These outcomes have cemented
CQI as an important component to
healthcare and public health systems
including newborn screening. Using CQI
to improve organizational outcomes and
objectives is critical in newborn screening
(NBS) systems where ensuring that
every baby is screened appropriately and
efficiently can be a matter of life or death.
With funding support from the Health
Resources and Services Administration
(HRSA), APHL is making CQI a priority
for newborn screening programs aiming
to address longstanding challenges and
system-wide inefficiencies.
Championing a Culture of NBS CQI
The NewSTEPs Quality Improvement
Project is a five-year collaborative that
provides funding support to NBS state and
territorial programs while also developing
leaders who can champion a culture of
CQI among their NBS colleagues and
create a space to share best practices
and lessons learned using data and
storytelling. Like the moonshot factory
at Google, which brings entrepreneurs
together to identify radical solutions to
some of the world’s largest problems,
applicants for the NewSTEPs Quality
Improvement Project are encouraged
to identify innovative solutions and
approaches to improving NBS using CQI.
Recent awardees of the NewSTEPs Quality
Improvement Project identified unique
and innovative solutions in NBS-specific
areas including education, timeliness
and health information technology. For
example Colorado’s NBS program plans to
use the data visualization tool Tableau to
develop dashboards that will track data
entry in real-time in order to monitor and
improve performance of data submission.
Another awardee, New York State, has
proposed the creation of an electronic
hospital communications portal or app
that will enable its NBS program to
communicate information directly to area
hospitals.
Although the NewSTEPs Quality
Improvement Project is in its infancy,
there is much excitement about its
potential impact over the next five years.
The opportunity to allow for continuous
testing of new ideas and solutions and
to implement those that work could
transform how many NBS systems screen
babies and save lives. n
Next Steps Toward Newborn Screening Data Exchange
by Mary Kate Yost-Daljev, PhD, J Michael Consulting; Marci Sontag, PhD, Center for Public Health Innovation and Joshua Miller, MPH, Center for Public Health Innovation
Timely and accurate communication among
all partners is paramount to achieving positive
outcomes in newborn screening (NBS).
Electronic data exchange is the bedrock of
this communication, yet the implementation of
seamless data interoperability for NBS has been
variable among jurisdictions. Data exchange, as it
applies to NBS, encompasses orders and results
exchanged between the health care provider and
the screening laboratory, and extends to other key
clinical and public health partners.
In May 2019, J Michael Consulting (JMC) and
NewSTEPs 360 at the Center for Public Health
Innovation (CPHI) convened a meeting in Atlanta
to better understand the current state of NBS data
interoperability and develop recommendations
to address the barriers to national adoption
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LAB MATTERS Fall 2019
of electronic data exchange for NBS. Barriers
identified include lack of resources and
stakeholder engagement. Attendees from state
public health departments and laboratories, the US
Centers for Disease Control and Prevention (CDC)
and the Association of Public Health Laboratories
(APHL) developed recommendations and a
roadmap to improve NBS data interoperability,
including strategies to expand the adoption of
electronic data exchange.
In follow up to the meeting, JMC and CPHI
authored a report that illustrates dependencies
among NBS stakeholders and outlines
recommendations to drive NBS data exchange
toward these goals. The first recommendation is
to form a steering committee to direct activities
to promote interoperability, provide technical
assistance, bolster partnerships and serve as a
common voice for all NBS stakeholders. At the
direction of the steering committee, the goals of
the NBS community will include:
• harmonization of electronic messaging
• development of resources to assist
stakeholders in implementation efforts
• fostering collaboration among public, private
and government partners.
The group also envisioned an ideal NBS
data exchange with a platform to streamline
transmission and translation of NBS data among
partners. These recommendations outline efforts
the NBS community can undertake to address
the above barriers and move data interoperability
forward. n
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