APHL 2022 POSTER ABSTRACTS
NEWBORN SCREENING & GENETICS
Development of an Interactive Tennessee Newborn Dried Blood Spots Screening Performance Indicators Dashboard
C Lechner 1 , M Rumpler 1 , MC Dorley 1 , Y Li 2 , A Ingram 2 , H Fryman 2 ;
1
Tennessee Department of Health Division of Laboratory Services ,
2
Tennessee Department of Health Division of Family Health and Wellness
Problem : Since 2015 , the Tennessee Newborn Screening Program has published monthly reports for key performance indicators on its webpage . However , these reports are static and convey statistics for the state and individual birthing facilities for one specific month . A need has been identified for a reporting tool that promotes data transparency while being dynamic , interactive and easily accessible .
Objective : Our goal was to develop an interactive Tennessee Newborn Dried Blood Spots ( DBS ) Screening Performance Indicators Dashboard that would include time trends for key performance indicators at the state and facility level . This would be used to monitor program performance and identify areas for improvement .
Methodology : Collaborating with the APHL Newborn Screening Bioinformatics Fellowship Program , a full-time fellow was placed with the program to spearhead the project . A team was formed including members from the newborn screening laboratory and follow-up program . The team met weekly for six months to design and develop this dashboard using Tableau ( v2021.2.7 ) software . Inspiration was drawn from existing public health dashboards , and the evolutionary prototyping model , where prototypes are iteratively created with additional functionality to address project needs and prior feedback , was utilized to develop this dashboard . Thirty hospital personnel across Tennessee gave feedback on the dashboard ’ s design during this process . The final iteration of the dashboard is in the process of becoming a publicly available resource .
Results : Performance indicators include screening rate , unsatisfactory specimen rate , and the timeliness of blood spot collection , transportation and reporting of screening results . The dashboard main page visualizes the three most recent months ’ worth of data for these statistics across Tennessee or for a userselected facility . Users can select each indicator and adjust the facilities , date range and date granularity ( monthly , quarterly , yearly ) of interest in separate views that are linked to the main page . The dashboard is automatically updated monthly to minimize the time and resources required to maintain it .
Conclusions : The Tennessee Newborn DBS Screening Performance Indicators Dashboard supplements the existing online performance reports . Once it is published , it can be accessed interactively by newborn screening personnel , hospital personnel , and the public . This dashboard will drive introspection at the state and facility level and make it possible to identify potential issues and necessary corrective actions earlier , therefore improving the completeness and timeliness of newborn screening in Tennessee . We hope that our experiences can be applied not only to the development of other dashboards within Tennessee newborn screening , but to other areas of public health in Tennessee and across other states .
Presenter : Charles Lechner , Tennessee Newborn Screening Laboratory , Charles . Lechner @ tn . gov
Prenatal Screening and Interventions for Lead and Mercury : Reducing Exposure
E Bind , A Steffens , V Chandra , CH Yu , D Haltmeier and Z Fan , New Jersey Department of Health
Lead and mercury readily cross the placental barrier and can severely harm developing babies ’ brains and bodies , change behavior , and cause a multitude of other issues . Taking steps early to reduce mothers ’ exposure helps reduce babies ’ in utero exposure . NJ Biomonitoring partnered with University Hospital ( UH ) in Newark , NJ to offer prenatal lead and mercury testing as standard-of-care to the patient population . Expectant mothers receive educational materials on minimizing exposure and micronutrient supplements at the first prenatal visit . A tube of blood is also collected at that visit , as is cord blood for the baby at birth . The specimens are sent to the NJ Biomonitoring for testing and the results are sent back to help guide doctors in making medical decisions . Patients with elevated lead ( ≥ 3.5 µ g / dL ) or mercury ( ≥ 5 µ g / L ) receive care through UH and other resources through Program partners . Elevated mercury samples are speciated and those data are combined with questionnaires to identify the source . Follow up testing is conducted to ensure that interventions are successful and compared to the cord blood at birth . To date , NJ Biomonitoring has analyzed specimens from over 9000 individual patients . We are conducting retrospective chart reviews to gain an in-depth understanding of the exposure risks faced by the patient population and to gauge how well the Program is improving measurable outcomes . We identified a surprising trend for mercury with 50 % of patients having levels at which health effects can be expected in babies . Chi-squared analysis indicates a significant trend in reduced exposure in babies during Phase 2 as compared to Phase 1 . Data analysis has also identified that patients of immigrant status as particularly vulnerable with exposure leading to statistically significant resulting adverse health outcomes ( lower Agpar scores , greater risk of abnormal newborn screen , etc .). Data analysis is still on-going and additional findings will be added . NJ Biomonitoring is concurrently looking to expand to other hospitals to 1 ) test the transferability of the model and 2 ) gather data from other geographic areas in the state .
Presenter : Eric Bind , New Jersey Department of Health , eric . bind @ doh . nj . gov
Modernizing Newborn Screening ( NBS ) Through Partnerships / Collaboration , Leveraging Funding and Technology Related to Electronic Testing Orders and Results
J Vasquez , Ruvos
Developing and fostering partnerships and collaborations that lend to closing gaps in funding and leveraging technology can assist state newborn screening programs in their efforts to develop and implement a fully interoperable NBS HL7 electronic orders and results process . Such partnerships include federal agencies , interstate agency partnerships , and programmatic partnerships within state Departments of Health . Ruvos has been working with state public health departments to to help them build their infrastructure needed to modernize NBS processes for electronic orders and results with the long term goal of identifying future
Newborn Screening