NYC DOHMH Automated Test Resulting System

NYC DOHMH Automated Test
Resulting System
Meighan Rogers
Region II IPP Meeting
November 10, 2009
Background I – School Screening
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NYC DOHMH Bureau STD Control conducts a
high school CT/GC screening program - tests
12,000 students/yr
Prior to automated resulting students called a
single person for test results
2007-2008, approx 17% students called for
results
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Inaccurate estimate, many calls unanswered, hangups
Relied on individual to answer phone calls during
work hrs
Background II – Clinics
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9 BSTDC clinics service >125,000 patient-visits
annually
Pts given call center phone number and date of
visit, told to call in one week
7200 results calls/month
Calls answered by centralized call center staffed
by 3 full time staff, 2-3 part time staff
Staff respond to 80 % of calls
Need
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Need for 24/7 system to handle multiple users,
high call volumes
Reduce staffing need
Handle minimum10,000 calls/month
Web and phone access for all callers
Messaging in Spanish
Separate systems for school screening and clinic
callers
Report functions
Security features
Methods
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BSTDC worked with DOHMH Division Informatics and Information
Technology to spec out automated test result systems:
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Functional requirements developed
Transmission of electronic data (ASCII files)
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Chose Televox from 3 vendors
File sent from informatics to Televox 7 days after date of visit/test
File includes patient identifiers and composite test result variable, based
upon algorithm
Security features
Development of algorithms, result messages
Testing, testing, testing
Go live! School Screening – Oct 08; STD Clinic – Oct 09
High school messages
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Positive Message: It is very important that we speak
with you about your chlamydia and gonorrhea results
from [CollectionDate] . Please call 212-788-4441 right
away. If nobody answers, leave a message and we will
reach you at school or on your cell phone.
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Negative Message: Your chlamydia and gonorrhea
results from [Collection Date] were negative, which
means we found no signs of chlamydia or gonorrhea.
Remember, we only tested you for chlamydia and
gonorrhea. To test for HIV, pregnancy, or other STDs,
visit the free, confidential clinics listed on the blue card.
For information on birth control, abortion, or other
health issues call 212-788-4441 or go to
www.nyc.gov/teenhealth
High school messages (cont)
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Inconclusive Message: Your chlamydia and gonorrhea
test results from [CollectionDate] were neither positive
nor negative. This is because we were not able to test
your urine, or because the test results were not clear.
You need to be tested again as soon as possible. Please
visit one of the free, confidential clinics on the blue card
to get tested again, or call 212-788-4441.
Clinic algorithm development
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Clinic algorithm runs 7 days after date of visit on
DOHMH end takes into account following test
results:
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CT results and treatment
GC results and treatment
Syphilis (RPR and FTA)
HIV – rapid testing, conventional western blot and
acute HIV testing
Pap
Hepatitis
HSV
Clinic algorithm (Cont)
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Treatment Algorithm
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Assess treatment for CT/GC
Looks for treatment at any visit up to 30 days
after date of visit for positive test
Corrective reports
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Triggers algorithm to run again
Will assign new message if warranted
Clinic messages
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Clinic Message: One of your test results from <date of
visit> indicates that you should return to the clinic as
soon as possible.
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HIV/Hep C PAP low-grade or high-grade SIL, CT/GC positive without
treatment, any test unsatisfactory/QNS
Call Message: Your test results from <date of visit> are
now available. Please call 877-364-8191 as soon as
possible for more information Monday through Friday
9am to 4:30pm.
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RPR/FTA positive, Herpes culture positive, CT/GC positive but treated
Clinic messages (cont)
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Normal Message: All test results from <date of
visit> are normal, which means your tests
showed no signs of infection.
Pending Message: One or more test results from
<date of visit> are not yet available. Please
check again in one week.
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Assigned if all unavailable or if available results are normal and
others are still pending
When all results are posted in EMR, Televox will assign a new
message according to the test results.
Security features
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800 # login
Required unique User ID minimum 8 digits
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Clinics – automatically assigned by EMR
School screening – use students unique School ID
number
Required minimum 6 digit password
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Students and clinic patients create their own
password
Lockout feature: Users have 5 attempts to login to
system, else locks out
Patient login
www.mytestresults.com
Additional features - Administration
Administration Portal website:
www.mytelevox.com
 Search individual patients, determine if message
delivered
 Aggregate reports
 Assign messages to specific patient or assign a
personal voice message
 File sent back from Televox to EMR when clinic
patients check Televox results
Delivered results in EMR
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Televox file returned to EMR w/in 24 hrs
when pts check results by phone or online
Shows date of most recent check and
whether phone/web – automatically
populates EMR
Results – School screening
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Go live – began last October 2008
During 2008-2009 school year (Oct-June) 27%
students checked results (37% of positives)
Current school year: Sept-Nov 4:
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20% (223/1135) of students have checked messages
33% (18/54) of positives have checked messages
Results – STD Clinics
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Go live – began October 22, 2009
First batch results sent to Televox Oct 29
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Overall, 25.3% (588/2326) of patients have
checked messages from Oct 29 through Nov 4
How much $$$??
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Manpower/Internal resources
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3 DOHMH staff (2 STD, 1 IT) at ~25% time
for 1.5 years, varying over time
Ongoing technical support from Televox,
DOHMH IT
Televox $$ - Approx set-up cost: $10K;
ongoing commitment by # messages
assigned, approx $800/month
Thank you
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Ian Espanol, DIIT, NYC DOHMH
Jessica Han, Rachel Paneth-Pollak, BSTDC
BSTDC supervisors Steve Rubin, Susan Blank
Contact:
Meighan Rogers
mrogers@health.nyc.gov
212-788-4428