User`s Manual for the Wyoming HHH System
Contents
1. Chesney Kenny CI 5 Pending View Report 2 Clicking on View Report will take you to a PDF version of your follow up actions From here you can save and or print your list of follow up actions Note You may need to temporarily disable your pop up blocker if you have difficulty viewing the PDF page Printing your facility s follow up actions is recommended as a way to stay organized and keep track of what and when children need follow up and when Note If you refer a child for follow up it is your responsibility to make sure that the follow up occurs E Printing a Child s Record 1 Search for the child whose record you want to print See step V on page 7 for instructions on how to search for a child 2 Once you have found the child click on his her name to open his her record Scroll over the Child tab at the top of the screen and then click on Child View Home search Child Maintenance Logout Child View gt Bob Smith Add Action tem Age 4ye Early Intervention Notes DOB 4 4 Sex Mah Hearing Hospital Wwinson Memorial Hospital 3 This page will display anything that has been saved in Notes the database for this particular child including Follow up Actions Patient Detail Screening Results Diagnostic Results Early Intervention Status Risk Factors ee SS SS 4 To print this page click on file and then print Different internet browsers have different ways of pri2. Wyoming EHDI Program Staff Nancy Pajak Director Sarah Fitzgerald Follow up Coordinator Susan Fischer Specialty Clinic Coordinator Joshua Kollaja Education amp Awareness Coordinator Abigail Pierson Administrative Assistant 715 Shield Street Laramie WY 82072 Phone 307 721 6212 Fax 307 721 6313 Email nanpajak aol com Website WWW Wyomingehdi org Wyoming Department of Health Developmental Disabilities Division 800 510 0280 Wyoming Department of Education Outreach Consultants for Deaf Hard of Hearing Program 307 777 6376 Your Health Care Provider The following websites have additional information regarding hearing loss www intanthearing org www babyhearing org IV How to Log into the EHDI Tracking Software 1 Using an Internet web browser go to the following website http ehdi health wyo gov 2 Enter User Name 1 il iil This information will be the same user name and password you provided on the HIPAA paperwork you completed and returned to the Wyoming EHDI Program Appropriate HIPPA paperwork must be completed before you are able to access the database See Appendix E If you need to create a user name password and sign the HIPPA paperwork the necessary forms can be found at the back of this manual You may also download the forms at www wyomingehdi org Fax or mail completed forms to the Wyoming EHDI Program at 307 721 6313 or 715 Shield Street Laramie WY 820
3. button at the bottom of the screen This will take you back to the child s main page and mark the referral action item as completed NOTE If you refer a child for follow up it is your responsibility to make sure that the follow up occurs 10 PLEASE NOTE only if letters are generated via the software system will it be noted documented or recorded that the referral actually occurred For this reason PLEASE make any and all referrals via the EHDI tracking and surveillance software G Adding Follow Up Actions 1 Use this function to add action items to a particular child 2 Scroll over the Child tab at the top of the screen and then click on Add Action Item A child s record must be open in order to enter or view the child s action items Home Search Child Maintenance Logou Child View Bob Smith Add Action item AA Early Intervention Notes DOB 1 4 Sex Mah Hearing Hospital Ivinson Memorial Hospital Notes 24 3 After clicking on Add Action Item a new page will Notes load Use the drop down menu to select the Action Item Type Add Action Item Action tem Type L Facility 4 Use the drop down Action tem Esp 12 months unless concems arse or a change in hearing is noted menu to select the Action Item you want to add to the child s record Action item Type LOHL Action item 1 Facility Rescreen in 3 Rescreen in 4 6 weeks Due
4. Wyoming CHDI Tracking Software for Late Onset Hearing Loss Hearing Screenings USER S MANUAL August 2013 ehdi health wyo gov Wyoming Early Hearing Detection amp Intervention EHDI Program 715 Shield Street Laramie WY 82072 Phone 307 721 6212 Website www wyomingehdi org I II IV VI VII VII IX XI XII XII XIV XV XVI XVII Table of Contents e e A PA T AE E SA A YE sera AE ES TA 4 POUT e sas a A A ROMAN RE 4 CONAC al ee NE re e e eee ee Me e eye ey Ne ean de Ke ey NE 5 HowtologintotheEHDI TrackingSoftware 6 Sede A TrA M A NE MERE MEME EE YEME YA 7 P Ka ni ga li ll al na Ga en a Gani crates 8 Entering LOHE Hearing Set enme Result saa an a a nn a a e eee 9 Usine the Vermncanon Fool seli a eydei ia edil eken ille 12 HowtoManageYourrFollow UpActons 14 CA Abo t Follow UP ACHONS ei li a kl A le e me elma iii 14 B OrganizingandViewingrFollow UpActions 14 C Searchingbyfollow UpActonms 16 D Prn ngfollow UpActons 21 E a yn az e k MM 21 F Generatingrollow Upletters 22 G AddingrFollow UpActons 24 Farny bs e 4 e eara aE T EAA A 26 REEI Le e E e e S 28 Adding Notesto a Ch
5. Brent D Sherard M D M P H Director and State Health Officer Governor Dave Freudenthal Wyoming Department of Health Developmental Disabilities Division Early Hearing Detection and Intervention Program 715 Shields Street Laramie WY 82072 307 721 6212 Date Dear Early Intervention Provider The Wyoming Department of Health Developmental Disabilities Division Early Hearing Detection and Intervention EHDI Program would like to invite you to participate in the Wyoming EHDI Database Project The Wyoming EHDI Database is operational and currently available to facilities that provide early intervention services for Wyoming children The Wyoming EHDI database currently has more than 20 000 Wyoming children s birth hearing screening records stored on the central database The 21 Wyoming birthing hospitals have made a huge effort to submit hearing screening data Historical EHDI records since 2004 have been entered into the Wyoming EHDI database Early intervention providers programs expend valuable energy completing and tracking hearing screening results for Wyoming children so that appropriate follow up occurs The intent of the Wyoming EHDI Database is to centralize a child s EHDI record so no matter where a child is seen for their next hearing screening or diagnostic audiological evaluation the early intervention provider has one place to go to obtain a child s complete EHDI record The results of the hearing screenings obtained b
6. database or withdraw at any time Should a parent decide to discontinue EHDI database participation the parent must complete an Opt Out form The original copy is maintained in the provider s office and a copy sent to the Wyoming EHDI Program The authority to prescribe rules and regulations for the management and control of newborn hearing screening is contained in Wyoming Statute 35 4 801 and 35 4 802 Name of Provider Organization Type of Organization Public Private Number of Early Intervention Sites in Organization Provider Organization s Representative ci Zp Phone FAX Ema As a condition of participating in the Wyoming EHDI Database the above Provider enters into this agreement with the Wyoming Department of Health and agrees to the following e To use the Wyoming EHDI Database only for the hearing needs of children The Provider and his or her staff will access the registry to e Assure appropriate follow up hearing screenings e Assure appropriate medical follow up e Assure appropriate audiological diagnostic evaluations e Assure appropriate enrollment in early intervention e Conduct ongoing audiological management e lf this agreement is violated by any use of the database in an unauthorized manner WDH reserves the right to terminate access to the database 52 e The Provider shall abide by the requirements in the Individual User and Confidentiality Agreement which is incorporated by reference into this agr
7. page 9 for information on how to enter child s screening results b Add Child The Add Child option will take you to the child s demographic page Here you may enter the child s address parent guardian information doctor information etc You don t need to complete every field but the more information you have for the child the better especially if the child is in need of follow up screenings Note If the child is in need of follow up screenings it is recommended that you use the Add Child option vs the Quick Add option i After you have entered the child s demographic information click on Add Child at the bottom of the screen to add the child into the database i Continue to step VII on page 9 for information on how to enter child s LOHL screening results VII Entering LOHL Hearing Screening Results Notes After locating a child using the search function and or adding a child into the database you are now ready to enter the child s LOHL screening results into the system 1 After you have found a child using the search option or after you have added a child using the Add Child option scroll over the Child tab at the top of the page scroll over Hearing and then click on Add Screening Note To enter LOHL screening results using the Quick Add option you can skip this step Once you add a child using the Quick Add option you wil
8. Date Refer to Primary Care Physician and rescreen in 4 6 weeks Refer to Primary Care Physician and rescreen in 3 months WT Referto ENT for medical and audiological evaluation and rescreen in 4 6 weeks Refer to ENT for medical and audiological evaluation and rescreen in 3 months Refer to Audiologist and Rescreen in 4 6 weeks Refer to Audiologist and Rescreen in 3 months Other IFSP IEP review S 5 Use the drop down menu to select the Facility that goes with the action item you are adding am Anderso Action tem Type Action item A Facility LUS Hospital McKay Dee Hospital Center Memorial Hospital of Carbon County Memorial Hospital of Converse County Memorial Hospital of Sheridan County Memorial Hospital of Sweetwater County Out of State Colorado Platte County Memorial Hospital Powell Valley Healthcare Presbyterian St Luke s Medical Center Primary Children s Medical Center Rapid City Regional Hospital Regional West Medical Center South Lincoln Medical Center St John s Medical Center St Vincent Healthcare Star Valley Medical Center The Children s Hospital KI 6 Type the Due Date that the action item needs to be completed by 7 Click on Add Action Item to save it in the database Once the action item is saved in the database it will appear on the child s record as well as on your list of follow up actions to do list Vue Lee Law Add Action te
9. Select the document you wish to add and click Open gion Data jistration NE Filename Bob Smith Report j All Files Open OS 5 Once the file name will appear in the box next to Browse click Add Document Add Document CAUsers MatiDocumen Add Document 6 The document will appear below File Name z Bob Smith Report doc 7 To view the document again scroll over the Child tab at the top of the screen and click on Add Document The document will be at the bottom of the page 40 XV Adding Referral Follow Up Notes 1 After a letter has been generated to an audiologist ENT or primary care physician a notebook icon will appear under the child s follow up actions FollowUp at stic Pending W27 2010 Pending 27 2010 Complete 17 2004 yeician Complete a Sa r 2010 Inleee concerns ariza or a rhanme in 2 Click on the notebook icon under FollowUp to enter information regarding the child s referral 3 On the Referral Follow Up page enter the current status of the child s referral Referral Follow Up Status Updated On 98 27 2010 iol Current Status gt Unknown Status Referral Has Not Been Acted Upon Followup is Scheduled But Not Yet Completed l Evaluation is in Progress but Diagnosis is Incomplete Other See Notes Below 4 Click on the Save button to save the current status of the child s referral
10. These again are children for whom you individually are responsible for Followup Actions Task PatientName Status Creation Date Due Date Z amp Rescresnin 4 6 weeks SCHUTZMAN TORRIE Pending 5 5 2008 11 26 2002 Ei Rescreen in 12 months unless concerns arise or a change in hearing is noted POLLEY BRENNAN Pending 5 5 2003 10 9 2003 Ei 3 Rescreenin 12 months unless concerns arise or a change in hearing is noted STUART HENRY Pending 5 5 2008 1 11 2005 Z Rescreen in 12 months unless concerns arise or a change in hearing is noted FERTIG CALVIN Pending 5 5 2008 3 11 2005 ZF amp Rescreen in 4 6 weeks RICHARD BEAU Pending 5 5 2008 10 2 2007 Z Rescreenin 4 6 weeks MINER TRISTAN Pending 5 5 2008 10 2 2007 Z amp Rescreenin 4 6 weeks GARAY BENTLEY Pending 5 5 2008 10 2 2007 Za Rescreenin 4 6 weeks EDGAR JAKE Pending 5 5 2008 10 8 2007 ZF amp Rescreen in 4 6 weeks OLMSTEAD SIERRA Pending 5 5 2008 10 8 2007 4 Rescreenin 4 6 weeks DAVIS JAMES Pending 5 5 2008 10 8 2007 12345678910 B Organizing and Viewing Follow Up Actions 1 You can organize the order in which the follow up actions are displayed according to Task Patient Name Status Creation Date and Due Date These headings are all displayed at the top of the Follow up Actions List FO in s Indy lowup Actions Rescreen in 12 months unk POLLEY BRENNAN Pending 2005 10 9 2003 Rescreen in 1
11. be found at the back of this manual or can be downloaded at www wyomingehdi org Please fax or mail completed forms to the Wyoming EHDI Program at 307 721 6313 or 715 Shield Street Laramie WY 82072 Screener Johnny Cash Jnset He SLP Kim Lewis Special Education Coordinator Mary Swanton SLP Nancy Axthelm SLF Ryan O Connor lor caregiver CELLULAS Ei us Sar ch 6 Use the drop down menu to select the Facility at which the child was screened oCreener SEES bes Procent fF Arapahoe Child Project Arapahoe E E RRT Bridger Valley Child Development Center Mountain CDS of Campbell County Gillette Inset Hearing L CDS of Fremont County Dubois LD5 of Fremont County Lander iption CDS of Fremont County Riverton CDS of Fremont County Shoshone al or caregiver co CDS of Natrona County Casper Child Development Center Buffalo i omes associated Child Development Center Sheridan Children s Resource Center Basin Children s Resource Center Cody Children s Resource Center Lovell Children s Resource Center Powell rent OF persistent Children s Resource Center Thermopolis Children s Resource Center Worand sek Dakota edi e Developmental Preschool amp Daycare Laramie Douglas Child amp Family Development Center 1 Trauma 7 If the child has tubes please indicate this by checking the box labeled Tubes Present Tubes Pre
12. can be first and last name Preferred Password 7 characters min Must include 1 number and 1 letter Do not use spaces PLEASE PRINT CLEARLY Note Passwords are case sensitive Role O Late Onset Hearing Loss Data Clerk O Late Onset Hearing Loss Screener O Physician LI Audiologist Region Number Primary Site i e Basin Afton etc Other Sites i e Worland and Thermopolis Mountain View and Kemmerer etc Primary Work Mailing Address Primary Work Phone Number Street Address City State Zip Code Employee Signature Date Date of most recently attended Hearing Screening Training Workshop Please sign this form keep a copy for yourself and mail the original to the Wyoming Department of Health Developmental Disabilities Division EHDI Program 715 Shield Street Laramie WY 82072 Individual and Confidentiality Agreement 06 08 55 Appendix F Wyoming Child Development Centers PERMISSION FORM TO SCREEN AND INCLUDE IN DATABASE I understand that the state of Wyoming maintains a screening results database The benefits of the database are to ensure appropriate screening follow up and referral processes Screening records are only accessible by authorized personnel Records will not be released to other sources without my written permission Parent Guardian Signature Date 56
13. follow up 41 XVI Late Onset Hearing Loss Reports Notes 1 Scroll over Report scroll over LOHL Reports and then click on LOHL Screener Report A h Maintenance Reports Logout LOHL Reports LOHL Screener Report g ns PatientName Status Creation Dai 2 Select the Date of Birth Range by selecting the Start Date and End Date This can be done by typing in the date in the MM DD YYYY format or by clicking on the calendar and selecting the date Date of Birth Range Start Date ao f End Date fol Screening Date Range 4 August 2010 b Start Date Su Mo Tu We Th Fr Sa 3 Select the Screening Date Range by selecting the Start Date and End Date This can be done by typing in the date in the MM DD YYYY format or by clicking on the calendar and selecting the date screening Date Range Start Date fo End Date fiol a Region 4 August 2010 b Su Mo Tu We Th Fr Sa 25 26 27 28 29 Si 5i View Renaot 4 Select the Region that your facility is in Region Regions 4 5 Once the region has been selected the facility will be able to be selected 6 Click View Report A report will generate regarding the number of children screened at your facility View Repot 49 42 XVII Providing Feedback Notes 7 At the bottom of every page is a red button called Feedback to Wyoming EHDI staff regarding software issues If you hav
14. hearing loss Recommend regular contact with other children who are deaf or hard of hearing GEG Ga 2 Ga Ga Baa Other Please describe in Notes section below 15 Select whether or not the child had a Case History Notes recorded Tests Case History Yes No 16 If the child had an Otoscopy test select if it was Bilateral Left Only or Right Only Tests Case History Otoscopy Bilateral Left Onty Right r 17 If the child had an OAE test select if it was Bilateral Left Only or Right Only Tests Case History Otoscopy Bilateral Left Only Right Only ToneRuret 18 If the child had a Tone Bursts test select if they were Bilateral Left Only or Right Only at 500 Hz 1000 Hz 2000 Hz and 4000 Hz Bilateral Left Only Right Only Bilateral Left Only Right Only Bilateral Left Only Right Only 4000 Hz Bilateral Left Ont Right Only 19 If the child had a Click ABR test select if it was Bilateral Left Only or Right Only for Air Conduction and Bone Conduction Tests Case History Otoscopy OAE ToneBurst Click ABR Air Conduction 7 Bilateral Left Only Right Only Bone Conduction Bilateral Left Only Right Only gt 7 20 If the child had an Immittance test select if it was Notes Bilateral Left Only or Right Only for High Frequency with Ac
15. or a change in hearing is noted be sure to check the box that says Include 12 month rescreens Leaving this box blank will narrow down your to do list gt Include 12 month recreen f Click on the Search button at the bottom of the screen to view your results Note To print your results click on View Report at the bottom of the screen This will take you to a PDF version of your results that you may save and or print Be sure to fill in ONLY the search criteria that go with each method as described in the manual For example if using Method 1 to search your follow up actions be sure that only the fields that pertain to Method 1 as described on page 16 are entered Leave the other fields blank Notes 20 D Printing Follow up Actions Notes 1 After you have selected which action items you want to view i e Due in 7 Days Due in 30 Days etc click on the View Report button at the bottom of the page Refer to Step VIII Sections B and C for information on how to narrow down your action item list Creation Date Due Date Hartman Nancy Refer to ENT for medical and audiological evaluation Cancelled Hartman Nancy Refer to ENT for medical and audiological evaluation Complete Anderson Sam Refer to Primary Care Physician Complete Hartman Nancy Refer to ENT for medical and audiological evaluation Pending Anderson Sam Refer to Primary Care Physician Pending
16. region by using the Region drop down men ntion Type v Region d Program Identifier Start Date e Bi Review Date Copyright 2007 Wyoming Departmer Select the facility at which the child is receiving Early Intervention services from the Program Identifier drop down menu Ay verin Child Development Services of Fremont County Dub 7 Program Identifier Start Date Arapahoe Child Project Arapahoe Bridger Valley Child Development Center Mountain Review Date Child Development Center Buffalo Child Development Center Sheridan m Child Development Services of Fremont County Lan Child Development Services of Fremont County Riv Child Development Services of Fremont County Sho Child Development Services of Natrona County Cas imi oi ieh Children s Developmental Services of Campbell Coun l Children s Resource Center Basin Children s Resource Center Cody About Us Enter the child s initial Start Date for either IFSP or IEP and his her next Review Date a Es Once all of the information has been accurately entered click on the Save button This will save the child s Early Intervention information into the database In order for the IFSP IEP review date to show up in your list of follow up actions you must add them as a follow up action To do this see step VIII Section G on page 24 Notes 27 X Risk Fac
17. 2 months unk STUART HENRY Pending 52008 1 11 2005 Click on the heading name for which you want to organize your follow up actions For example a b Click on Task to organize according to the task needing to be completed Click on Patient Name to organize alphabetically Click on Status to organize according to status pending completed cancelled etc Click on Creation Date to organize according to the creation date also the date the follow up action was entered into the software NOT the date the screening was completed on the child Click on Due Date to organize according to the date by which the follow up actions are to be completed by 3 Rescreen in 4 5 weeks SCHUTZMAN TORRIE Pending S2008 11 26 2002 Notes 14 3 Clicking on the notebook at the far left of a child s name will Notes allow you to add new and or additional screening results for that child without having to click under the child view drop down menu when the follow up action is a rescreen task i e Rescreen in 4 6 weeks Refer to Step VII on page 9 to add screening results Clicking on the notebook when the follow up action is a referral to a child s Primary Care Physician Ear Nose and Throat Doctor and or Audiologist will allow you to generate a letter to the child s parents guardian Refer to Step VIII Section F on page 22 to generate letters Followup Actions T
18. 72 3 Enter Password 1 il Note Password 1s case sensitive Note You will be locked out of the system if you enter an incorrect password more than three 3 times and will have to contact the Wyoming EHDI Program at 307 721 6212 or email nanpajak aol com 4 Click the Log In button OHDI 5 If you have forgotten your password please contact the Wyoming EHDI Program at 307 721 6212 or email nanpajak aol com NOTE Before logging into the database please verify all data and hearing screening forms are complete to ensure successful and proper entry into the database You must be a registered user before you will be allowed access to the EHDI tracking system Notes V Searching for a Child Notes Before entering a child s Late Onset Hearing Loss LOHL screening results into the system you must first find the child in the database 1 Use the search function to locate a child in the database Scroll over the Search tab at the top of the screen and then click on Search by Child OHDI Home search Maintgn Logout Search By Child Followu Search By Follow UD Actions PatientNam az amp Rescreen in 4 6 weeks Alithetime gt t Reerreen in AR weeke Fwee Qnar 2 Enter the child s last name date of birth and gender These three fields are required and the must be entered in order to complete your search Once these fields are entered click on
19. Search Note Once a child has been added to the database under your user name you can henceforth search for that particular child using only his her last name Child Search Date of Birth fol Last Name 3 If child is in the database his her name will appear at the bottom of the screen Click on the child s last name to view information and or to add screening results for that particular child Continue to step VII on page 8 to add hearing screening results Child Search LastName Smith Date of Birth 01 01 05 hol Sex Mae Female Add Ci Quick Ada Minson Memorial Hospital VI Adding a Child Notes If a child is not found in the database using the search function you will need to add him her before recording their LOHL screening results into the system 1 You can add the child into the database using one of two methods Quick Add and Add Child 2 After searching for the child see step V on page 6 and receiving the message No children match search criteria click on either Quick Add or Add Child Note The child s Last Name First Name DOB and Gender MUST be entered before clicking on Quick Add Child Search Last Name Smith a Quick Add This option allows you to skip the child s demographic page adding address phone number etc and go straight to adding the child s LOHL screening results Continue to Step VII on
20. anguage may occur Many hearing problems in children are minimal yet developmentally significant It is important that even slight hearing loss be identified so that appropriate developmental management can be provided Many hearing losses are temporary and may be successfully treated with medical attention If you have any questions comments or concerns about the hearing screening results or about our hearing conservation program please contact me or the hearing screening technician at 3333333 Sincerely Note If you wish to make changes to the text of the referral letter you may do so at this point 6 Clicking on the button labeled View in Spanish will translate the letter into Spanish View in Spanish 7 There is a place at the bottom of this screen for you to enter in Notes about the child Hotes 8 Click on View Printable Version at the bottom of the page This will take you to a PDF version of the letter you have generated From there you can print and or save the letter View Printable Version Cl include Screenings Note You may need to temporally disable your pop up blocker if you have difficultly previewing the letter ence 2009 x Untitled Page x Allow pop ups for ehdi health wyo gov Edit Pop up Blocker Options Don t show this message when pop up Show https ehdi health wyo gov Sec 9 Once you have printed and or saved the letter click on the Submit
21. ask A Rescreen in 4 6 weeks SCHUTZMAN TORRIE Deaserasn in 177 manthe unless ennrarn s ariza nr a rhanna in hzarinn is nto ON I Pw AOPRIAIA 4 Clicking on the x will cancel the child s follow up action You will be asked to confirm a deletion of any follow up action A suggestion for managing your follow up actions is to delete the following actions from your list Rescreen in 12 months unless concerns arise or a change in hearing is noted Note Because Late Onset Hearing Loss LOHL is known to occur throughout a child s life it is recommended that a child s hearing be screened annually Early diagnosis of acquired late onset hearing loss will lessen the impact the hearing loss has on the child s development However each facility has the option of deleting this follow up action for children who have no risk factors and who are not receiving early intervention services This option will narrow down your to do list and allow each facility to use the software in the most effective way to support their program Followup Actions Rescreen in 4 6 weeks SCHUTZMAN TORRIE 5 Clicking on the child s name will allow you to view the child s information including demographic guardian and screening history Note demographic guardian information etc 1s populated ONLY if done so by the person logged into the software i e screener or data clerk This information becomes useful to u
22. e Medical v Physician Eg Evaluation Date 6 2 2008 fio Facility v 6 Select whether the child s medical condition was Confirmed or Not Confirmed by the child s physician at the time of his her medical evaluation gt Medical Condition Confirmed gt Medical Condition Not Confirmed 7 Click on Medical Follow Up and the following choices will appear Select the physician s recommendations for medical follow up for the child Recommendations 1 week 2 weeks 3 weeks 4 weeks D Recheck PRN Other 8 If the child s physician referred the child to a specialist click on Referrals and select to whom the child was referred Recommendations Medical Follow Up Referrals Refer to Early Intervention Speech Thearpy OT PT etc Refer to Audiology Referral to Opthamology Optometry Referral to Genetics Referral to Ears Nose and Throat physician Refer to Cochlear Implant Center Team Other see Notes 9 Next click on Medication to select if any medication was prescribed to the child by the physician Recommendations Medical Follow Up Referrals Medication E Prescribed El Not Prescribed 32 10 Use the Notes section to type any notes regarding the child and his her medical evaluation 11 Click Save Diagnostic to save the child s medical diagnostic info
23. e follow up actions by searching for only those that are due in a particular date range Home Search Maintenance Li search By Child Fallo Search By Followup Actions LASK 2 The following page will come up Action Item Search Due Date Start fiol Create Date Start fol Due Date End fiol Create Date End fiol Facility v Status Type Task Type X Due in 7 Days Due in 30 Days Include 12 month rescreens Only show my action items 9 3 This page allows you to Search by Follow Up Actions using 4 different methods 4 Method 1 a Use the drop down list to select your Facility LALEL a EEE Task lceland Yukon Notes 16 Select a Due Date Start and Due Date End These are the date ranges for when the follow up actions are due For example selecting Due Date Start of 04 01 2010 and a Due Date End of 06 11 2010 will allow you to see the follow up actions that are due between 04 01 2010 and 06 11 2010 Dye Date Start 4 1 2010 lol EEE ue Date End 6 11 2010 fiol Next select the Status Type You can choose to view follow up actions that are pending complete or cancelled GD Status Type Include 12 month Pending rescreens Complete Cancelled If you want to include the follow up action of Rescreen in 12 months unless concerns arise or a change in hearing is noted be sure to check the b
24. e any questions comments or concerns regarding the software please provide us with feedback by clicking this button Feedback to Wyoming EHD staff regarding software issues q 8 Use the box to enter any information you would like the Wyoming EHDI Program to know about the software Add Feedback 9 To submit your feedback click Add Feedback ndd Feedback 4 43 44 Appendix A Hearing Screening Results Form Please Print Reguired Information Classroom Screener Locale Child s Name DOB Gender OM OF Parent s Caregiver Phone Parent s Caregiver Address Child s Physician Permission to send results to Physician O Yes O No If necessary permission to rescreen O Yes O No I Hearing Screen Results Please use this space to display results of hearing screenings conducted throughout the year x sa 1 E E ee ee E A DE R JR ER N ee ee E a m a a a ce E E KE EA ee naper ee Fm e ee a es ee ce ee H ee eee ee ee ee a ee re ee ee S eee Follow up to Referral Recommendation Date Result use s 1 10 use s 1 13 See Below See Below Notes S E PS a Eri gt E Screen Date ECV TM COMP MEP 1 000 Hz 2 000 Hz 4 000 Hz OAE Pass P Fail F Screener Initials Audiologist Review Results entered into II Follow up Recommendations Please choose one based on hearing screening results HI Follow up to Medical and or Audio
25. e child fails his her screening and is on an IFSP IEP plan select the recommendation that best meets the needs of the child for appropriate hearing hearing management This will usually result in a rescreen occurring sooner than the child s annual IFSP IEP review date Right Result Fal Recommendation Rescreen in 12 months unless concerns arise or a change in hearing is noted Rescreen in Z months unless concerns arise or a change in hearing is noted Rescreen in 3 months Rescreen in 4 5 weeks Refer to Primary Care Physician and rescreen in 45 weeks Refer to Primary Care Physician and rescreen in 3 months a Refer to ENT for medical and audiological evaluation and rescreen in 4 5 weeks Refer to ENT for medical and audiological evaluation and rescreen in 3 months 11 12 The verification tool is intended to allow you to verify your interpretation of the immittance results If you have questions comments or need assistance with the interpretation of immittance measures It is strongly recommended that you attend a LOHL screening training Please call 307 721 6212 at any time for assistance 13 Verification of your hearing screening results is available by clicking on the Use Verification Tool button By clicking on this button you will be able to enter the results you obtained from the hearing screening equipment Note Use of the verification tool is not required If you open the verification tool y
26. eement Each staff member needing access to the Wyoming EHDI Database must sign the Wyoming EHDI Individual User and Confidentiality Agreement which must be kept with the employee s Personnel File e The Provider acknowledges that unauthorized disclosure of confidential information may result in civil and or criminal penalties The Provider will take all reasonable steps to assure employee compliance with confidentiality requirements e The Provider shall cooperate with WDH in notifying parents or guardians about the system e The Provider shall furnish specified demographic and hearing information about children s hearing screenings on a prompt basis striving for submission within one week after screening results are obtained Signing this form signifies agreement to be a Wyoming EHDI Program authorized user Please sign the form keep a copy for yourself and mail the original to the Wyoming Department of Health Developmental Disabilities Division EHDI Program 715 Shield Street Laramie WY 82072 Signature of Provider or Authorized Representative Date Signature of Wyoming Department of Health Date Developmental Disabilities Division Program Representative Signature of Wyoming EHDI Program Manager Date Provider Site Enrollment Agreement 6 08 53 e Wyoming e D Commit to your health Mf e epartment visit healthywyomin g 0rg A of Health dii Brent D Sherard M D M P H Director and State Health Officer Governo
27. er user ID and password and agree to not give a user ID and or password to others or to post a user ID and password on any place When an authorized user leaves this site the site manager or designee must fax the Remove User form to the Wyoming EHDI Program office within twenty four 24 hours of the employee s last day of employment By signing this form the User acknowledges the conditions under which access to the Wyoming EHDI Program is granted and agrees to be held to the following conditions e Child specific information is only available to authorized users e He she has read and agrees to abide by the Wyoming EHDI database Individual User and Confidentiality Agreement e Information contained in the Wyoming EHDI database is confidential and can only be used for those purposes outlined in the Wyoming EHDI database Provider Enrollment Agreement e The Wyoming EHDI database user IDs and passwords should be changed every regularly to protect security e The computer should not be left unattended when a Wyoming EHDI database session is open e Always log off and close the browser when you are finished with a Wyoming EHDI database session 54 Individual User and Confidentiality Agreement By signing this form the User acknowledges the conditions under which access to the Wyoming EHDI Program is granted and agrees to be held to these conditions Each field listed below is required Print Employee Name Email Address User Name
28. g Add Diagnostic Diagnostic Type o Aydiological Audiologist Evaluation Date 97 22 2009 fiol Facility v Left Ear Hearing Loss Type v Degree of Hearing X Loss Slope of Hearing Loss Recommendations Right Ear Medical Hearing Loss T le na Amplification Degree of Hearing pa Loss Audiology Follow Up Schedule Slope of Hearing Pressure Equalization Tubes when present Loss School Age Children Additional Recommendations Other um Tests Case History Otoscopy OAE ToneBurst 5 Enter the day the evaluation was completed under Evaluation Date Use the drop down menus to select the Audiologist and Facility Diagnostic Information Diagnostic Type Audiological iv Audiologist iv Evaluation Date 6 2 2008 fio Facility 6 For BOTH the Left Ear and the Right Ear use the drop down menu to select the Hearing Loss Type dila ay Hearing Loss Type i Degree of Hearing Loss Slope of Hearing Sensory Loss Neural AN AD Mixed Other 7 For BOTH the Left Far and the Right Far use the drop down menu to select the Degree of Hearing Loss Degree of Hearing Loss Normal Limits Slope of Hearing Minimal Loss Mild Mild To Moderate Moderate Moderate To Severe Severe Severe To Profound Frofound Other Tine tien Notes 34 8 For BOTH the Left Fa
29. g E Insert Phones F Ear Phones E Sound Field Visual Reinforcement Audiomety 25 Select whether or not the child had a Behavioral Observation Audiometry test Visual Reinforcement Audiomety Behavioral Observation Audiometry Yes No Sedation 26 Select whether or not the child was sedated Behavioral Observation Auc Used Not Used 27 Click on Save Diagnostic to save the child s audiological diagnostic information into the database or click cancel to erase changes and return to the main page Save Diagnostic 28 Once the child s audiological diagnostic information 1s saved in the database it will appear on the child s main page Note Completing the diagnostics page cancel refer to audiologist action item 39 XIV Adding a Document Notes 1 If you have a document you would like to add to a child s page through the software use this section to do so Note Only the person who adds the document and the EHDI administrator will be able to view the document on the software 2 Scroll over the Child tab at the top of the screen and click on Add Document Home Search Bob Smith Age 5ye DOB 1 1 2 Sex Male Hospital Ivins Child Maintenance Log Child View Add Action tem Early Intervention Notes Add Document Hearing 3 Click on Browse This will open the document folder on your computer Add Document Add Document 4
30. his component targets identification of hearing loss that occurs after the newborn leaves the hospital but develops prior to entry into kindergarten Late Onset Hearing Loss LOHL These screenings are available at no charge from the Child Development Centers within Wyoming Children who fail the screenings are referred to their primary care physician and or for audiological follow up 3 Audiological Diagnosis Children referred from their hearing screenings should receive a follow up diagnostic medical and or audiological evaluation as soon as possible after the referral from their failed hearing screenings 1s made 4 Early Intervention When appropriate children identified with a hearing loss after receiving a diagnostic audiological evaluation should be enrolled in an appropriate intervention program Intervention will facilitate speech language acquisition academic achievement and social and emotional development 5 Tracking and Surveillance Software The purpose of the EHDI Tracking Software is to ensure appropriate screening follow up and referral processes for all children who receive a hearing screening The goal of EHDI is to provide better outcomes for children with hearing loss and their families through early screening diagnosis intervention and tracking HI Contact Us Notes If you have any questions or want more information regarding hearing hearing screening and or hearing loss in children please contact
31. ild S RECO d rise sn mlm el idil e iile dinine hereee 30 IVS GC Al TOTO OS INC Sie irc stare ccs laleli laleli ala dll nebi 31 AMOIOLO CICA Da OHOSTICS aaa allel ast Abani salli lil einen kaleli 33 yede a DOCUMEN lame an yam allel am caren dy weg Heeler rardan He 40 Addins Referral EO LOW AL Des n ana e a amir al m m la ami am amy Mik 4 Late Onset Hearn Coss REDOMS sanmas n nnd sisle akileidab an enli kiplik ne 42 Providing Elb e ae aa ea il a le iar nl siye bi dak ali E 43 A B C D Appendices Hearne Scrcenins Results OEM ka a a aki ale ha al awed era his e 44 EHDI Tracking Software Description Phase L L 46 EHDI Tracking Software Comments Page 47 EHDI Tracking Software Bugs ProblemsReportingPage 48 Welcome Notes Welcome to the Wyoming Early Hearing Detection and Intervention EHDI Program Tracking Software for Newborn and Childhood Hearing Screenings User s Manual The EHDI Program is designed to ensure that all children with hearing loss are identified as early as possible and provided with timely and appropriate management About EHDI The EHDI program is made up of five 5 basic components 1 Newborn Hearing Screening All Wyoming newborns should be screened for hearing loss prior to leaving the hospital at the time of their birth 2 Hearing Screening for Infants Toddlers and Preschoolers T
32. ill very talkative child etc To enter notes for a child scroll over the Child tab at the top of the screen and click on Notes A child s record must be opened in order to enter or view notes Home Search Child Maintenance Logout Child View Bob Smith Add Action tem Age 4ye Early Intervention Notes DOB ahi Qer Mali Hearing This will open the Notes page as seen below Details Add Note After you have typed your notes click on Add Notes at the bottom of the screen This will save the notes into the database The time date and user will automatically appear with the saved notes The information will appear above the Add Note text box Ray Username jcash Note Date 5 27 2006 10 37 40 AM Child cried and moved around a lot during the screening Add Note n a 5 The child s notes will not appear on the child s main page To view a child s notes you must follow step 2 in this section Scroll over the Child tab at the top of the page then click on Notes The child s record must be open NOTE Currently spell check and or a means by which to alter notes after you have saved them in not available Future versions of the software will offer this feature Notes 30 XII Medical Diagnostics Notes 1 If a child is referred for medical diagnostics Primary Care Physician and or Ear Nose and Throat Doctor use this sectio
33. known Severe asphyxia at birth Unknown Late Onset Hearing Loss Risk Factors Parental or caregiver concern regarding hearing speech language and or developmental delay Unknown Unknown Syndromes associated with progressive hearing loss Head Trauma Unknown v Unknown ren or persistent otitis media with effusion for at least 3 months Notes 28 4 The Birth Risk Factors are marked by nurses who screen Notes hearing for the child at the time of birth These risk factors can be edited when the child reaches six 6 months of age For each risk factor a child may or may not have use the drop down menu to select a Yes for Yes this child has this risk factor or No for No this child does not have this risk factor For risk factors that don t apply or if you are not sure leave the selection as Unknown If you believe that a birth Risk Factor is not correct please contact the EHDI Program at 307 721 6212 to have it changed Birth Risk Factors Description Family history of hearing loss Unknown g Syndrome associated with hearing loss Unknown Yes Perinatal infection No Bacterial meningitis Unknown vw Ototoxic medication Unknown vw Hyperbilirubinemia Unknown iv Craniofacial anomalies Unknown J Low birth weight Unknown iv Prolonged ventilation Unknown Severe asphyxia at birth Unknown iv 5 The Late Onset Hearing L
34. l already be on the Add Screening page Home Search Child Maintenance Logout Child View Bob Smith Add Action tem Age 4ye Early Intervention Notes DOB Wal Sex Mal Hearing Add Screening Hospital Ivinson Memorial Hospital Add Diagnostics Risk Factors You can also click on Add LOHL Screening Child Screenings No current child screenin Add LOHL Screening 2 Enter the screening results for the child by using the drop down boxes This information can be found on the child s Hearing Screening Results Form Appendix A on pages 44 45 Please enter the results into the database just as it appears on the form 3 Enter the Screening Date Note This is not the date the results are entered into the database It 1s the date the child s hearing was screened You can enter the date manually or click on the calendar and select the date from there 4 Use the drop down box to enter the Screening Type Notes An Initial Screening is the first screening within the school year July Ist to June 30th Rescreenings are any additional screening done through that fiscal year Ee screening Type initial Initial 5 Use the drop down menu to select the Screener This is the person who actually screened the child s hearing Note If the screener does not appear he she has not been registered with the EHDI Program Software Database The necessary registration forms can
35. logical Referral Please choose one for each referral made 1 Rescreen in 12 months unless concerns arise or a change in hearing is noted Hearing levels appear 1 Physician confirmed medical condition adequate for speech language development at this time 2 Physician did not confirm medical condition 2 Rescreen in3 months Hearing levels appear adequate for speech language development at this time 3 Audiologist confirmed hearing loss conductive SNHL mixed 3 Rescreen in 4 6 weeks 4 Audiologist reports hearing within normal limits at all frequencies 4 Refer to Primary Care Physician and rescreen in 4 6 weeks 5 Pressure equalization tubes placed 5 Refer to Primary Care Physician and rescreen in 3 months 6 Per parent report medical referral ha not been acted upon Child has not been seen by doctor 6 Refer to ENT for medical and audiological evaluation and rescreen in 4 6 weeks 7 Per parent report audiological referral has not been acted upon Child has not been seen by audiologist 7 Refer to ENT for medical and audiological evaluation and rescreen in 3 months 8 Per parent report medical appointment follow up is scheduled but pending 8 Refer to Audiologist and rescreen in 4 6 weeks 9 Per parent report audiological appointment follow up is scheduled but pending 9 Refer to Audiologist and rescreen in 3 months 10 Phone call to parent No answer Left message asking them to call 10 Other 11 Phone call to parent No answe
36. m 25 IX Early Intervention Notes 1 The Early Intervention function is to be used when a child is on an IFSP IEP etc Please be aware that this function is being expanded for use in demonstrating a child s developmental educational progress The current application primarily has use in making certain children on an IFSP IEP have their hearing status rescreened annually 2 Scroll over the Child tab at the top of the screen and then click on Early Intervention A child s record must be open in order to view or edit his her early intervention status Home search Child Maintenance Logout Chill View Bob Smith Add Action item Age 4 ye Early Intervention 3 This will open the Early Intervention Page Notes Bob Smith Age 4years 6 months 21 days DOB 1 1 2005 Sex Male Hospital Ivinson Memorial Hospital Physician Audiologist Physician Number Guardian Relation Parent Name Jane Smith Intervention Type v Region E Program Identifier m Start Date fiol Review Date fol Save Cancel 4 Use the Early Intervention Type drop down menu to select the child s current early intervention status May Intervention Type Region Individual Family Service Plan Individual Education Plan Program Identifier No Early Intervention Plan at this Time Refered for Development Evaluation Other Start Date Review Nate fiol X 6 Select the
37. mbrane TM Compliance for the left and right ears Note NP is a valid result entry TM Compliance GS a 20 Use the drop down menu to select Did Not Test Absent or Present for Acoustic Reflex 21 Acoustic Reflex Did not Test n Did not Test A 22 Confirm all of the results are entered correctly and then click Verify to receive the verification of the hearing screening results 23 If there are any additional comments that need to be made enter them in the box labeled Notes mt Cancel 24 Confirm all of the information is correct and then click on the Save button This will save the child s screening results recommendations and risk factors into the database Hitting cancel will delete all of the information and take you back to the child s main page DON T FORGET TO HIT SAVE re Cancel 13 VIII How to Manage Your Follow Up Actions A About Follow Up Actions 1 Once you are logged in you will see a list of Follow Up Actions on the home page only screeners will be able to view the follow up actions If you are logged in as a data entry clerk you will not see these follow up actions These follow up actions are specific to you the screener and the children for whom you are responsible 2 The children listed are those who are in need of hearing rescreens or follow up care regarding medical and or audiological referrals
38. n to enter in the medical diagnostic results Note These results will come from the child s doctor and you will be responsible for entering the results into the software It is highly recommended that a Release of Information form for the child s primary care provider by included with the screening consent This simple but valuable clerical action will prove critical to your ability to effectively obtain follow up information 2 Scroll over the Child tab at the top of the screen scroll over Hearing then click on Add Diagnostics A child s record must be open in order to view and edit his her medical diagnostic information Notes DOB 1 11 Hearing Add Screening Sex Mal 7 Hospital Ivinson Memorial Hospital Add Diagnostics T Risk Factors 3 The Diagnostics Page will open Scroll down to the Add Diagnostics section The Medical Diagnostics Type 1s set as the default d Diagnostic Evaluation Date Medical 4 The Medical Diagnostics page will look similar to the Diagnostic Type Physician Evaluation Date 44 19 2008 fiol Facility Iceland X Medical Condition Confirmed Medical Condition Not Confirmed Recommendations Medical Follow Up Referrals Medication Notes 5 Enter the day the evaluation was completed under Notes Evaluation Date Use the drop down menus to select the Physician and Facility iagnostic Information W ostic Typ
39. nting so how you print this page will depend on your internet browser For example for some browsers the printing options are displayed in the top right hand corner others are along the top left hand corner Edit View History Delicious Bookn New Window Ctrl N d New Tab Ctrl T m nt E Open Location Ctrl L Open File Ctrl O QL Close Window Ctrl Shift W OL Mi Close Tab Ctrl W Save Page As Ctrl S Send Link Page Setup Print Preview Print Ctrl P Import 5 If the child is in need of follow up it is recommended that this page be printed and placed in the child s folder if they are on an IFSP IEP This information will be useful to the case manage service provider and or parent at the time of the IFSP IEP review meeting F Generating Follow Up Letters 1 Ifa child has received a hearing screening and is in need of follow up a letter can be generated from the software detailing the recommendations for the child s family A letter can only be generated if the child has the following follow up actions a Referral to Primary Care Physician b Referral to Ear Nose and Throat Doctor c Referral to Audiologist 2 For a letter to generate the following demographic information must first be entered into the child s record a Parent or Guardian Name s b Mailing Address 3 To generate a letter open the child s record Scroll down until you see the child s Follow Up Ac
40. oss Risk Factors can be edited at any time For each risk factor a child may or may not have use the drop down menu to select Yes No or Unknown Note If the child has a risk factor for hearing loss that is not listed type the risk factor in Other Risk Late Onset Hearing Loss Risk Factors Unknown K Yes Head Trauma No Unknown v Parental or caregiver concern regarding hearing speech language and or developmental delay Syndromes associated with progressive hearing loss Recurrent or persistent otitis media with effusion for at least 3 months Other Risk 6 Onceachild srisk factors are saved in the database they will appear on the child s main page Late Onset Hearing Loss Risk Factors Parental or caregiver concern regarding hearing speech language and or developmental delay Syndromes associated with progressive hearing loss Head Trauma Unknown Recurrent or persistent otitis media with effusion for at least 3 months Unknown Other Risk XI Adding Notes to a Child s Record 1 The Notes section can be used as a communication log as it relates to a child s hearing status or other information pertinent to the child It can also be used to express how the child behaved during the screening which may or may not have affected the results 1 e child was crying during the screening child would not hold st
41. ou will have to fill in all necessary result information If at any time you choose not to use the tool click Close Verification Tool Use Verfication Tool i Close Verfication Tool 14 Use the drop down menu to select Pass Fail or N A for the Otoscopic results for both the left and right ears Left IF Right IF Otoscopic Passi Pass Reed 15 Use the drop down menu to select Pass Fail or N A for the Otoacoustic Emissions results for both the left and right ears Note To enter otoacoustic emission results please make sure to check the box Otoacoustic Emmisions FE Pass Pass 16 Use the drop down menu to select Pass Fail or N A for the Pure Tones results for both the left and right ears at 1 000 Hz 2 000 Hz and 4 000 Hz Note To enter pure tone results please make sure to check the box PureTones E 1000 Hz Pass Pass 2000 Hz Pass Pass 4000 Hz Pass Pass Notes 12 9 17 Under Immittance enter the numerical result for the Notes Far Canal Volume for the left and right cars immittance Ear Canal Volume h 9 18 Under Immittance enter the numerical result for the Middle Ear Pressure for the left and right ears Note NP is a valid result entry Middle Ear Pressure 9 19 Under Immittance enter the numerical result for the Tympanic Me
42. oustic Reflexes High Frequency without Acoustic Reflexes Non High Frequency with Acoustic Reflexes and Non High Frequency without Acoustic Reflexes ToneBurst High Frequency with Acoustic Reflexes i i Bilateral Left Only Right Only High Frequence without Acoustic Reflexes Bilateral Left Only Right Only Non High Freguencey with Acoustic Reflexes j Bilateral Left Only Right Only Non High Freguencey with out Acoustic Reflexes Bilateral Left Only Right Only 21 If the child had an Auditory Steady State Response test select if it was Bilateral Left Only or Right Only ToneBurst Click ABR Immittance 2 Auditory Steady State Response Bilateral Left Only Right Only Conditioned Play Audiometry 22 If the child had a Conditioned Tone Audiometry test select if it was Bilateral Left Only or Right Only Immittance Auditory Steady State Response Conditioned Play Audiometry Bilateral Left Only Right Onby Pure Tone Audiometry 23 If the child had a Pure Tone Audiometry test select if it was Bilateral Left Only or Right Only EP LR LL Pure Tone Audiometry Bilateral Left Only Right Only Theee regulie were nhtsimer hu izini 38 24 Select the method s that was were used to obtain the Notes audiological results Pure Tone Audiometry gp These results were obtained by usin
43. ox that says Include 12 month rescreens Leaving this box blank will narrow down your to do list to include only those children who are in need of follow up actions other than rescreen in 12 months unless concerns arise or a change in hearing is noted Include 12 month di Pes creens Next use the drop down box to select the Type of follow up actions you want to view You can choose from Child and IFSP follow up actions Note If a child is on an IFSP IEP refer to Step IX on page 26 us into the database Then click on the Search button at the bottom of the page to view your results aad chi E gt Note To print your results click on View Report at the bottom of the screen This will take you to a PDF version of your results that you may save and or print Notes 17 5 Method 2 Notes a Use the drop down list to select your Facility ua Lr Lel ar E Fiy rc O lceland Yukon b Select Create Date Start and Create Date End These are the date ranges for when the follow up action were created For example selecting a Create Date Start of 04 01 2010 and a Create Date End of 06 11 2010 will allow you to view the action items that were created between the dates of 04 01 2010 and 06 11 2010 GED Create Date Start 4 1 2010 20 create Date End 6 11 2010 hal c Next use the drop down box to select the Type of follow
44. r and the Right Far use the Notes drop down menu to select the Slope of Hearing Loss Te Be e Slope of Hearing Loss Tests 9 Select any Medical Recommendations given by the Audiologist to the child Recommendations Continue Medical Management as Prescribed Medical Referal to POP Medical Referal to ENT Refer to opthamala ist optometry GE 2 4 o Refer to Cochlear Implant CentenTeam 10 Select if any the Amplification that was recommended to the child by the Audiologist Recommendations Hearing Aid Fitting Trial Inservice regarding how to operate the hearing aid insertion volume etc Hearing Aid Maintenance listening checks sethoscope Hearing Aid Troubleshooting battery insertion earmold cleaning Hearing Aid Warranty repair replacement Hearing Aid Wearing Schedule discussed and determined Hearing Aid Tracking Chart distributed to parent how to track usage Evaluation of assitive listening devices including use of personal or home classroom FM 11 Select the Audiologist s recommended Follow up Schedule for the child ecommendations lweek Z weeks 3 weeks 4 waaks 12 Select the Recommendation made by the Audiologist Notes for Pressure Equalization Tubes if present Recommendations Amplification Audiology Follow Up Schedule Pressure Equalization Tubes when present Monitor pressure equalization tubes sta
45. r Did not leave message 11 IESP Review 12 Letter sent to parent 13 Other 45 IV Risk Factors for Late Onset Hearing Loss Not Present Noted at Birth check all that apply 1 Parental or caregiver concern regarding hearing speech language and or developmental delay 2 Syndromes associated with progressive hearing loss such as Neurofibromatosis Osteopetrosis and Usher s Syndrome 3 Head trauma 4 Recurrent or persistent Otitis Media with effusion for at least 3 months 5 Other 6 None Lt Li uU ee G E V Early Intervention Status O IFSP O IBP O Referred for Developmental Evaluation O No Early Intervention at this time IFSP IEP Start Date If Applicable Next IFSP IEP Annual Review Date If Applicable Other VI Known Hearing Loss Yes 0 No VII Notes Legend DNT did not test CNT could not test CNE could not establish MEP middle ear pressure COMP tympanic membrane movement compliance ECV ear canal volume physical size OTO otoscopy OAE otoacoustic emissions Form 1 Version Date 6 9 08 Appendix B EHDI Tracking Software Description Phase I III and III The goal of the Wyoming Early Hearing Detection and Intervention EHDI Program is to provide better outcomes for Wyoming children with hearing loss and their families through early screening diagnosis intervention and tracking Phase I Tracking Newborn Hearing Screening Results Phase Il Sof
46. r Dave Freudenthal Wyoming Department of Health Developmental Disabilities Division Early Hearing Detection and Intervention Program 715 Shield Street Laramie WY 82072 307 721 6212 Individual User and Confidentiality Agreement This form shall be signed by any employee needing access to the state EHDI database It defines requirements to maintain confidentiality and the employee s agreement to abide by the system s rule The signed copy is to be kept with the Employee s Personnel File The Wyoming Early Hearing Detection and Intervention EHDI Program is implemented by the Wyoming State Department of Health under the authority of Wyoming Statutes 35 4 801 and 35 4 802 It provides the authority to prescribe rules and regulations for the management and control of early hearing detection and tracking The Wyoming EHDI program uses a web based database operated by the Wyoming Department of Health WDH Developmental Disabilities Division EHDI program All information in the system is confidential and all users have a responsibility to abide by confidentiality laws Users who violate these laws will have access to the Wyoming EHDI database immediately revoked by the Program Manager An incident report will be filed and following investigation appropriate action taken which may include civil and or criminal penalties Each individual user must sign this form prior to receiving a User ID and password All users shall safeguard his h
47. rmation into the database or click Cancel to erase changes and return to the main page Save Diagnostic 12 Once the child s medical diagnostic information is saved in the database it will appear on the child s main page Note Completing the diagnostics page will cancel the Refer to Physician action item XIII Audiological Diagnostics 1 Ifa child is referred for audiological diagnostics use this section to enter in the audiological diagnostic results Note These results will come from the child s audiologist and you will be responsible for entering the results into the software Here again if at all possible remember to get a Release of Information form signed by the parents at the time the referral is made 2 Scroll over the Child tab at the top of the screen scroll over Hearing and then click on Add Diagnostics A child s record must be open in order to view and edit his her medical diagnostic information Age 4ye Early Intervention Notes DOB 44 Hearing Add Screening Sex Mah Hospital Ivinson Memorial Hospital Add Diagnostics de Risk Factors 3 The Diagnostics Page will open Scroll down to the Add Diagnostics section Under Diagnostic Type use the drop down menu and select Audiological FP Add Diagnostic L Evaluation Date Medical Notes 33 4 This will open the Audiological Diagnostic Page and will look similar to the followin
48. s Screenings are done year round by personnel at Child Development Centers for children age birth to 5 years of age Screenings include all children who have a developmental screening 1 before 2 Child Find Physician referrals parent request etc children who have an IFSP or IEP Screening methods consist of Otoscopy Immittance and Pure Tones or Otoacoustic Emissions OAE Results will be web based and reported to the Wyoming EHDI Program 46 Appendix C EHDI Tracking Software Comments Page Please let us know your comments and or suggested modifications you would recommend for future Software revisions Please return this completed page to the Wyoming EHDI Program Mail to 715 Shield Street Laramie WY 82072 Or 47 Fax to 307 721 6313 Appendix D EHDI Tracking Software Bugs Problems Reporting Page Please list any bugs or problems you encountered while using the EHDI Software Please be as detailed as possible i e write down exactly what you were trying to do when you encountered the problem steps you took to get there etc Report problem s to the Wyoming Department of Health Help Desk 307 777 5940 ie Please return this completed page to the Wyoming EHDI Program Mail to 715 Shield Street Laramie WY 82072 _or 48 Appendix E EHDI Tracking Software Start up Paperwork m Wyomi ef yi yoming M pp Department Committe your hath lia vi i i TA of Health
49. se during follow up activities for children who need management beyond screening and rescreening Completing this section is not necessary for children who pass their initial and or first rescreening Followup Actions PatieniName A Rescreen in 4 6 weeks SCHUTZMAN TORRIE Fi X Rescreen in 12 months unless concerns arise or a change in hearing is noted POLLEY BRENNAN a Rescreen in 12 months unless concerns arise or a change in hearing i noted STUART HENRY 6 The child s information page looks similar to the picture below You can edit update the child s demographic information by clicking on Update Child By clicking on Details you can view additional information Border Baby Address etc Border babies are defined as children who are Wyoming residents but who are born in hospitals in the surrounding six states i e UT SD CO NE ID and MT Jelly Bean Physician Who Dr Age 0 years 2 months 11 days Audiologist Physician Number B DOB 9 8 2008 Guardian Relation Parent Sex Male Name Bean Mrs Hospital General Hospital Primary Language Border Baby Transfer Baby Home Birth Address Information 123 Front Street Cheyenne WY 82001 Update Child C Searching by Follow Up Actions 1 You can also search for specific follow up actions by scrolling over the Search tab and then clicking Search by Follow Up Actions This is useful to minimize th
50. sent 10 8 Under Screening Method select the screenings Notes performed You have the option of checking the boxes for Otoscopic Immittance and Acoustic Reflexes You also have the option of selecting either OAE or Pure Tones Screening Method Otoscopic W Pure Tones ig Acoustic Reflex W 9 Ifachild has a Late Onset Hearing Loss Risk Factor it should be noted in this section Use the drop down menu for each risk factor the child has Note It is recommended that children with risk factors for late onset hearing loss receive a hearing screening annually or at any time concerns arise or a change in hearing is noted Late Onset Hearing Loss Risk Factors Parental or caregiver concern regarding hearing speech language and or developmental delay Unknown sel Syndromes associated with progressive hearing loss Head Trauma Recurrent or persistent otitis media with effusion for at least 3 months 10 Under Screening Results please select Pass Fail or N A for the left and right ear results Note N A may be chosen for example in a case of an atretic ear Screening Results Left Resut Pass w ie P 11 Use the drop down menu to select a Recommendation for the child based on his her screening results Note If the child passes his her screening but is on an IFSPAEP plan select the recommendation of IFSP IEP Review If th
51. tions Followup Actions a Refer to Primary Care Physician Pending 6 2 2008 6 2 2008 a X Comolete Medical Diaanostic Pendina 6 2 2008 7 7 2008 4 Click on the notebook that is to the left of the follow up Notes action for which you want to generate a letter Remember you can only generate letters for follow up actions that include a referral to the child s Primary Care Physician Ear Nose and Throat Doctor and or Audiologist Followup Actions a kd Refer to Primary Care Physician Fending 5 A letter will show up similar to the one below 6 2 2008 Dear Jen Anderson Recently Sam Anderson s hearing was screened Sam s hearing screening results fell outside the typical range for his age at the time of the screening It is recommended that you share these results with Sam s primary care physician for his her review and ask for any medical recommendations they may have Enclosed you will find Sam s most recent hearing screening results For your convenience we have enclosed a second copy to take to Sam s physicians Hearing plays a vital and often subtle role in the early development of children Children learn speech and language from listening to others speak The first few years of life are especially critical for speech and language development If hearing loss exists a child may not be able to receive optimal benefit from spoken language during this period of growth and as a result delays in speech and l
52. tors 1 There are various risk factors for late onset hearing loss LOHL If a child has a risk factor for hearing loss the Risk Factor function should be used Risk Factors can also be entered in via the Add Screening page If a child has a risk factor for late onset hearing loss it should also be found on the hard copy of the child s Hearing Screening Results Form It is recommended by the Joint Committee on Infant Hearing JCIH that children with risk factors for late onset hearing loss receive a hearing screening annually or anytime sooner if concerns arise or a change in hearing is noted 2 Scroll over the Child tab at the top of the screen scroll over Hearing then click on Risk Factors Note A child s record must be opened in order to enter or view a child s risk factor s Home search Child Maintenance Logout Child View Bob Smith Add Action tem Age 4ye Early Intervention Notes DOB 44 3 sex Mal Hospital lvinson Memorial Hospital Add Diagnostics Hearing Add Screening gt 3 The Risk Factors page will open and look similar to the Hisk Factors following Birth Risk Factors Descrioti Family history of hearing loss Unknown Syndrome associated with hearing loss Unknown Perinatal infection Unknown Bacterial meningitis Unknown Ototoxic medication Unknown Hyperbilirubinemia Unknown Craniofacial anomalies Unknown Low birth weight Unknown Prolonged ventilation Un
53. tus through hearing screening program at CDC every month Monitor pressure equalization tubes status through hearing screening program at CDC every 3 months Monitor pressure equalization tubes status through hearing screening program at CDC every 6 months 13 Select the recommendation made by the Audiologist if the child is school aged Recommendations Medical Amplification Audiology Follow Up Schedule Pressure Equalization Tubes when present School Age Children Inservice regarding classroom management techniques Preferrential seating Classroom observation Refer to school districts educational audiologist Screening E valuation of speech and language skills Note Taking closed cationed films visual aids 14 Select any additional recommendations made by the Audiologist for the child Recommendations Refer to Earby Intervention Refer parents to Educational consultation program supervision by WDE Outreach Consultant Refer parents to Wyoming EHDI Program Refer parents to Hands and Voices Organization Refer to Public Health Nurse Refer to Women Infants and Children WIC Use of Hearing Protection when exposed to high levels of noise Refer for Second Opinion Verification of diagnosis Provide inservice regarding effects of hearing loss to caretakerteachenparents etc Give parents auditory developmental milestones Verity update risk factors for late onset
54. tware has been in use since 2004 Nurses at the 21 birthing hospitals in Wyoming screen 98 of newborns for hearing loss before the babies leave the hospital The newborn hearing screening method is an Automated Auditory Brainstem Response AABR The results of the newborn hearing screenings are reported monthly to the Wyoming EHDI Program Newborns that fail the hearing screening twice at the birthing hospital are referred to an audiologist for a pediatric diagnostic test battery to determine the amount of hearing loss present The use of this software alerts the PCP if their patient fails the newborn hearing screening The use of this software alerts parents if their infant needs follow up Tracking Diagnostic Results of Children Who Are Referred from the Hospital and Late Onset Hearing Loss Screenings Phase III Audiologists perform a battery of pediatric diagnostic evaluations to determine the degree of hearing loss for children referred from newborn hearing screenings Web based reporting of results is available on the EHDI Tracking Software Results for an individual child will be reported to the Wyoming EHDI Program after each audiological appointment and probably will be entered by child development center staff Results will be available to early interventionists that work with children with hearing loss and who have registered with the program Tracking Hearing Screening Results from Child Development Centers Late Onset Hearing Los
55. up action you want to view You can choose from Child and IFSP follow up actions Status Type r d Next select the Status Type You can choose to view follow up actions that are pending complete or cancelled Status Type Include 12 month Pending rescreens Complete Cancelled e If you want to include the follow up action of Rescreen in 12 months unless concerns arise or a change in hearing is noted be sure to check the box that says Include 12 month rescreens Leaving this box blank will narrow down your to do list am Include 12 month d Testi Ellis f Then click on the Search button at the bottom of the page to view your results Note To print your results click on View Report at Notes the bottom of the screen This will take you to a PDF version of your results that you may save and or print 6 Method 3 a Use the drop down list to select your Facility LLE Ler Lel b Then click on the Due in 7 Days button to view all follow up actions that need to be completed in the next 7 days O Due in 7 Days Due in 30 Days c Next select the Status Type You can choose to view follow up actions that are pending complete or cancelled Status Type Include 12 month Pending rescreens Complete Cancelled d Next use the drop down box to select the Type of follo
56. w up action you want to view You can choose from Child and IFSP follow up actions Status Type al e If you want to include the follow up action of Rescreen in 12 months unless concerns arise or a change in hearing is noted be sure to check the box that says Include 12 month rescreens Leaving this box blank will narrow down your to do list ED Include 12 month feecreens f Click on the Search button at the bottom of the screen to view your results Note To print your results click on View Report at the bottom of the screen This will take you to a PDF version of your results that you may save and or print 19 7 Method 4 a Use the drop down list to select your Facility ee Lel i Lk a ER Faciiy 7 Task lceland Yukon b Then click on the Due in 30 Days button to view all follow up actions that need to be completed in the t 30 days nex ays 5 te Due in 7 Days Due in 30 Days c Next select the Status Type You can choose to view follow up actions that are pending complete or cancelled Bp tatus a Pending Complete Cancelled d Next use the drop down box to select the Type of follow up action you want to view You can choose from Child and IFSP follow up actions Status Type e If you want to include the follow up action of Rescreen in 12 months unless concerns arise
57. with early intervention program staff to further improve the quality of development for Wyoming children with hearing loss We look forward to working with you Please call if you have any comments questions or concerns regarding the enclosed paperwork Sincerely Sara Mofield Early Intervention Program Manager Nancy Pajak M S CCC A EHDI Project Manager Sarah Fitzgerald EHDI Follow Up Coordinator Enclosures Provider Enrollment Agreement Individual User and Confidentiality Agreement 51 Mr Wyoming Department Cor su visi Z S of Health Brent D Sherard M D M P H Director and State Health Officer Governor Dave Freudenthal Wyoming Department of Health Developmental Disabilities Division Early Hearing Detection and Intervention Program 715 Shields Street Laramie WY 82072 307 721 6212 Provider Enrollment Agreement The Wyoming Early Hearing Detection and Intervention EHDI Program uses a web based database operated by the Wyoming Department of Health WDH Developmental Disabilities Division EHDI Program Enrolled providers can obtain hearing information for children including tracking and recall Child information is confidential and is only available to the authorized users of the registry The hearing screening records of all children in Wyoming may be included in the system with parental consent An individual or parent or guardian may choose not to have their child s records included in the
58. y Child Development Center personnel may be directly entered into the EHDI database through the web application There are several useful management tools available to the service providers through the EHDI Database web application These tools include Child s individual EHDI birth record Risk factors present at birth as they relate to late onset hearing loss History of subsequent hearing screening results for each individual child Printable reports of the child s hearing screening results Monthly submission of hearing screening data to WY EHDI program To Do List for managing the early intervention facility s hearing screening list 033033 The Wyoming Department of Health is a covered entity under HIPAA Data sharing agreements with the providers will protect the confidentially of the EHDI record User ID and passwords will be established to allow early intervention program staff access to the EHDI database Copies of the data sharing agreements are enclosed for your reference The Wyoming EHDI Program staff are available to discuss the opportunity for you to participate with the Wyoming EHDI Database They are also available to conduct an onsite demonstration of the web application if needed Please call us at 307 721 6212 to discuss any needs you may have as it pertains to the Wyoming EHDI Database 50 This is a great opportunity for the Wyoming Department of Health Developmental Disabilities Division EHDI Program to partner
Download Pdf Manuals
Related Search