SYSTEM SELF EVALUATION TOOL ESSET FINAL CDC-RFA-DD17-1701.xlsx

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Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
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CDC-RFA-DD17-1701
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SYSTEM SELF EVALUATION TOOL ESSET FINAL CDC-RFA-DD17-1701

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Atch 1 Statement of Work dd 17 August 2023.pdf Aug 2023 Yoga Instructor
SPECIFICATION_20APR_2017_FOR_ANACAPA_WPB_110B_DD_17R1.pdf Apr 20, 2017 DRYDOCK USCGC ANACAPA
SYSTEM SELF EVALUATION TOOL ESSET FINAL CDC-RFA-DD17-1701.xlsx Same revision and size as this file Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
WORK PLAN MEASURE TEMPLATE CDC-RFA-DD17-1701.xlsx Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
oppCDC-RFA-DD17-1701-cfda93.314-cidCDC-RFA-DD17-1701-instructions.pdf Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
oppCDC-RFA-DD17-1701-cfda93.314-cidCDC-RFA-DD17-1701.pdf Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
WORK PLAN MEASURE TEMPLATE CDC-RFA-DD17-1701.xlsx Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
CDC-RFA-DD17-1702PUBLICATION.pdf Revision not stated Surveillance, intervention, and referral to services activities for infants with microcephaly or other adverse outcomes linked with the Zika virus
CDC-RFA-DD17-1701PUBLICATION.pdf Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
CDC-RFA-DD17-1701PUBLICATION.pdf Revision not stated Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)
CDC-RFA-DD17-1702PUBLICATION.pdf Revision not stated Surveillance, intervention, and referral to services activities for infants with microcephaly or other adverse outcomes linked with the Zika virus
RFA-DD-17-001PublicationAmendment.pdf Revision not stated Coordinating Center for Research to Promote the Health of Children with Birth Defects and People with Developmental and Other Disabilities
RFA-DD-17-001Publication.pdf Revision not stated Coordinating Center for Research to Promote the Health of Children with Birth Defects and People with Developmental and Other Disabilities
oppRFA-DD-17-001-cfda93.073-cidRFA-DD-17-001-instructions.pdf Revision not stated Coordinating Center for Research to Promote the Health of Children with Birth Defects and People with Developmental and Other Disabilities
oppRFA-DD-17-001-cfda93.073-cidRFA-DD-17-001.pdf Revision not stated Coordinating Center for Research to Promote the Health of Children with Birth Defects and People with Developmental and Other Disabilities
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Instructions

*This tool is intended to assess an EHDI Information System (EHDI-IS) in relation to the 2015 EHDI Functional Standards. This tool was adapted from the Center for IDEA Early Childhood Data Systems (DaSy). More information about the Functional Standards is available at: www.cdc.gov/ncbddd/hearingloss/ehdi-is-functional-standards.html
The following navigation bar is available at the top of all worksheets. The underlined tab indicates the current sheet. Click on the tab to jump to the corresponding sheet.

Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Please Continue to Examples Tab or Click HERE

Version C, December 2016 DD17-1701 EHDI System Self-Evaluation Tool (ESSET) Instructions:

Jurisdictions are encouraged to use the tool as part of an ongoing quality improvement planning process. The results will help you identify the strengths and weaknesses of their EHDI-IS and set priority areas. This is not intended to be used as a road map in that it does not tell you where to start or what to do next. After reviewing the results, you should determine the priority areas for improvement that will be addressed in the project work plan. The EHDI System Self-Evaluation Tool (ESSET) provides options to rate each priority as low, medium, or high. Please fill out information requested in all tabs.

This Tool Includes the Following 14 Worksheets / Tabs Instructions Examples Key Information Standard Rating Sheets (8) Programmatic Goal 1 thru 8 Data Elements Summary Additional Comments Saving the ESSET as a PDF File You will need to save the ESSET as a PDF so that you may attach it to your application. The print area has been set for this entire workbook. To save the entire work book as a PDF follow the steps below.

1. Choose File and Save As

2. Choose the desired saved location on your computer

3. Update the File Name in the dialogue box to STATENAME_ESSET_17-1701.xls

4. Choose PDF in Save as Type drop-down menu (Underneath File Name)

5. At the bottom of the dialogue box check Options a smaller dialogue box will appear

6. Under Publish What, Check Entire Workbook

7. Under Include Non-Printing Info, ensure that both the Document Properties and Document Structure Tags for accessibility, boxes are checked.

8. Choose Okay, and then Save. The PDF will publish and open (if set to do so, if not it should be at the chosen save location).

Examples Need to move to another tab? You can use the tabs below to navigate the tool!

Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Below you can find examples on how to use the built-in drop-down menus to assign ratings to each Functional Standard.

Standard RatingsStandard RatingDefinition
1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
Each of the 8 worksheets (i.e., tab) represents a different Programmatic Goal, which includes a series of Functional Standards. A rating can be assigned to each of the Functional Standards. In the Rating column, enter the rating for each element by entering the number (1 to 4) or by selecting the value from the drop-down list (See example below). A summary of all the assigned Standard Ratings will appear in the Summary Tab.2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
NotesIndication of Functional Standard in Work Plan
Immediately below each Programmatic Goal is a Notes text box (in yellow) for documenting the supporting notes for the assigned standard rating for Programmatic Goal. This space has a limit of 250 characters.To the right of each goal standard rating and place where you can indicate whether the information is received electronically or manually, is a column for you to indicate where in the Work Plan a functional standard is addressed. If you rate a standard a 2 or 3, this indicates that the program will plan to work on this or is currently working on this standard, therefore, it should be addressed in the work plan. Please indicate where in the work plan this item can be located by selecting which goal it is part of in the drop-down menu (seen to the right). If you are not working on a particular item, already have the capability, or cannot work on an item due to policy or law, please leave this cell blank. An example of this drop-down menue is to the right.
How does the program receive this information?
To the right of each standard rating in the Goal Standards Tabs and the Data Elements Tab, please indicate the primary method in which your program receives the information using the drop-down menu (i.e., Manual or electronically). The primary method refers to 75% or more of your data being received via a certain method. Primarily electronic receipt refers to receiving the information and auto-populating the EHDI-IS or there is little to no manual entry needed to enter into the IS. Primarily manual receipt of information refers to receiving the information either by fax, mail, email, disc, or external hard drive and then having to manually enter into the EHDI-IS. If you do not receive a certain standard or item in your data collection process, you may select N/A. If you receive an item or standard both electronically and manually, meaning that some of the hospitals/audiologists/other service providers can electronically submit this information where others submit the same information via manual submission. An example of how this menu looks in the tool can be seen to the right.
Data Elements
The Data Elements Tab allows you to identify all of the data elements currently collected by the EHDI-IS. There are 5 categories of data elements: Child-level, Hearing Screen, Rescreen, Diagnostics, and Part C / Early Intervention. To the right of each data item there are 3 columns of drop-down menus (yellow): System currently has this; will have this in 1-2 years; and how data elements are received (electronic / manual). Some of the elements may not have all three column options, only yellow cells have drop down menus to select an option. Please see an example of this menu to the right.
Additional CommentsSummary
This tab is intended for users to include further supporting information or comments they would like to share.The summary tab is an overall summary of the ratings given to each goal. This tab auto-populates and cannot be edited by user. The summary is intended to be used as a visual picture of ratings for the entire EHDI-Information System as it relates to the Functional Standards.

Please Continue to the Key Information Tab or Click HERE

Key Information Need to move to another tab? You can use the tabs below to navigate the tool!

Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

* Please fill out all of the information below.

Please Key in Jurisdiction Name to the right:

Contact Information
NameEmailTelephone Number
Principle Investigator / Project Director
EHDI Coordinator
Business Official
*Please report data on babies born in calendar year 2015
NumberPercent
Annual Births
Screened for Hearing Loss
Not Pass Final / Most Recent Hearing Screening
LFU/LTD Diagnostics
Referred to Part C Early Intervention
Enrolled in Part C Early Intervention
LFU/LTD Early Intervention
201320142015
Number of Infants Identified with Permanent Hearing Loss

Please Continue to Goal Standard 1 (GS 1) Red Tab or Click HERE

GS1

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Yes
Programmatic Goal 1No
*Please indicate if the following standards are met (Yes) or not met (No). Also tell how the program receives the information. Both items have a drop-down menu.Electronic
Manual
Goal 1Document unduplicated individually identifiable data on the delivery of newborn hearing screening services for all infants born in the jurisdictionMet (Y / N)How does program receive this information? Electronic or Manual Information System CapabilityN/A
1.1The EHDI-IS SHALL provide a unique patient record for each newborn child born in the jurisdictionBoth
Notes:
1.2The EHDI-IS SHALL receive and document information about patient's birth encounter and newborn admission information in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law
Notes:
1.3The EHDI-IS SHALL receive and document patient's maternal demographic information, in accordance with scope of practice, organizational policy and jurisdictional law.
Notes:
1.4The EHDI-IS SHALL receive and document all individual newborn hearing screening procedures and results, in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.
Notes:
1.5The EHDI-IS SHOULD receive and document information about risk factors of infant hearing loss at the time of newborn hearing screening.
Notes:
1.6The EHDI-IS SHALL review incoming and existing patient records and document the most recent newborn hearing screening status and outcome (pass, refer, not screened) of the patient.
Notes:
1.7The EHDI-IS SHALL receive and document information on the reason why an infant hearing screening is not performed or completed
Notes:
1.8The EHDI-IS SHALL provide the ability to capture and document information about an infant's NICU stay and transfer status.
Notes:
1.9The EHDI-IS MAY receive submissions of newborn hearing screening information in accordance with interoperability standards endorsed by CDC for message content, format and transport
Notes:

Please Continue to Goal Standard 2 (GS 2) Green Tab or Click HERE

GS 2

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 2

For each item under Goal 2, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.Strategy 1
Strategy 2Goal 1Electronic
Strategy 3Goal 5Manual
Strategy 4N/A
Goal 2Support tracking and documentation of the delivery of follow-up services for every infant/child who did not receive, complete or pass newborn hearing screeningStandard Rating (1-4)How does program receive this information? Manual or Electronic Information System Capabilities?If planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work PlanStrategy 5Both
2.1The EHDI-IS SHOULD provide a unique patient record for each infant/child born out of the jurisdiction but currently reside within the jurisdiction and is in need of hearing screening or diagnostic follow-up services.Standard Rating:Standard RatingDefinition
1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
Notes:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
2.2The EHDI-IS SHALL provide the ability to generate and present a list of infants who did not pass newborn hearing screening (Including initial screening and any follow-up rescreening) and are in need of follow-up rescreening and/or diagnostic evaluation services.Standard Rating:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
Notes:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
2.3The EHDI-IS SHALL provide the ability to generate and present a list of infants who did not receive or complete newborn hearing screening and are in need of recommended screening and/or diagnostic evaluation services.Standard Rating:
Notes:
2.4The EHDI-IS MAY provide the ability to make referrals for recommended follow-up servicesStandard Rating:
Notes:
2.5The EHDI-IS SHALL document referrals made.Standard Rating:
Notes:
2.6The EHDI-IS SHALL receive and document information on rescreening procedures and results in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.Standard Rating:
Notes:
2.7The EHDI-IS SHALL receive and document information on procedures and results of ALL follow-up audiological diagnostic evaluation services in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.Standard Rating:
Notes:
2.8The EHDI-IS SHALL receive and document information whenever there is a change in the patient's hearing status and/or an update on previously inconclusive/incomplete diagnostic result.Standard Rating:
Notes:
2.9The EHDI-IS SHOULD receive and document information about referrals and/or recommendations made following an audiological diagnostic evaluation.Standard Rating:
Notes:
2.10The EHDI-IS SHALL receive and document information on the reason why an infant did not receive recommended follow-up servicesStandard Rating:
Notes:
2.11The EHDI-IS SHOULD provide the ability to notify parents and health care providers of infants who are in need of follow-up services.Standard Rating:
Notes:
2.12The EHDI-IS MAY provide the ability to generate, present, and transmit a standard-based Hearing Plan of Care document to guide follow-up practices in accordance with scope of practice, organizational policy and jurisdictional lawStandard Rating:
Notes:

Please Move to Goal Standard 3 (GS 3) Grey Tab or Click HERE

GS 3

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 3

For each item under Goal 3, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.
Electronic
Strategy 1Manual
Strategy 2N/A
Strategy 3Both
Goal 3Document ALL cases of permanent hearing loss, including congenital, late-onset, progressive, and acquired cases for infants/children <3 years old.Standard Rating (1-4)How does program receive this information? Manual or Electronic Information System CapabilitiesIf planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work PlanStrategy 4
Strategy 5
3.1The EHDI-IS SHALL receive and document information on all confirmed hearing loss cases identified through the newborn hearing screening follow-up process and reported from audiological providers.Standard Rating:Standard Rating Table
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
3.2The EHDI-IS SHALL provide the ability to receive and document information on additional infants/children with hearing loss that are not identified through the newborn hearing screening follow-up process, e.g. reported from primary care providers, or through data exchange with the Early Intervention systems, and other public health information systems and/or registries, in accordance with scope of practice, organizational policy and jurisdictional law.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
3.3The EHDI-IS SHALL use the ASHA standards for classifying degree of hearing loss.Standard Rating:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Notes:
3.4For every documented permanent hearing loss case in the EHDI-IS. The EHDI-IS SHALL provide the ability to generate and present the patient's complete screening and diagnostic services history including date, location, type and results of tests performed and or diagnosed made.Standard Rating:
Notes:
3.5The EHDI-IS SHOULD receive and document information on hearing loss risk factors.Standard Rating:
Notes:
3.6The EHDI-IS SHOULD provide the ability to regularly evaluate incoming and existing hearing screening and diagnostic information to continually refine, modify and efficiently identify late onset, progressive and acquired hearing loss.Standard Rating:
Notes:
3.7The EHDI-IS SHALL provide the ability to generate and present separate lists of infants/children with presumed congenital (referred on newborn hearing screening) and late-onset/progressive/acquired hearing loss.Standard Rating:
Notes:

Please Continue to Goal Standard 4 (GS 4) Yellow Tab or Click HERE

GS 4

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 4
For each item under Goal 4, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.Strategy 1
Strategy 2Electronic
Strategy 3Manual
Strategy 4N/A
Goal 4Document the enrollment status, delivery and outcome of early intervention services for infants and children with hearing loss < 3 years old.Standard Rating (1-4)How does program receive this information? Electronic or Manual Information System CapabilitiesIf planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work PlanStrategy 5Both
4.1The EHDI-IS SHALL provide the ability to identify infants/children who need EI services.Standard Rating:Standard Rating
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
4.2The EHDI-IS SHALL receive and document information about referrals to Part C services.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
4.3The EHDI-IS SHALL receive and document information about eligibility to part C services.Standard Rating:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Notes:
4.4The EHDI-IS SHALL receive and document information on Part C early intervention services enrollment (i.e. date when the IFSP is signed).Standard Rating:
Notes:
4.5The EHDI-IS Shall receive and document information on other non-Part C early intervention services enrollment, in accordance with scope of practice, organizational policy and jurisdictional law.Standard Rating:
Notes:
4.6The EHDI-IS SHOULD provide the ability to receive and document recommended audiologic intervention method upon a hearing loss diagnosis from providers.Standard Rating:
Notes:
4.7The EHDI-IS SHOULD provide the ability to receive and document data on early intervention outcomes.Standard Rating:
Notes:
4.8The EHDI-IS SHOULD provide the ability to compare infants in the system and those in the EI system to identify missed cases.Standard Rating:
Notes:
4.9The EHDI-IS SHOULD provide the ability to notify parents, healthcare and EI providers of infants' need for EI services.Standard Rating:
Notes:
Please Continue to Goal Standard 5 (GS 5) Orange Tab or ClickHERE

GS 5

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InstructionsExamplesKey InformationGS1GS2GS3GS4GS5GS6GS7GS8Data ElementsSummaryAdditional CommentsStrategy 1
Strategy 2
Strategy 3
Programmatic Goal 5Strategy 4
Strategy 5
For each item under Goal 5, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.Electronic
Manual
N/A
Both

Goal 5 Maintain data quality (accurate, complete, timely data) of individual newborn hearing screening, follow-up screening and diagnosis, early intervention and demographic information in the EHDI-IS. Standard Rating (1-4) How does program receive this information? Electronic or Manual Information System Capabilities If planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work Plan

5.1The EHDI-IS SHALL provide the ability to regularly evaluate incoming and existing patient records to identify, prevent, and resolve duplicate and fragmented records.Standard Rating:Standard Rating
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
5.2The EHDI-IS SHALL store all EHDI-IS Minimum Data Elements.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
5.3The EHDI-IS SHALL provide the ability to obtain other Core Data Elements.Standard Rating:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Notes:
5.4The EHDI-IS SHOULD provide the ability to obtain Extended Data Elements.Standard Rating:
Notes:
5.5The system SHALL provide the ability to analyze information with respect to data quality according to scope of practice, organizational policy, and/or jurisdictional law.Standard Rating:
Notes:
5.6The EHDI-IS SHALL retain all patient data in the system till the patient reaches at least 3 years old, except where prohibited by law, regulation, or policy.Standard Rating:
Notes:
5.7The EHDI-IS SHOULD allow re-activating a case when new information has arrived that illuminate the disposition of a case.Standard Rating:
Notes:
5.8The EHDI-IS SHOULD provide the ability for staff to record notes and phone interactions with the public (parents, providers, hospitals) under each child's file.Standard Rating:
Notes:
5.9The EHDI-IS SHOULD provide the users with easy access to metadata, system documentation and user guide.Standard Rating:
Notes:
Please Continue to Goal Standard 6 (GS 6) Blue Tab or ClickHERE

GS 6

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 6
Strategy 1
For each item under Goal 6, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.ElectronicStrategy 2
ManualStrategy 3
N/AStrategy 4
BothStrategy 5
Goal 6Preserve the integrity, security, availability and privacy of all personally-identifiable health and demographic data in the EHDI-IS.Standard Rating (1-4)How does program receive this information? Electronic or Manual Information System CapabilitiesIf planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work Plan
6.1The EHDI-IS SHALL have written confidentiality and privacy practices and policies based on applicable law or regulation that protect all individuals whose data are contained in the system.Standard Rating:Standard Rating
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
6.2The EHDI-IS SHALL have written data sharing and confidentiality/privacy agreement with any other information systems which the system links to and/or shares data with.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
6.3The EHDI-IS SHALL have user access controls and logging, including distinct credentials for each user, least-privilege access, and routing maintenance of access privileges.Standard Rating:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Notes:
6.4The EHDI-IS SHALL be operated or hosted on secure hardware and software in accordance with industry standards for protected health information, including standards for security/encryptioin, uptime and disaster recovery.Standard Rating:
Notes:
Please Continue to Goal Standard 7 (GS 7) Blue Tab or ClickHERE

GS 7

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 7Electronic
Manual
N/A
For each item under Goal 7, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.Strategy 1Both
Strategy 2
Strategy 3
Goal 7Enable evaluation and data analysis activitiesStandard Rating (1-4)How does program receive this information? Electronic or Manual Information System CapabilitiesIf planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work PlanStrategy 4
Strategy 5
7.1The EHDI-IS SHALL provide the ability for authorized users to extract and use data to assess program progress towards achieving national/jurisdictional benchmarks.Standard Rating:Standard Rating
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.
7.2The EHDI-IS SHOULD provide the ability to generate performance measurement reports as defined by the jurisdictional system evaluation plan.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.
7.3The EHDI-IS SHOULD provide the ability for authorized users to export data to other data management and analytical software tools such as MS Excel, SAS, SPSS, etc.Standard Rating:4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Notes:

Please Continue to Goal Standard 8 (GS 8) Blue Tab or Click HERE

GS 8

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Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Programmatic Goal 8Electronic
For each item under Goal 8, assign the following: (1) a Standard Rating (1-4), (2) select how your program receives the information that it collects and (3) if you are currently working toward achieving one of the standards, where it is located within your work plan. These three items can be assigned by using the drop-down menus in blue. If you wish to provide supporting information or notes regarding a particular standard, you may do so in the Notes section which is yellow. If you need to reference the Standard Rating definitions, the ratings and their respective definitions can be found in the table in grey below.Manual
N/A
Both
Goal 8Support dissemination of EHDI information to authorized stakeholders.Standard Rating (1-4)How does program receive this information? Electronic or Manual Information System CapabilitiesIf planning to address an item in the next 1-2 years, or if rated as a 2 or 3 using the rating scale above, please indicate where this is addressed in your Work Plan
Strategy 1
8.1The EHDI-IS SHALL provide the ability to generate, present and transmit standard and/or custom-defined reports (e.g., CDC HSFS survey, loss to follow-up, or other important indicators by geographic, demographic, provider, or provider groups, hospital performance report) for authorized users without assistance wfrom system vendor or IT personnel.Standard Rating:Standard RatingStrategy 2
Notes:1Jurisdiction is unable to address this standardDue to external factors or barriers (law, policy, or legislation) jurisdiction is unable to meet the standard and is not or will not be working on this.Strategy 3
8.2The EHDI-IS SHOULD provide the ability for authorized healthcare providers to electronically access newborn hearing screening and follow-up service information of their patients.Standard Rating:2Jurisdiction is considering work on meeting this standard.Standard will be part of work plan in near future (i.e., 1 - 2 years).Strategy 4
Notes:3Standard is currently part of the work plan.Jurisdiction is working on the standard, but is in early stages of testing or implementing and less than 75% of related data are being collected.Strategy 5
4Standard MET - Jurisdiction has completely met standard.Jurisdiction has completely met the standard. If not completely met, jurisdiction has achieved the standard in 75% or more of related data collection.
Please Continue to the Data Elements Tab or ClickHEREGoal 4
Goal 5

Data Elements Need to move to another tab? You can use the tabs below to navigate the tool!

InstructionsExamplesKey InformationGS1GS2GS3GS4GS5GS6GS7GS8Data ElementsSummaryAdditional Comments
Yes1Electronic
Instructions: The Data Elements Tab allows users to identify all of the data elements currently collected by the EHDI-IS. There are five categories of data elements: Child-level, Hearing Screen, Rescreen, Diagnostics, and Part C / Early Intervention. To the right of most data items are 3 columns of drop-down menus: System currently has this; will have this in 1-2 years; and how data elements are received (electronic / manual). Some of the elements may not have all three column options, only yellow cells have drop down menus to select an option.No0Manual
N/A
Comprehensiveness of Data Elements by Programmatic GoalYesTotPct.Both
1.Child Level Data Elements00ERROR:#DIV/0!
2.Hearing Screening Data Elements00ERROR:#DIV/0!
3.Rescreen Data Elements00ERROR:#DIV/0!
4.Diagnostic Data Elements00ERROR:#DIV/0!
5.Part C Data Elements00ERROR:#DIV/0!
Total00ERROR:#DIV/0!
How does program receive this information?
1. Child Level Data ElementsCurrently Has ThisWill have in 1-2 YearsElectronic or Manual Exchange / Receipt
Child IDM1.1, 1.4, 2.1
Child NameM1.1, 1.4, 2.1, 3.1, 3.2
Date of BirthM1.1, 1.2
GenderM1.1, 1.2
Plurality and OrderM1.2
Time of BirthE1.2
Birth WeightE1.2
Birthing Facility ID/NameM1.2
Birthing Facility Address/ContactM1.2
Home Birth or Hospital BirthM1.2
Insurance TypeE1.2
Adoption StatusE1.2
Mother's NameC1.3
Maternal Date of BirthC1.3
Maternal RaceC1.3
Maternal EthnicityC1.3
Maternal EducationC1.3
Mother's Residence Address/ContactC1.3
Father's NameE1.3
Father's Address/ContactE1.3
Father's Date of BirthE1.3
Father's RaceE1.3
Father's EthnicityE1.3
Fathers EducationE1.3
2. Hearing Screening Data ElementsHas This?Electronic / Manual Exchange / Receipt
Date of TransferM1.8
Transferring Facility Type/Name/Address/ContactC1.8
Receiving Facility Type/Name/Address/ContactC1.8
Was the baby in NICU?M1.8
Days in NICU (if applicable)E1.8
Risk Factors for Hearing Loss (collected at birth)E1.5
Date of ScreeningM1.4
Time of ScreeningE1.4
Screening Result (Left Ear)M1.4
Screening Result (Right Ear)M1.4
Screening Method (Left Ear)C1.4
Screening Method (Right Ear)C1.4
Screening Facility ID or NameM1.4
Screening Facility Address/ContactM1.4
Disposition (rescreen, refer, or evaluation)E1.4
Reason for not Performed/Completed ScreeningM1.7
3. Rescreen Data ElementsHas This?Will have in 1-3 YearsElectronic / Manual Exchange / Reciept
Date of Referral Made to Follow-up ServiceM2.5
Provider Referred toM2.5
Date of RescreenM2.6
Result of Rescreen - Left earM2.6
Result of Rescreen - Right earM2.6
Method of Rescreen - Left earC2.6
Method of Rescreen - Right earC2.6
Rescreening Facility Name/Address/ContactM2.6
Rescreen DispositionM2.6
4. Diagnostic Data ElementsHas This?Will have in 1-3 YearsElectronic / Manual Exchange / Reciept
Date of Diagnostic EvaluationM2.7
Result of Diagnostic Evaluation - Left EarM2.7, 3.1, 3.2
Result of Diagnostic Evaluation - Right EarM2.7, 3.1, 3.2
Type of Diagnostic Test - Left EarC2.7
Type of Diagnostic Test - Right EarC2.7
Evaluation Site Name/Address/ContactM2.7
Audiologist Name/ContactM2.7
Reason for not Receiving Recommended Rescreen/Diagnostic Evaluation ServiceM2.10
Diagnostic Evaluation Disposition/Recommended ReferralsE2.10
Follow-up Appointment DateE2.9
Date of DiagnosisM2.9
Type of Hearing Loss - Left EarM3.1, 3.2
Type of Hearing Loss - Right EarM3.1, 3.2
Degree of Hearing Loss - Left EarM3.1, 3.2
Degree of Hearing Loss - Right EarM3.1, 3.2
Laterality of Hearing LossM3.1, 3.2
Risk Factors (Collected at Diagnostic Evaluation)E3.5
5. Part C Data ElementsHas This?Will have in 1-3 YearsElectronic / Manual Exchange / Reciept
Part C EligibilityM4.2
Date of Referral to Part CM4.1
Date of Part C EI Enrollment (Date when IFSP is Signed)M4.3
Date of Non-Part C EI EnrollmentM4.4
Intervention Method (Hearing Aid, Cochlear Implant)E4.5
OutcomeE4.6

This is the end of the ESSET! If you would like to provide further comments, please go to the Additional Comments Tab or Click HERE

Saving the ESSET as a PDF File You will need to save the ESSET as a PDF so that you may attach it to your application. The print area has already been set for this entire workbook. To save the entire work book as a PDF follow the steps below.

1. Choose File and Save As

2. Choose the desired saved location on your computer

3. Update the File Name in the dialogue box to STATENAME_ESSET_17-1701.xls

4. Choose PDF in Save as Type drop-down menu (Underneath File Name)

5. At the bottom of the dialogue box check Options a smaller dialogue box will appear

6. Under Publish What, Check Entire Workbook

7. Under Include Non-Pringint Info, ensure that both the Document Properties and Document Structure Tags for accessibility boxes are checked.

8. Choose Okay, and then Save. The PDF will publish and open (if set to do so, if not it should be in location chosen for it).

Summary Need to move to another tab? You can use the tabs below to navigate the tool!

Instructions Examples Key Information GS1 GS2 GS3 GS4 GS5 GS6 GS7 GS8 Data Elements Summary Additional Comments

Quality IndicatorMet Y/N
Goal Statement 1
1.1The EHDI-IS SHALL provide a unique patient record for each newborn child born in the jurisdiction0
1.2The EHDI-IS SHALL receive and document information about patient's birth encounter and newborn admission information in a timely manner in accordance with scope of practice.0
1.3The EHDI-IS SHALL receive and document patient's maternal demographic information, in accordance with scope of practice, organizational policy and jurisdictional law.0
1.4The EHDI-IS SHALL receive and document all individual newborn hearing screening procedures and results, in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.0
1.5The EHDI-IS SHOULD receive and document information about risk factors of infant hearing loss at the time of newborn hearing screening.0
1.6The EHDI-IS SHALL review incoming and existing patient records and document the most recent newborn hearing screening status and outcome (Pass, refer, not screened).0
1.7The EHDI-IS SHALL receive and document information on the reason why an infant hearing screening is not performed or completed.0
1.8The EHDI-IS SHALL provide the ability to capture and document information about an infant's NICU stay and transfer status.0
1.9The EHDI-IS MAY receive submissions of newborn hearing screening information in accordance with interoperability standards endorsed by CDC for message content, format, and transport.0
Rating (1-4)Related Work Plan Strategy
Goal Statement 2
2.1The EHDI-IS SHOULD provide a unique patient record for each infant/child born out of the jurisdiction but currently reside within the jurisdiction and is in need of hearing screening or diagnostic follow-up services.00
2.2The EHDI-IS SHALL provide the ability to generate and present a list of infants who did not pass newborn hearing screening (including initial screening and any follow-up rescreening) and are in need of follow-up rescreening and/or diagnostic evaluation services.00
2.3The EHDI-IS SHALL provide the ability to generate and present a list of infants who did not receive or complete newborn hearing screening and are in need of recommended screening and/or diagnostic evaluation services.00
2.4The EHDI-IS MAY provide the ability to make referrals for recommended follow-up services.00
2.5The EHDI-IS SHALL document referrals made.00
2.6The EHDI-IS SHALL receive and document information on rescreening procedures and results in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.00
2.7The EHDI-IS SHALL receive and document information on procedures and results of ALL follow-up audiological diagnostic evaluation services in a timely manner in accordance with scope of practice, organizational policy and jurisdictional law.00
2.8The EHDI-IS SHALL receive and document information whenever there is a change in the patient's hearing status and/or an update on previously inconclusive/incomplete diagnostic result.00
2.9The EHDI-IS SHOULD receive and document information about referrals and/or recommendations made following an audiological diagnostic evaluation.00
2.10The EHDI-IS SHALL receive and document information on the reason why an infant did not receive recommended follow-up services.00
2.11The EHDI-IS SHOULD provide the ability to notify parents and healthcare providers of infants who are in need of follow-up services.00
2.12The EHDI-IS MAY provide the ability to generate, present, and transmit a standard-based Hearing Plan of Care document to guide follow-up practices in accordance with scope of practice, organizational policy and jurisdictional law.00
Goal Statement 3
3.1The EHDI-IS SHALL receive and document information on all confirmed hearing loss cases identified through the newborn hearing screening follow-up process and reported from audiological providers.00
3.2The EHDI-IS SHALL provide the ability to receive and document information on additional infants/children with hearing loss that are not identified through the newborn hearing screening follow-up process, e.g. reported from primary care providers, or through data exchange with the Early Intervention systems, and other public health information systems and/or registries, in accordance with scope of practice, organizational policy, and jurisdictional law.00
3.3The EHID-IS SHALL use the ASHA standards for classifying degree of hearing loss .00
3.4For every documented permanent hearing loss case in the EHDI-IS. The EHDI-IS SHALL provide the ability to generate and present the patient's complete screening and diagnostic service history including date, location, type and results of tests performed and/or diagnosis made.00
3.5The EHDI-IS SHOULD receive and document information on hearing loss risk factors.00
3.6The EHDI-IS SHOULD provide the ability to regularly evaluate incoming and existing hearing screening and diagnostic information to continually refine, modify and efficiently identify late onset, progressive and acquired hearing loss.00
3.7The EHDI-IS SHALL provide the ability to generate and present separate lists of infants/children with presumed congenital (referred on newborn hearing screening) and late-onset/progressive/acquired hearing loss.00
Goal Statement 4
4.1The EHDI-IS SHALL provide the ability to identify infants/children who need EI services.00
4.2The EHDI-IS SHALL receive and document information about referrals to Part C services.00
4.3The EHDI-IS SHALL receive and document information about eligibility to Part C services.00
4.4The EHDI-IS SHALL receive and document information on Part C early intervention services enrollment (i.e. date when the IFSP is signed).00
4.5The EHDI-IS SHALL receive and document information on other non-Part C early intervention services enrollment, in accordance with scope of practice, organizational policy and jurisdictional law.00
4.6The EHDI-IS SHOULD provide the ability to receive and document recommended audiologic intervention method upon a hearing loss diagnosis from providers.00
4.7The EHDI-IS SHOULD provide the ability to receive and document data on early intervention outcomes.00
4.8The EHDI-IS SHOULD provide that ability to compare infants in the system and those in the EI system to identify missed cases.00
4.9The EHDI-IS SHOULD provide the ability to notify parents, health and EI providers of infants' need for EI services.00
Goal Statement 5
5.1The EHDI-IS SHALL provide the ability to regularly evaluate incoming and existing patient records to identify, prevent, and resolve duplicate and fragmented records.00
5.2The EHDI-IS SHALL store all EHDI-IS minimum Data Elements.00
5.3The EHDI-IS SHALL provide the ability to obtain other Core Data Elements.00
5.4The EHDI-IS SHOULD provide the ability to obtain Extended Data Elements.00
5.5The system SHALL provide the ability to analyze information with respect to data quality according to scope of practice, organizational policy, and/or jurisdictional law.00
5.6The EHDI-IS SHALL retain all patient data in the system till the patient reaches at least 3 years old, except where prohibited by law, regulation, or policy.00
5.7The EHDI-IS SHOULD allow re-activating a case when new information has arrived that illuminate the disposition of a case.00
5.8The EHDI-IS SHOULD provide the ability for staff to record notes and phone interactions with the public (parents, providers, hospitals) under each child's file.00
5.9The EHDI-IS SHOULD provide the users with easy access to metadata, system documentation and user guide.00
Goal Statement 6
6.1The EHDI-IS SHALL have written confidentiality and privacy practices and policies based on applicable law or regulation that protect all individuals whose data are contained in the system.00
6.2The EHDI-IS SHALL have written data sharing and confidentiality/privacy agreement with any other information systems which the system links to and/or shares data with.00
6.3The EHDI-IS SHALL have user access controls and logging, including distinct credentials for each user, least-privilege access, and routing maintenance of access privileges.00
6.4The EHDI-IS SHALL be operated or hosted on secure hardware and software in accordance with industry standards for protected health information, including standards for security/encryption, uptime and disaster recovery.00
Goal Statement 7
7.1The EHDI-IS SHALL provide the ability for authorized users to extract and use data to assess program progress towards achieving national/jurisdictional benchmarks.00
7.2The EHDI-IS SHOULD provide the ability to generate performance measurement reports, as defined by the jurisdictional system evaluation plan.00

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