Thank you for your contributions to the successes we have had in Iowa’s Early Hearing Detection and Intervention (EHDI) system of care for infants and toddlers. Undetected hearing loss is a developmental emergency, and EHDI providers and their staff play a critical role in ensuring all infants receive timely and appropriate hearing healthcare follow-up. Working collaboratively with the EHDI Team, we can ensure that hearing loss is detected as soon as possible. Together we can support children who are deaf or hard of hearing and their families.
Types of EDHI providers
As the primary provider, it is your role to connect families to the appropriate audiological, intervention and consultative services to develop a plan specifically designed for the infant identified with hearing loss or identified with factors associated with early hearing loss. The Joint Committee on Infant Hearing Position Statement charges you to “assume responsibility to ensure that the audiological assessment is conducted on infants who do not pass screening and must initiate referrals for medical specialty evaluations necessary to determine the etiology of the hearing loss.” Your cooperation is imperative for ensuring that the child achieves the best possible outcomes.
Use the resources below to further explore best practices, research articles, potential communication options, laws governing your practice and information available for your patients, along with other reference pieces.
As an audiologist or an otolaryngologist, you have a wealth of knowledge to share with your fellow providers and families with children that are diagnosed with hearing loss or at risk for developing hearing loss. Your role is to provide timely follow-up screening, perform or refer for necessary diagnostic audiological tests and educate family and team members about hearing loss and audiological support. The Joint Committee on Infant Hearing Position Statement charges you to “provide comprehensive audiological diagnostic assessment to confirm the existence of the hearing loss, ensure that parents understand the significance of the hearing loss, evaluate the infant for candidacy for amplification and other sensory devices and assistive technology, and ensure prompt referral to early intervention programs.” All of this puts you at the front line of early detection and intervention against hearing loss. Iowa children and families are depending on you for guidance.
Nurses play a vital role in newborn hearing screening and follow up in our state. Currently, only four birthing facilities have audiologists and audiology technicians on staff to assist with screening. The remaining birthing facilities rely on nursing staff to perform all hearing screens prior to hospital discharge while midwives provide education and guidance to the families they serve on where they can take their infant for a hearing screen. We like to think of nurses as being “first responders.” Through screening, a nurse may identify an infant that needs additional testing if they did not pass their newborn hearing screen which in turn may lead to a diagnosis of hearing loss. A nurse may also impact a family’s decision to follow up for a timely outpatient screen through their communication about hearing screening and the information they provide regarding recommended follow up.
Hearing screening results or missed screens should be promptly transmitted to the medical home and the Iowa Department of Health and Human Services Early Hearing Detection and Intervention program. Communication of the importance of hearing screening, results of the hearing screening and recommended follow up is key to the best possible outcomes for children and to a sustainable system supporting families in Iowa.
As the early interventionist, you are critical to connecting families to the services that they need as they navigate life with a child with hearing loss. By acting quickly and serving as a constant resource, you are catalyzing continuous improvement and empowering them to live a normal life despite hearing loss. Please contact the EHDI team with questions or concerns about funding sources, family support services, and communication options. Working collaboratively, we can support families to make informed decisions that will best meet their needs.
Forms included on this page are meant to be a resource to support newborn hearing screening and follow-up. Information submitted to the EHDI program shall be submitted electronically through the EHDI database. Please contact EHDI staff with questions.
This form should be used to refer children diagnosed with hearing loss to early intervention services. This can also now be done through the new database system.
These forms should only be used until access to the EHDI database is granted. All reporting should be completed electronically in the EHDI database.
This form should be used to assist families with next steps when their child has been diagnosed with hearing loss. This form is a guide for possible referrals that may be necessary to establish a comprehensive healthcare plan for a child with hearing loss.
These forms should be used if a parent wishes to decline hearing screening for their child. These forms should only be signed following education about newborn hearing screening.
This form should be used if a parent wishes to decline diagnostic hearing assessment for their child. This form should only be signed following education about diagnostic hearing assessments.
This form should be used if a parent wishes to decline Congenital Cytomegalovirus (cCMV) testing. This form should only be signed following education about cCMV testing.
EHDI Database Resources
Iowa Newborn Screening Information System (INSIS) is an integrated, web-based data system that serves as the statewide tracking and surveillance system for children from birth to age 3 for all newborn screening programs in Iowa. These programs are; EHDI, Critical Congenital Heart Disease (CCHD) and Dried Blood Spot.
INSIS is a password-protected data system and access into the system is only available to approved parties. To gain access into INSIS (because you screen or diagnose children under the age of 3), receive a copy of a previously recorded training or to schedule a live training, please contact EHDI staff.
NANI is the application that accepts and processes ADT messages that contain demographic (contact) information about newborn patients. The information is used to follow-up with a newborn’s contact for follow-up care. Therefore, it is critical that the contact information be as complete and accurate as possible when the outreach takes place. NANI outperforms human data entry in two measurable ways: it works during labor shortages and outages, and it gathers even the most up-to-date information available for the patient’s contact. Addresses and phone numbers are not infrequently updated after a patient is discharged, and if that new information is shared with your facility, NANI will receive and process it. All data is exchanged using industry standards to protect patient information.
Learning more about how NANI works
Hospitals have the ability to electronically import all important demographic information directly from their electronic medical health records system (or admitting or patient account systems) using the demographic import tool in INSIS. No software is needed to set up the import. INSIS has the capability of electronically populating the majority of the required reporting fields- except for the infant’s primary care provider at this time. An import file is created by the hospital’s IT department that contains demographic information for each patient born the previous day. Many IT departments write ASCII files to interface with other hospital databases and this is the same concept.
You might ask how this works. The hospital IT department will run a query or job to create an import file on a daily basis. This file will contain the demographic information that you select as necessary for your patient records in INSIS. An INSIS user at your hospital will use the import function daily to import the demographics file which will automatically create new patient records.
The hospital’s hearing screening manager, along with the hospital’s IT department should work together to determine the contents of the ASCII file. Please set up your import to capture as many fields as you can. Most hospitals choose to enter risk factors manually versus through the import but some have also been able to import those. If you import all the necessary fields, you will only need to enter the primary care provider, risk factors (if you cannot capture them through the import) and then move the patient from inpatient to outpatient and enter the discharge date! Importing information from hospital records saves time and also reduces the number of data entry errors. Below you will find a data dictionary which includes a list of possible elements to include in the file and how they must be coded. It is NOT necessary to include every element, if you do not have that element, however, some are required fields that you will recognize. Once you have a sample file ready, OZ Systems (our vendor), will test the file before going “live.” This helps us to ensure the file is set up correctly and everything is working properly. Please contact EHDI staff when you are ready to have the file tested or have specific questions about the process.
Once IT creates the file and it has been tested by the vendor, a one-time setup in INSIS is required and the configuration can be saved for repeated use. The final document below, Importing Instruction Sheet, is for creation of the import map. It outlines the decisions that will need to be made as to what type of file to create (i.e. tab delimited, inclusion of headers, etc.) EHDI staff will schedule an online meeting to walk INSIS users through the steps to set up the import map and do the import after the file is tested and approved by the vendor.
These example test files will provide a visual of what a sample file may look like. It is not complete but will give your IT contacts an idea of what is needed.
Example test file - Comma Delimited
EHDI - Laws and Administrative Rules
Due to the serious ramifications of undetected hearing loss, Iowa legislature passed a law which requires universal hearing screening of all newborns and infants in Iowa. It further provides that any birthing facility, including Area Education Agencies (AEAs), as well as providers, such as physicians, audiologists or other health care professionals are legally required to report the results of a hearing screen, re-screen or diagnostic assessment for any child under three years of age to the Iowa Department of Health and Human Services within six business days.
Read below to learn more about your role in the law and the administrative structure required for this program to work within your facility.