MMRIA ABSTRACTOR OFFICE HOURS ENHANCING REVIEWS AND SURVEILLANCE TO ELIMINATE MATERNAL MORTALITY (ERASE MM) JANUARY 16, 2020 Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health
THEMES • Record Access • HIPAA/Confidentiality • Case Narrative Development • MMRIA System/Upgrades • Self-Care
RECORD ACCESS Q1. Is there an MOU template for requesting medical records from hospitals? • May be determined by the authority that the MMRC operates under. (There may not be a need for MOU if granted legislative authority to request records.) • Consider developing a standard cover letter with description of such authorities and protections. • Record request sample letters can be found on Reviewtoaction.org
HIPAA/CONFIDENTIALITY Q2. Is it permissible for providers and/or facilities to be disclosed during the MMRC case discussion? • Abstractors should fully understand their authority and protections • Strong recommendation: Identifiers (provider names, facilities) should not be disclosed to the MMRC • Remember the MMR process is not a peer review.
CASE NARRATIVE DEVELOPMENT Q3. Why can’t I save my case narrative on the Case Narrative Form? • Currently edits in the case narrative text box are not being saved. • We plan to roll out a fix for this issue on Thursday, January 23, 2020 . • Until that time please do not enter any data in the case narrative text-box on the Case Narrative Form. In the meantime you may want to save your narrative: ➢ on a reviewer notes page ➢ On a Word document stored securely
DATA ENTRY: DROP DOWN BOXES IN MMRIA Q4. Why can’t I find the right option in a dropdown? A review of all MMRIA forms drop down options will be done this next month to search for those areas that might need clarity or additional options added.
Q5. EXPLAIN THE OPTIONS ON PARENT SECTION OF THE BIRTH CERTIFICATE FORM- OPTIONS INDICATE PRESENT INFECTION SUCH AS “BLANK”, “NOT SPECIFIED”, OR “NONE OF THESE”. “Blank” option is the default, and is used to indicate that the abstractor has not yet made a data change for this question in MMRIA If you look at the paper form , and this question is left completely unanswered, then mark “Not Specified” If you look at the paper form , and if the response option “none/none of the above/none of these” is marked on the paper form, only then mark “None of These”
Q6. ON THE BIRTH CERTIFICATE FORM “WAS A FORCEPS OR VACUUM EXTRACTION ATTEMPTED BUT UNSUCCESSFUL”? This box asks if procedure was attempted and unsuccessful. Options are “yes”, “no”, or “not specified”. • If used but successful then you would mark “no”. • If used but unsure of success then mark “not specified” If vacuum and forceps used you will also note it in this box.
Q7. ON THE PRENATAL FORM THE QUESTION “WAS PREGNANCY PLANNED”. THERE IS NO CLEAR OPTION TO INDICATE THE PREGNANCY WAS NOT PLANNED OR SIMPLY “NO”. What options would best capture a “no” answer?
Q8. ON SOCIAL/ENVIRONMENTAL FORM WE NEED AN OPTION FOR “OTHER” UNDER SUBSTANCE USE Although the list provided does not include “other” there is a separate data entry box for you to specify any other substance.
Q9. HOW CAN I DELETE A CASE OR CASE FORM OPENED /INITIATED IN ERROR?
Q10. CAN A TEXT BOX BE ADDED UNDER MEDICATIONS TO DOCUMENT ADDITIONAL DETAILS? ❑ Currently do not have “Comments text - box” within several grids (sub -forms). ❑ Recommend records significant remarks pertaining to various data- fields, in the “Reviewer notes” located at the bottom of each form.
Q11. IN PRINT FUNCTION IS THERE A WAY TO SAVE THE DOCUMENT TO A PDF RATHER THAN WEBPAGE? ❑ Currently do not have the “Print to PDF” feature currently in MMRIA. ❑ Adding this to the requirements backlog for implementation in the future.
OVERALL CASE STATUS + FORM STATUS CHANGE ❑ Add Overall Case Status that is manually set by each abstractor. Options: 1. Abstracting (incomplete) 2. Ready for review (abstraction complete) 3. Completed review (abstraction & review complete) 4. Out of Scope ❑ Arrange Case Listing Grouped by Overall Case Status with key information to quickly identify case: ❑ Case ID#, Age @ death, Timing of death, Review date, Pregnancy relatedness ❑ Export Cases belonging to a selected Overall Case Status ❑ Add Individual Form Status within each form – so it’s status can be marked correctly while on the data collection form itself. Options: 1. Not Started 2. In Progress 3. Completed 4. Not Available 5. Not Applicable
ABSTRACTOR SELF-CARE “The expectation that we can be immersed in trauma and not be affected is like walking through water and note getting wet”. (Ifetayo White)
NEW RESOURCES • MMRIA Committee Decision Form v18 (pdf printable form) • Informant Interview Guide for Maternal Mortality Committees • Reference Guide for Pregnancy Associated Death Identification • Article published in AJOG: Changing the conversation: applying a health equity framework to maternal mortality reviews • MMRIA v 2.1 went live on Dec. 20 th !
ANY ADDITIONAL QUESTIONS?
2020 PLANNED MMRIA SYSTEM UPDATES ❑ Move All states to Central Hosting ❑ Process Improvements ❑ Improve User Interface ❑ Automate Import of Vital Records data ❑ Enhance Reporting ❑ Improve Data Export ❑ Integrate Data Visualization
PROCESS CHANGES ❑ On the Login and Home page, provide ways of contacting MMRIA Technical support. ❑ Have System Availability Status indicator on Login page, and notify users when the system will be unavailable for maintenance. ❑ Create Document Repository that contains all available documentation, FAQs, guidance documents, recommended reading, and system update notifications. ❑ Have Fillable PDFs of Forms used in data abstraction.
PROCESS CHANGES ❑ Add logic checks to flag inconsistent data. ❑ Provide N/A and Unknown options so fields are not left Blank.
DATA ENTRY FORM ENHANCEMENTS ❑ Looking at various options including moving navigation to top, to free up more space for abstractors. ❑ Links on individual data collection forms to potentially move between forms.
DATA ENTRY FORM ENHANCEMENTS ❑ Reorganize forms with goal of tying Inputs & Outputs together cohesively.
DATA ENTRY FORM ENHANCEMENTS ❑ Make Birth/Death Certificate MMRIA forms match US Standard BC/DC – to ease data entry issues – in the sequence order they are laid out on the paper form.
DATA ENTRY FORM ENHANCEMENTS ❑ Add Field List to help locate records on Repeating Forms. ❑ Display a field list to help identify repeating forms, Order sequentially by applicable dates.
DATA ENTRY FORM ENHANCEMENTS ❑ Evaluate if Tab Controls can be used to organize data in tabs to reduce scrolling. ❑ Fix date fields to allow for typing. ❑ Change most Date/Time fields to Date only. ❑ Alphabetize choices on drop-downs where applicable (Not on Birth/Death Cert).
AUTOMATE IMPORT OF VITALS ❑ State Vitals data in JSON format that can be uploaded into MMRIA using a software application that Jurisdiction Administrators in a state can run at periodic intervals. ❑ Will be available middle of next year.
INTEGRATE DATA VISUALIZATION ❑ Advanced Dashboards using Microsoft Power BI (Business Intelligence) software
REPORTING ENHANCEMENTS ❑ Initially visualizing overdose data, but will be eventually scaled to key data fields in MMRIA. ❑ Expand aggregate report to include additional MMRIA core variables. ❑ Summary report of missing data. ❑ Better print version of selected form laid out exactly like data collection form.
EXPORT ENHANCEMENTS ❑ PDF of complete system data dictionary. ❑ Simplify export with ability to export data from selected forms and/or fields only.
PLANNED SYSTEM UPDATES SCHEDULE ❑ March 2020 ❑ Microsoft Power BI generated Overdose Summary Reports ❑ Navigation enhancements ❑ July 2020 ❑ User Interface enhancements ❑ Automated Import of Vital records ❑ Document repository ❑ Dec 2020 ❑ Additional User Interface enhancements ❑ Report & Visualization enhancements ❑ Export enhancements
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