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MC 1947
PO Box 149347 Austin, TX 78714-9347
1100 W. 49th Street
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Data Transfer Capability Survey

Data Transfer Capability Survey

Newborn Screening Laboratories

< Return to Newborn Screening Laboratories main page

This form sends an email to the DSHS Lab.
Please answer the questions and then click "Submit."

Facility/Department Name:	Submitter ID Number (8 digits):		Facility's NPI (10 digits):
Responder's Name		Responder's Title:
Telephone:	Fax (HIPAA compliant):		Email:
IT Contact's Name (if different from above):		IT Contact's Telephone:
If your facility is part of a larger health organization or university system that shares IT or administrative resources; e.g. Hospital Corporation of America (HCA), Harris County Hospital District, VHA, Texas Health Resources (THR), please provide the name and telephone number for the main IT or administrative contact.
Name:		Telephone:
Please indicate the types of newborn screens that you collect/submit (check all that apply): Initial Screens (24-48 hours) Second screens (7-14 days) Requested repeats due to abnormal screens Requested repeats due to unsatisfactory specimens Do you complete the NBS specimen submission form in-house? Yes No If not, who does? Where (what department) is the NBS specimen submission form filled out? Does the area have access to a printer? Yes No Do you currently print labels for these forms? Yes If so, list the type of printer(s) that you use: Does the area have access to a bar code scanner or similar device? Yes No Do you currently have access to the internet? Yes No Please indicate how you would like to access your test results (check all that apply): Mail Fax Web HL7 Can you initiate a project by March 2008 for HL7 or Web implementation? Yes No Do you have an information systems department in your facility? Yes No Do you have a laboratory Information Management System (LIMS) or any data or other system that captures all of the data from the NBS specimen submission form? Yes No Do you have a Laboratory Information Management System (LIMS) or any other data system that captures part of the data from the NBS specimen submission form? Yes No Please list the fields or areas that you DO NOT capture in any of your data systems: Please list the name of the system(s) and who the vendor(s) is/are: Will the data need to be obtained from multiple information systems? Yes No If so, please explain the process: Is your system(s) able to export patient record data? Yes No If so, what file formats can the system(s) produce? (Check all that apply) ASCII Flat file Text Excel Access DBF HL7 If HL7, what version? Are you currently transmitting data outside your facility via HL7? Yes No Do you have the capability to create HL7 transmissions of patient data? Yes No Are your HL7 processes vendor supported? Yes No Are your HL7 processes supported in-house? Yes No If you do not have the capability to transmit data by HL7, how long do you estimate it would take for your facility to implement an HL7 file format solution that includes all NBS specimen submission form fields (even if you do not currently use/collect all fields) and a system to print labels to attach to the NBS specimen submission forms? 1-3 Months 4-6 Months 7-9 Months 10-12 Months >12 Months Not available Please list any known barriers to implementation within your facility: Feel free to add any questions and/or additional comments below:

When you click "Submit," you will see a pop-up window. Select "OK" and then "Yes." No confirmation will be displayed.
Thank you for participating in the survey!M

Last updated June 22, 2010

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