January 29, 2007 By Merrill Douglas
"Going to the tandem mass spectrometry was a radical change in the design of the system," Quinlan said. "It needed a completely different technology."
So the CDHS scrapped its program-in-progress and started planning all over again.
The new law came at a perfect time, Camacho said. "Had it come much later, we would have had to backtrack. We were at a point where, ideally, it was a great time to stop and incorporate that piece into it."
The CDHS could have conducted two separate technology projects -- one to adopt a modern computer platform, and one to incorporate tandem mass spectrometry and more genetic tests.
"We decided to go for broke," Quinlan said, and department officials determined it would be much less costly to wrap both upgrades into a single initiative.
It would also be a great deal of work -- especially with the Legislature's Aug. 1, 2005 deadline less than a year away.
"We had frank discussions about, once we start, it's a point of no return," Camacho said. "We told staff, 'This will mean people can't take vacations. Around the holidays will be some of our busiest times.' We were going to have to run the marathon at a sprint."
After a couple of small pilots -- including the one that saved the baby's life -- the department started a statewide pilot implementation in June, running both the new and old systems. Then it started shutting down Huey, Dewey and Louie and relying entirely on the SIS.
"We flipped the switch in mid-July, a couple of weeks early," Quinlan said.
Developed in conjunction with Deloitte Consulting, the SIS is a Web-based system, built on Microsoft .NET technology and running on the CDHS's extranet. It receives data from the labs in batch files and uses Business Objects software to produce reports.
The new system supports tandem mass spectrometry and lets the state screen newborns for 75 genetic conditions -- up from 39 in the days before the SIS.
"It allows us to evaluate results using newborn birth weight, which was not possible with the legacy system," said John Sherwin, acting chief of the CDHS's Genetic Disease Branch.
In addition, the SIS has streamlined and improved many processes that are part of the state's genetic screening program.
Unlike the previous system, it supports the entry of demographic data using intelligent character recognition/optical character recognition, Sherwin said. "There are a number of management reports that are much more distributed and more easily available directly to authorized users. It has shortened the time for our staff to identify that patients have gotten into appropriate follow-up care."
In all, the system supports more than 150 reports as well as ad hoc reporting, according to a description published by the CDHS.
The SIS can also match the results of prenatal and newborn genetic screens -- a function that was previously unavailable with the old system.
"A portion of our quality assurance program is the ability to identify if the mother of an affected infant had prenatal screening and what was the outcome," Sherwin said. The SIS also tracks data that enhances the value of genetic counseling in later pregnancies, such as whether a woman previously gave birth to a child with a genetic disorder.
The SIS will soon help the CDHS manage a new genetic screening challenge. In September 2006, Gov. Arnold Schwarzenegger signed a bill that expands the state's genetic screening program to include two more tests, for cystic fibrosis and biotinidase deficiency.
"We're programming for more screening," Quinlan said.
From the start, the CDHS designed the SIS so it could easily add screens for new conditions, Camacho said. "We didn't want to have to go in and rebuild the system."
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