INBSI Application

Please complete the following form to apply for your state (including all states, territories, and the District of Columbia) to participate in the Innovations in Newborn Screening Interoperability (INBSI) Learning Collaborative. This application is intended to provide a high-level overview of a jurisdiction’s current state of newborn screening interoperability and an indication of where the jurisdiction wants to be. The INBSI project welcomes applications from states and jurisdictions at all levels of interoperability planning. You may also contact us at NBSinterop@altarum.org.

Contact Information

Please provide your primary contact information.

Last Name

First Name

Title/Role

Address (Street)

State/Territory/District

Zip Code

Phone

Newborn Screening Program Details

Please provide some details surrounding your state/territory's current level of NBS interoperability.

What is your current Level of Dried Blood Sport (DBS) Interoperability?

DBS orders or results are exchanged electronically between the state and providers following an HL7 standard.

What is your current Level of EHDI Interoperability?

Hearing screening or diagnostic audiology results are exchanged electronically between the state and providers following an HL7 standard.

What is your current Level of pulse oximetry screening for CCHD Interoperability?

Pulse oximetry screening results for CCHD are exchanged electronically between the state and providers following an HL7 standard.

Please select the month you are available to begin participation.

Comments

Please add any relevant comments or details.

Application Narrative

If you would like to upload your full application narrative, please use the file upload feature below. Or you may email your full application to NBSInterop@altarum.org.

State Interoperability Status & Goals

Please describe the current state of electronic data exchange and interoperability in your state today and the vision for expanding and utilizing interoperability for NBS data in the future. Please include challenges and barriers to implementing NBS interoperability. Describe how participating in the INBSI project will help you achieve your goals. (500 words or less)

Composition of the State Team

Please describe the composition of the state team identified to work with on the INBSI project. Indicate which NBS programs will be included on the state team. Identify the project lead. (250 words or less)

Interoperability Implementation

Please describe your commitment to implement the interoperability roadmap developed as part of the INBSI project. (250 words or less)

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