2026 Early Hearing Detection & Intervention Conference
March 15-17, 2026 • Jacksonville, FL
3/10/2025 | 10:35 AM - 11:05 AM | Loss to documentation or loss to follow-up? An assessment of loss to documentation at rescreen and diagnostic stages in Tennessee | 301
Loss to documentation or loss to follow-up? An assessment of loss to documentation at rescreen and diagnostic stages in Tennessee
Introduction:
One-third of Tennessee infants who fail newborn hearing screening don’t have final evaluation outcomes documented in Tennessee’s Newborn Screen Program (NSP) database, i.e. they are lost to follow-up (LTFU). In some cases, infants have received rescreen or diagnostic evaluation, but the results were not reported to the NSP, i.e., lost to documentation (LTD). This can happen when the rescreen results were not reported, or when the diagnostic evaluation results were not reported. To assess the extent of LTD at different stages, two projects were implemented since 2023.
Method:
Project #1 is an ongoing collaboration with Community Health Access and Navigation in Tennessee (CHANT) started in April 2024. Lists of LTFU cases were shared with CHANT quarterly and the families were asked for rescreen or diagnostic evaluation information. The first two lists completed had 244 cases and information was received on 126 cases (52% response rate). 224 out of the 244 cases (92%) were LTFU at rescreen stage.
Project #2 focused on LTFU children during the diagnostic stage. 509 children were included. An audiology student contacted audiology practices and received information back on 451 children (89% response rate).
Results:
For project #1, information was received on 117 of the 224 cases and 51 of them passed rescreen, resulting in an LTD rate of 44%. For project #2, 439 children were kept in the analysis after certain exclusions. 63 (14%) children were LTD.
Conclusions:
The LTD rate was 44% among LTFU children at the rescreen stage, where the primary care providers likely failed to report the results. The LTD rate was 14% among LTFU cases during diagnostic evaluation stage, where the audiologists did not report the results. The future steps include investigating the barriers to reporting and identifying potential solutions to reduce LTD, thus reducing the overall LFTU rate in Tennessee.
- The participant will be able to describe the two stages where the loss to documentation can happen during the hearing follow-up process
- The participant will be able to apply Tennessee experiences to their own programs to reduce loss to documentation
- The participant will be able to identify at least two barriers for providers to report hearing results to the state’s EHDI program
Presentation:
3545975_18084YinmeiLi.pdf
Handouts:
3545975_18084YinmeiLi.pdf
Transcripts:
CART transcripts are NOT YET available, but will be posted shortly after the conference
Presenters/Authors
Yinmei Li
(Primary Presenter,Author), Tennessee Department of Health, yinmei.li@tn.gov;
Dr. Yinmei Li is the lead epidemiologist in the Perinatal, Infant and Pediatric Care section of the Family Health and Wellness division of the Tennessee Department of Health and has been in this role since 2014. Before joining the FHW division, she worked for three years as the chronic disease epidemiologist and then expanded her scope of work to include maternal and child health and injuries as the director of the Surveillance, Epidemiology and Evaluation section for 8 years with the TDH. She received an MD equivalent degree from Shanghai Medical College, Fudan University in China, and a Master’s degree in Experimental Statistics, a Master’s degree in Epidemiology, and a PhD in Veterinary Medical Sciences from Louisiana State University.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
Charles Lechner
(Co-Presenter,Co-Author), Tennessee Department of Health, charles.r.lechner@tn.gov;
Charles Lechner joined the Newborn Screening Follow-up Program within the TN Department of Health in February 2023 as an epidemiologist. Prior to this, he was an Association of Public Health Laboratories Data Analytics Fellow stationed within the TN Newborn Screening
Laboratory. His background is in bioinformatics and he is passionate about using technology and data to better the lives of others, especially within the fields of neonatology and pediatrics.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
Holli Allen
(Co-Presenter,Author,Co-Author), Department of Health, Holli.N.Allen@tn.gov;
Holli Allen, B.A. is the Program Director for the Tennessee Early Hearing Detection and Intervention Program. Her professional experience includes care coordination for families with special health care needs and federal grant management. Holli holds a Bachelor of Arts in Political Science from the University of Tennessee at Martin and a graduate certification in Health Care Management from East Tennessee State University.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
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Non-Financial relationship with .
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Emily Podgorny
(Co-Author), University of Tennessee Health Science Center, ejohnson22098@gmail.com;
Dr. Emily Podgorny achieved her Doctorate in Audiology in May 2024 and previously obtained her Master’s in Audiology from the University of Tennessee Health Science Center while working through school in May 2022. She earned her Bachelor of Science degree in Audiology and Speech Pathology from the University of Tennessee in 2020. While attending school her externships included working in a private practice, an ENT office, a balance center and the school system. Her broad experience has allowed her to gain knowledge with all populations and rare hearing disorders. Dr. Podgorny specializes in diagnostic testing and hearing aid fittings and currently works in for a private practice in Illinois. In addition to routine audiological testing, she is developing specialties in tinnitus and cochlear implants.
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Kristen Gentry
(Co-Author), Tennessee Department of Health, Kristen.t.gentry@tn.gov;
Kristen moved to Tennessee in 2001 from Rochester, NY, where she worked for 10 years at a Residential Treatment Center for Emotionally Disturbed Adolescents. Since moving she spent one year working at Big Brothers Big Sisters of the TN Valley, 3 years for Department of Children’s Services and the remaining time at the Tennessee Department of Health. At the Sevier County Health Department, she worked as a HUGS Care Coordinator for 17 years and transitioned to CHANT Team Lead during that time. In January of 2022 she accepted the role as CHANT Program Director. Her work has focused on children and families for the past 30 years, providing support services to families in need in. She has been married for 26 years and has one daughter. And while she is now a Tennessee native she remains a die hard Buffalo Bills fan!!
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Angela Keyton
(Co-Author), Tennessee Department of Health, angela.keyton@tn.gov;
Angela Keyton, RN, Public Health Nurse Consultant Manager - RN Coordinator for Pediatric Case Management at the Tennessee Department of Health. With 16 years of experience as a Registered Nurse, including 10 years in Pulmonary Step-Down Care, Angela has been dedicated to public health for the past seven years. In her current role, she oversees pediatric nurse case managers' activities in newborn screening, newborn hearing screening, newborn CCHD screening, and the childhood lead poisoning prevention program.
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Hilary Fryman
(Co-Author), Tennessee Department of Health, hilary.fryman@tn.gov;
Hilary Fryman, RN BSN is the Education and Quality Improvement Nurse for the Pediatric Case Management and Newborn Screening Follow-up Program. She has been a Registered Nurse for 15 years and has been in with the Tennessee Department of Health for 8 years. In her current role, she works closely with the Director of Pediatric Case Management and Tennessee Newborn Hearing Screening Program Director to create and update processes and procedures for daily nurse case management task rotations and education for hospitals, midwives, pediatricians, and audiologists. Hilary provides ongoing hospital education and completes visits to hospitals that are need of technical assistance in meeting state benchmarks, such as the initial hearing screening rate and initial fail rates. Hilary has played a key role in several implementations for the newborn screening program such as, Remote Diagnostics Entry Portal for Audiologists. Hilary helps bring awareness to newborn screening by organizing events for Rare Disease Day and CCHD Awareness in February, Speech and Hearing in May, and Newborn Screening Awareness Month in September. Hilary serves as the Co-Chair for the APHL National Continuous Quality Improvement Sub-Committee.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
Brittany Day
(Co-Author), Vanderbilt University Medical Center, brittany.day@vumc.org;
Brittany Day, AuD, is the Director of the Mama Lere Childhood Hearing Programs at Vanderbilt University Medical Center and is the contracted Audiology Consultant for the Tennessee EHDI program. She participates in clinical pediatric hearing research and previously directed the inpatient pediatric audiology and newborn hearing screening clinical programs at VUMC. Her clinical interests include early hearing detection and intervention and audiologic diagnosis for medically complex infants and children. Brittany volunteers as Clinical Director for the Tennessee Special Olympics Healthy Hearing program and is completing her Master of Public Health degree in Healthcare Management.
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Amanda Ingram
(Co-Author), Tennessee Department of Health, amanda.d.ingram@tn.gov;
Amanda Ingram, RN is the Director of the Pediatric Case Management and Follow-up Program for the Tennessee Department of Health. She has been a Registered Nurse for 24 years with 13 years of Neonatal Intensive Care experience and has been with the State of TN Department of Health for 8 years. She has served as Director for Newborn Screening Follow-up for the past 6 years. Prior to this role she served as the Case Management Coordinator and prior to that she was a case manager for the program. She oversees all follow-up and case management activities for Newborn Screening, Newborn Hearing Screening, Newborn CCHD Screening, and the Childhood Lead Poisoning Prevention Program.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
Julie Beeler
(Co-Author), University of Tennessee Health Science Center, jbeeler8@utk.edu;
Julie Beeler, an audiologist and speech-language pathologist, is the program liaison with the University of Tennessee Health Science Center Department of Audiology and Speech Pathology in Knoxville. She is also an instructor for courses in aural rehabilitation. From 2008 to early 2015, Julie served as the audiology consultant to Tennessee’s Early Hearing Detection and Intervention (EHDI) Program. Early in her career, was a clinical educator at UT specializing in aural rehabilitation and cochlear implant programming. She has also worked in a rural school system and a large hospital. Currently, Julie sits on the advisory board of Tennessee Hands & Voices. She continues to enjoy collaborating with the state’s EHDI Program on various projects.
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