first year of life. in his words, "it's a tall order, yes, but if we all work together, i believe we can fill it." in 1990, the jcih added three more risk factors (ototoxic medication, prolonged mechanical ventilation, syndromic stigmata) for a total of ten. congressman james t. walsh (r-ny) sponsored and introduced the first attempt at federal legislation with the hearing loss testing act of 1991 requiring the hearing testing of every child born in the united states at the time of birth and establishing uniform standards for such testing. although the committee on energy and commerce referred this legislation to subcommittee, congressman walsh continued to promote legislation throughout that decade as the co-founder and co-chair of the congressional hearing health caucus. in 1993, the national institutes of health consensus statement initiated the concept of "1-3-6" as the monthly milestones for screening, diagnosis and intervention. between 1993 and 1996, the national center for hearing assessment and management at utah state university conducted the rhode island hearing assessment project (rihap), which demonstrated the feasibility of using transient oaes for universal screening. in 1994, both the jcih and the dshpshwa endorsed universal newborn hearing screening. in 1996, the us preventive services task force concluded that the evidence was insufficient to assess the balance of benefits and harms and assigned an "i statement" grade for newborn hearing screening. all us states participate in early hearing detection and intervention (ehdi) programmes. the birth of ehdi may be attributed to passage of the children's health act of 2000 which included language from walsh's proposed legislation and authorized the secretary of the department of health and human services, acting through the centers for disease control and prevention and the health resources and services administration, to establish "statewide newborn and infant hearing screening evaluation and intervention programs and systems." congress provided hrsa with the authority to support statewide services and the cdc with the authority to provide technical assistance for data management and applied research. in addition, the national institute on deafness and other communication disorders at nih provided the authority to continue a programme of research and development on the efficacy of new screening techniques and technology. the year 2000 position statement of the jcih provided the principles and guidelines for early hearing detection and intervention programs. in 2006, the hhs secretary's advisory committee on heritable disorders in newborns and children (sachdnc) included newborn hearing as one of the conditions to be included in their recommended uniform screening panel (rusp). with growing research evidence, in 2007 united states preventive services task force (uspstf) recommended screening of hearing loss in all newborn infants with an assigned b grade. by 2010, 43 states enacted legislative statutes or written regulatory language related to universal newborn hearing screening. the electronic age of ehdi may have begun during the next decade. the quality, research, and public health (qrph) planning and technical committees of integrating the healthcare enterprise published a series of ehdi technical documents. these profiles promote the automated collection and communication exchange of ehdi data between clinical and public health information systems (results, demographics, care plans, quality measures). the u.s. national library of medicine maintains the newborn screening coding and terminology guide to promote and facilitate the use of electronic health data standards in recording and transmitting newborn screening test results. this includes ehdi standard vocabulary codes and terminologies, including logical observation identifiers names and codes (loinc), systematized nomenclature of medicine — clinical terms (snomed ct). the national quality forum the centers for medicare & medicaid services, and the joint commission for hospital accreditation have endorsed and/or supported adoption of ehdi electronic quality measures. ehdi-pals (pediatric audiology links to services) provides web-based link to information, resources, and services for children with hearing loss. in 2018, health level 7 (hl7) approved the early hearing detection and intervention (ehdi) implementation guide as a normative standard. situation worldwide in 2014 to 2019 the international newborn and infant hearing screening (nihs) group asked via questionnaire for the status of the hearing screening in 196 states worldwide; data from 158 states were obtained: in 64 states there is no or less screening (38% of the world's population); in 41 states (38% of the world's population) >85% of the babies are screened. the mean living standard in these states was 10 times higher than in countries without screening. it could show how useful a hearing screening can be: average age at diagnosis of hearing disorders was 4.6 months for screened children and 34.9 months for non-screened children.