The Nation’s First Statewide Health

Information Exchange

Robert White DHIN Chair

Delaware Physicians Care, Inc.

Gina B. PerezDHIN Project Director

Advances in Management, Inc.

Paula K. RoyExecutive Director

Delaware Health Care Commission

• What is it?• Why is it needed?• Who participates?• What does it do?• How is it funded?• What are the benefits?

DHIN

What is DHIN?• Created statutorily in 1997 as a public

instrumentality of the State of Delaware – To advance the creation of a statewide

health information and electronic data interchange network for public and private use.

– To be a public-private partnership for the benefit of all citizens of Delaware

– To address Delaware's needs for timely, reliable and relevant health care information.

DHIN Vision

Develop a network to exchange real-time clinical information among all health care

providers (office practices, hospitals, labs and diagnostic facilities, etc.) across the state to

improve patient outcomes and patient-provider relationships, while reducing service duplication and the rate of increase in health

care spending.

DHIN Management

• Hospitals• Physicians• Consumers• Business• Insurance• State Government

Consumer Advisory

Committee

Executive Committee

Clinical Advisory

Group

HIMS Committee

Board of Directors

Project Management Committee

DHIN Value• Reliable, secure and available

information • Support physicians regardless of their

level of technology adoption • Manage need along the adoption curve

– “low-tech” vs “high-tech” physicians• Eliminates multiple delivery methods

Why is it needed?Clinical information is missing in

13.6% of primary care visits: • Lab results - 6.1%• Radiology results - 3.8%• History & Physicals - 3.7%

Missing information is judged to:• Adversely affect care in 44% of visits• Delay care in 59% of visits

(“JAMA”, January 2005)

• Medications - 3.2%• Dictation - 5.4%

Why is it needed?• Most Doctors receive laboratory results from

5 different labs all sending results in a different format and method

• Up to 20% of test are ordered due the original test results being lost.

• Lack of clinical information results in adverse drug events, avoidable hospitalizations and death

• Clinicians who use computerized records system are more compliant with immunization schedules

Current Functionality• Secure Results Delivery

– Lab and Pathology Results - Secure Inbox– Radiology Reports - Auto-Print– Admission Face Sheets - EMR Interface

• Public Health Reporting – Real-time reporting of data from hospitals to the Division

of Public Health’s DERSS system (Delaware Electronic Reporting and Surveillance System)

• Security Access Controls• Audit Processing & Reporting• EMR Interfaces• Consumer Participation via Consumer

Advisory Committee

Christiana Care Health System

Initial Data Senders

Bayhealth Medical Center

Beebe Medical Center

LabCorp (statewide)

85% Laboratory

Testing&

81% Hospital

AdmissionsOver 1.5 Million

Transactions Processed per

Month

Christiana Care Health System

Additional Data Senders - 2008

Bayhealth Medical Center

Beebe Medical Center

St. Francis Hospital

Quest Diagnostics & Doctors Pathology Services

(statewide)

Nanticoke Memorial Hospital

LabCorp

DHIN Enrollment• 54 practices currently live or in the

training process, equates to:- 100 practice sites- 284 physicians - 625 users

• 8 additional practices comprised of 45 physicians are currently in queue for enrollment and training

DHIN EnrollmentDemonstration Phase

Completed

Future Functionality2008-2011 • Enhanced Public Health Reporting

- Cancer Registry - Trauma Registry- Immunizations Registry - First Responders- Birth Defects Registry - Public Health Alerts

• Patient Portal• Patient Record Search• Medication History• Chronic Disease Management• Radiology Images• Clinical Decision Support• Outcomes and Incentive Management• Benefit Eligibility and Claims Processing• Care Coordination – Long Term Care

Patient Portal• Keep personal health information and print• Obtain disease-management information• Fill out registration form for medical

appointment and e-mail or print• Request report of audit logs• Future Enhancements

- Review record history in DHIN- Securely communicate with practitioners

Patient Record Search• Review results and reports available in

DHIN• Search capability based on physician-

patient relationship in DHIN• Others search on “need to know” basis

– New physician-patient relationship– Emergency care

• History from May 1, 2007

Patient Record Search duringPhysician Office Visit

The medical practitioner in his or her office will have access to all the information needed to make good clinical judgments at the time and place of care –lab results, radiology reports, hospitalizations, and eventually medications will be at his/her fingertips.

One Standard DHIN Format

Security• HIPAA compliant• Secure VPN • 128-bit SSL encryption• Robust security and access

control model• Complete auditing and logging

Privacy“DHIN has better privacy controls than

paper”• Consumer Advisory Committee• Hospital Privacy Officers• Patient Portal• Patient education at the point

of care

Benefits of DHIN• Saves Time

– Results and Reports Immediately– All results in one place, in one format

• Improves Care– Out of range alerts– Less chance of error– Continuity of information in event of a disaster

• Reduces Cost– Reduces Duplication– Fewer Co-pays from Duplicate Services

• Enhances Privacy – Secure System – Ability to request audit

• Phase I: Strategic Planning (FY05-10)– AHRQ State and Regional Demonstration

• $4.7 million over 5 years• Phase II: Capital Funding

– State and Private Matching Funds (FY07-09)• FY07 = $2.0 million• FY08 = $3.0 million• FY09 = $1.5 million

– National Health Information Network (FY08)• $1.9 million (one year with 2 optional years)

• Phase III: Operations and Maintenance (FY10)– Fee/Subscription Model– Those who benefit will pay

Financing Model: 3 Phases

What physicians are saying about DHIN

“It’s a great product; it saves a lot of time.”“I received a critical result as soon as the test result was

ready—it would normally have been days before I got the information. Because of DHIN, I was able to take immediate action.”

“We get information faster than we would normally.”“DHIN listens to us and responds to our needs very quickly”“We are as pleased as can be. With DHIN, we have taken

days off preparation time for office visits, especially for post-hospital office visits.”

“Technical support has been excellent.”“Set-up is so easy that they couldn’t have made it any

easier.”“Since communication is from provider to provider, DHIN

gives us another way to show we are HIPAA compliant.”

Questions?Call (302) 672-5190