The Nation’s First Statewide Health Information Exchange Presentation to the Delaware Health Care Commission May 3, 2007 Robert White DHIN Chair Delaware Physicians Care, Inc. Gina B. Perez DHIN Project Director Advances in Management, Inc.

Agenda What is DHIN? Why do we need it? Who participates in DHIN? What does it do? How is it funded? What are the benefits?

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 Governance Structure Statutorily Created in 1997 Public-Private Board of Directors under the Delaware Health Care Commission Active Executive Committee Multi-Stakeholder Project Management Team Consumer Advisory Committee Clinical User Group

What is DHIN? Secure network for distributing clinical results and reports from the hospital, lab or radiology center to the treating physician Data is managed by those who order the test and those who perform the test

Timeline Year Activity Funding Source 2001 HIE Concept Embraced DHCC Pilot Funds 2004 Project Director Contracted Longwood Foundation & Federal Funding (beginning in Sept. 2005) 2005 Requirements Definition Began Federal AHRQ* Funding Secured State Funding thru DHCC & Federal Funding 2006 IT Vendor Selected System Implementation Began State, Private and Federal Funding 2007 DHIN CIO Hired Federal Funding System Go-Live *Agency for Healthcare Research and Quality

Why do we need it? Most Doctors receive laboratory results from 5 different labs all sending results in a different format and method Clinicians who use computerized records system are more likely to adhere to clinical guidelines

Why do we need it Missing information is Judged to: 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 Medications - 3.2% Dictation - 5.4% (“JAMA”, January 2005)

DHIN Phase 1 Priorities 2006-2007 Secure results/reports delivery to ordering physician Lab/Pathology Results Radiology Reports Admission, Discharge & Transfer Reports Admission Face Sheets/Demographics Security access controls Audit processing & reporting Electronic Medical Record (EMR) interfaces Consumer participation via Consumer Advisory Committee

Phase 1 Data Senders Bayhealth Medical Center Account for: 85% Kent Milford Beebe Medical Center Christiana Care Health System Christiana Wilmington LabCorp Account for: 85% Laboratory Testing & 81% Hospital Admissions in Delaware

Phase 1 Data Receivers Cardiology Consultants CN-MRI 16 offices statewide 30 physicians EMR CN-MRI 2 locations in Kent County 9 physicians Nephrology Associates 8 offices statewide 21 physicians Electronic Inbox Dover Family Practice 1 location in Kent County 4 physicians Electronic Inbox Georgetown Family Medical 1 locations in Sussex County 2 physicians Fax and Electronic Inbox Total: 28 practice sites 66 physicians

A Day in the Life of One Doctor’s Fax Machine 115 faxes 10 ads 55 lab results 30 consult reports 19 pharmacy renewals 1 stat abnormal mammogram that needs immediate attention A Day in the Life of One Doctor’s Fax Machine Case in point. As you can see, it’s a noisy world. It’s also a world where every result is precious.

One Standard DHIN Format

Security HIPAA compliant Secure Virtual Private Network (VPN) 128-bit secure socket layer (SSL) encryption Complete auditing and logging Data management at the source system 1st 2 – scalability Last 2 - reliability SSL –secured socket layer SAN - Storage Area Network Use RFP to refer to metrics Internet explorer is preferred but others will work (e.g., firefox)

DHIN Phase 2 Priorities Future Priorities 2007-2008 MSDHub – Value Added Services Patient Centric History Medication history Public Health reporting Consumer participation via Patient Portal Electronic order entry Future Priorities 2009-2011 Chronic Disease Management Outcomes and Incentive Management Benefit Eligibility and Claims Processing

Physician Use of Technology Source: University of Delaware Center for Applied Demography and Survey Research, Primary Care Providers in Delaware 2006

Physician Interest – Next Wave 66 Physician Practices 21 in Kent County 18 in New Castle County 23 in Sussex County 4 statewide Practices 29 Primary Care Practices 33 Specialty Practices 4 Federally Qualified Health Centers

Benefits of DHIN Improved Patient Care Reduced “Hassle Factor” More complete clinical information Better communication Reduced “Hassle Factor” Information available at appointment Fewer forms to fill out

Benefits of DHIN Reduced Healthcare Costs Increased Efficiencies Fewer duplicated tests Better medication management Increased Efficiencies Greater productivity Reduced delivery/mailing costs

THANK YOU from For a Decade of Support!