1. 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.

2. 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?

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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)

9. DHIN Phase 1 Priorities
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

10. 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

11. 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

12. 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.

14. One Standard DHIN Format

16. 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)

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

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

19. 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

20. 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

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

22. THANK YOU from
For a Decade of Support!