1. The Nation’s First Statewide Health Information Exchange Robert White DHIN Chair Delaware Physicians Care, Inc. Gina B. Perez DHIN Project Director Advances in Management, Inc. Paula K. Roy Executive Director Delaware Health Care Commission

2. What is it? Why is it needed? Who participates? What does it do? How is it funded? What are the benefits? DHIN

3. 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.

4. 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.

5. 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

6. 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

7. 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%

8. 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

9. 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

10. Christiana Care Health System Initial Data Senders Bayhealth Medical Center Beebe Medical Center LabCorp (statewide) 85% Laboratory Testing & 81% Hospital Admissions Over 1.5 Million Transactions Processed per Month

11. 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

12. 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

13. DHIN Enrollment Demonstration Phase Completed

14. Future Functionality 2008-2011 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

15. 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

16. 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

17. Patient Record Search during Physician 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.

18. One Standard DHIN Format

22. Security HIPAA compliant Secure VPN 128-bit SSL encryption Robust security and access control model Complete auditing and logging

23. Privacy “DHIN has better privacy controls than paper” Consumer Advisory Committee Hospital Privacy Officers Patient Portal Patient education at the point of care

24. 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

25. 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

26. 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.”

27. Questions? Call (302) 672-5190