State Roles

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State Roles What it Takes to Succeed
Building HIE Networks
South Dakota HIT Summit Souix Falls, SD October
7-8, 2008
Paula K. Roy Executive Director Delaware Health
Care Commission
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Agenda

• What is DHIN
• Key Success Factors
• Physician Engagement
• Benefits

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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.
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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
• Missing information is Judged to
• Adversely affect care in 44 of visits
• Delay care in 59 of visits

(JAMA, January 2005)
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A Day in the Life of One Doctors Fax Machine
1 day 1 doctor 115 faxes 10 ads 55 lab results 30
consult reports 19 pharmacy renewals 1 stat
abnormal mammogram that needs immediate attention
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DHIN Governance

• 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.

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DHIN Management

• Hospitals
• Physicians
• Consumers
• Business
• Insurance
• State Government
• Insurance
• Medicaid
• Management Budget
• Public Health
• Technology Information

Project Management Committee
Board of Directors
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Key Success Factors

• Taking the Time to Plan
• Take the Time for Strategic Planning
• Engage Those with Greatest Interest
• Build Consensus Around Functionality and
  Architecture
• Understand the Value for Stakeholders

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Defining What It is
So, oft in theologic wars The disputants, I
ween, Rail on in utter ignorance Of what each
other mean And prate about an Elephant Not one
of them has seen! John Godfrey Saxe
(1816-1887)
Vision
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DHIN Creates Value

• Reliable, secure and available information
• one chance to get it right
• Support physicians regardless of their level of
  technology adoption
• Manage need along the adoption curve
• low-tech vs high-tech physicians
• Eliminate current delivery methods
• Make it affordable

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Physician Access to Technology
Source University of Delaware Center for Applied
Demography and Survey Research, Primary Care
Providers in Delaware 2006
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Physician Use of Technology
Source University of Delaware Center for Applied
Demography and Survey Research, Primary Care
Providers in Delaware 2006
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Current Functions
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What We Do

• Secure Results Delivery
• Lab and Pathology Results
• Radiology Reports
• Admission Face Sheets
• Transcribed Reports
• Public Health Reporting
• Real-time reporting of data from hospitals to the
  Division of Public Healths DERSS system
  (Delaware Electronic Reporting and
  Surveillance System)

• Secure Inbox
• Auto-Print
• - EMR Interface

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Data Senders
gt85 Laboratory Testing Hospital Admissions
Over 1.5 Million Transactions Processed per
Month
Christiana Care Health System
St. Francis Hospital
LabCorp
Quest Diagnostics Doctors Pathology Services
(statewide)
Nanticoke Memorial Hospital
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DHIN Enrollment
Demonstration Phase Completed
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Electronic Medical Records(EMR)

• Helping doctors get more out of their EMR
• 28 of DE primary care providers use EMR
• DHIN delivers results directly to EMR
• 3 EMR vendors connected to DHIN
• 5 EMR vendors testing with DHIN
• DHIN-EMR vendor negotiated discounts
• Medicare EHR Demonstration
• funding to physicians for EMR adoption

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New Functions
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New DHIN Functions

• eOrder Entry
• Patient Record Search
• Patient Portal
• Medication History
• Radiology Images
• Care Coordination Long Term Care/Home Health
• Value Added Physician Workflow Tools

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Future Functions
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State Initiatives

• Dept. of Health and Social Services
• Medicaid
• ePrescribing
• Administrative Savings
• Evaluation
• Physician/Provider Outreach
• Administrative Transactions
• Div. of Public Health
• Biosurviellance Reporting
• Cancer Registry
• Immunizations Registry
• Communicable Disease Registry
• EMS first responder

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State Initiatives (contd)

• Division of Substance Abuse and Mental Health
• Dept. of Services for Children Youth Families
• Dept. of Corrections
• Office of Management and Budget
• Dept. of Technology and Information

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Planned Services 2010-2011

• Enhanced Patient Portal
• Review record history in DHIN
• Securely communicate with practitioners
• Enhanced Public Health Reporting
• Cancer Registry
• Immunizations Registry
• Birth Defects Registry
• Chronic Disease Management
• Clinical Decision Support
• Outcomes and Incentive Management
• Benefit Eligibility and Claims Processing

• Trauma Registry
• First Responders
• - Public Health Alerts

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Key Success Factors

• Sustainability
• Those paying for the system should define the
  model
• Start simple and plan for operational
  sustainability
• Add value functions that bring new stakeholders
  to the table

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Financing Model

• Capital Funding
• State and Private Matching Funds
• AHRQ State and Regional Demonstration
• National Health Information Network
• Maintenance Funding Model
• Fee/Subscription Model
• Data Providers
• Health Plans
• Fair and Equitable

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Benefits of DHIN

• Saves Time
• Results and Reports Immediately
• All results in one place, in one format
• Administrative Savings
• Cleaner Claims Submission Eligibility
  Verification
• Public Health Reporting and Management
• Improves Quality of Care
• More complete information in Emergency Dept.
• Less chance of error
• Connectivity to Personal Health Record
• Continuity of information in event of a disaster

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Benefits of DHIN

• Reduces Cost
• Reduces Duplication of Service
• Improved Case Management
• Fewer Co-pays from Duplicate Services
• Enhances Privacy
• Secure System
• Access Controls
• Audit Reporting

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All who have accomplished great things have had a
great aim, have fixed their gaze on a goal which
was high, one which sometimes seemed impossible

• -Orison Swett Marden

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Questions?

• Paula K. Roy
• [phone]
• Paula.Roy_at_state.de.us
• www.DHIN.org