DHIN Update for theDelaware Health Care

Commission

February 2, 2012

Dr. Jan LeeExecutive Director

Delaware Health Information Network

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Agenda

• Acknowledgements• DHIN’s Progress• Benefits Realization• Current and Future Initiatives• A Word about ACOs…

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Acknowledgements

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DHIN’s Progress

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Current Functionality(as of January 2012)

• Community Master Person Index (CMPI)• Record Locator Service (RLS)• Results delivery (from data sender to ordering provider)

– Labs– Radiology Reports– Admission, Discharge, Transfer (ADT)– Pathology Results– Transcribed Reports

• Query (search for unknown data)• Public Health Syndromic Surveillance Reporting

– Emergency Room chief complaint– Reportable labs (currently testing for enhanced data feeds)

• Certified electronic medical record(EMR) interfaces (4 certified, 9 in beta testing, 4 under contract)

• Secure messaging– Immunization reporting– Connection to HealthVault PHR

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Current Membership in DHIN

(as of Jan 2012)Hospitals• Bay Health• Beebe• Christiana• St Francis

• AI du Pont

Labs• Lab Corp• Quest• Drs Pathology Svcs

Radiology Groups (1)

Providers • Over 5,000 users in more

than 500 practices

Home Health Agencies (4)

Skilled Nursing Facilities (28)

Long Term Care (2)

Assisted Living (1)

Hospice (3)

Pharmacies (5 in process)

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Practice Enrollment

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Provider Adoption of DHIN(as a percent of Delaware healthcare providers)

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EMR Interfaces (results delivery only)

# EMR-DHIN interfaces Potential Practice Impact(practices currently enrolled in DHIN)

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EMR Interfaces(lab results only – as of Jan 2012)

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Unique Patients in DHIN Database

(as of Oct 2011)

Delaware 840,602 District of Columbia

1,318

Maryland 60,539 New Jersey 23,874 Pennsylvania 53,602 Virginia 6,816 West Virginia 426 All Other States 22,772 No State Assigned 160,111

TOTAL UNIQUE PATIENTS

1,170,060

Delaware population per 2010 census:897,934

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• Evaluation Performed by Maestro Strategies

• Evaluated Reports and Data including– DHIN Management Reports– Reports generated from DHIN database– User Logs & Access– Test Results

• Conducted Interviews & Focus Groups with– Consumer Advisory Committee– Clinical Advisory Group– Emergency Room Physicians– Practice Managers/Office Managers Using DHIN– DHIN Leadership

DHIN Benefits EvaluationObjectives of Measurement

Conduct “a rigorous evaluation of the data exchange program” to assess the nature and extent to which DHIN had an impact on important patient safety, quality processes, and outcomes within the state

Requirement of DHIN’s AHRQ Contract

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DHIN Benefits EvaluationMeasurement Findings

• Over $2 million in savings for data senders with providers who utilize the DHIN – Based on the average cost to send results compared to using traditional methods of fax and

mail

• Additional potential savings of $1 million could have been realized for the same period if all DHIN member providers used DHIN as primary source of results reporting

• Providers have reduced resource requirements related to results receipt and processing

• Significant savings can be realized when providers utilize DHIN to connect their EHRs to meet HITECH Meaningful Use Requirement for interoperability vs. point to point approach. Comparing point to point cost vs. DHIN connection:

– Estimated implementation cost savings of between $18,500 and $28,500 can be realized by each provider practice

– Across all providers, total potential savings estimated at $7.5 million in one-time costs and $1.5 million in annual costs.

Cost Reduction Measures: Has DHIN impacted cost of care delivery?

DHIN has helped senders and receivers of data reduce their cost in delivering care

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DHIN Benefits EvaluationMeasurement Findings

• End users interviewed, without exception, indicated that using the DHIN information, was part of their workflow.

• Provider use of DHIN to access information on “new” patients increased ten-fold between July 2010 and June 2011

• Data and interviews demonstrated the DHIN is searched for results and reports to support effective and efficient care

• Providers interviewed consistently agreed data provided in the DHIN will have an impact on care delivery including reduction in duplicate tests

• For select high cost and high volume tests, the rate of test results per unique patient sent through the DHIN in June 2011 as compared to June of 2009 was 30 percent lower for radiology exams and 33 percent lower for lab results

Care Process Effectiveness & Efficiency Measures: Has DHIN improved provider workflow?

DHIN has become part of the workflow - “Did you DHIN the patient?” and “DHIN-ing” the patient are common phrases among users

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New Initiatives• Providers as data senders (CCD exchange)• Health Plans as both data senders (claims data)

and receivers (clinical data)• Consumer engagement

• All Payer Claims Database (population management tools) – DHIN’s role TBD

• Clinical quality reporting tools• Improved tools to manage transitions in care• Connections to other states, other HIEs

- PHR links- ? Patient portal- Home care medical device links

- Patient-specific education- Reminders for prevention & FU

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A Word About ACOsBlue box indicates functionality DHIN does NOT currently support

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What happened?

What could happen?

What ought to happen?

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Policy Questions…

• How much of the infrastructure and supporting services should be a shared utility?

• Governance, financing of data aggregation and analytics

• New skills required for analytics – build vs buy? Hire vs contract?

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Thank You