DHIN Update

Jan Lee, MDExecutive Director

12.06.2012

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• The “Community Health Record”

• Continuing Growth of DHIN

• DHIN and “Meaningful Use”

• A Word about ProAccess

• Near Term Development Initiatives (FY13)

• Vision and Strategic Direction

2

Agenda

The Community Health Record

• Clinical data sent into DHIN hosting center from many sources

• Aggregated into a longitudinal Community Health Record

• Information may be accessed in several ways:– Directly populate a practice EMR through interface– Auto-print for inclusion in a paper record system– View over a web portal (ProAccess)– May be incorporated into a patient-controlled PHR

Data Senders DHINData Receivers

Aggregates all known data about each patient

Auto-print

or

or

PopulateEMR

View data via web portal

•Lab results•Radiology reports•Pathology reports•Hospital ADTs•Transcribed reports•+/- Medication Hx

Provider Adoption of DHIN(as a percent of Delaware ordering providers – Oct 2012)

Denominator = 2,746

64% of these receive results exclusively through DHIN

Radiology Groups (75% by #, ~95% by vol) • Tri-State Open MRI• Papastavros• Ocean Medical

Imaging• Mid-Del Imaging• DE Diagnostic Gp

Health Plans (~43%)•Medicaid•State Employees•BCBS

Current Membership in DHIN (as of November 2012)

Hospitals (100%)• Bayhealth• Beebe• Christiana Care• St Francis• AI duPont• Nanticoke• Atlantic General (MD)

Labs (99%)• Lab Corp• Quest• Drs Pathology Svcs• Med Labs Diagnostics

(NJ)• Accu Reference Labs• Ameritox (B’more)

Providers (96%)• Over 6,000 users in 616

practices

FQHCs (100%)

Skilled Nursing (100%)

Assisted Living (62%)

Home Health (4)

Hospice (3)

Pharmacies (5)

Division of Public Health

Red = new in past yearGray = strong prospect

Unique Patients in DHIN Database(as of June 2012)

Delaware 787,068 District of Columbia 1,516 Maryland 62,726 New Jersey 25,165 Pennsylvania 54,177 Virginia 7,553 West Virginia 470 All Other States 145,443 No State Assigned 251349

TOTAL UNIQUE PATIENTS

1,401,057

Delaware population per 2010 census:897,934

# EMR-DHIN interfaces(one-way results delivery)

Potential Practice Impact(practices currently enrolled in DHIN)

Availability of DHIN Certified Interface

Practices 272 57% of all DHIN practices using an EHR

Providers 1146 FY 13 Goal: 65% of EHR practices have results- delivery interface available

Major Challenge:• 62 EHRs used by members of DHIN• 47% of these are in only one practice• Interest in interfacing to DHIN is low for the vendors with small footprint

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Status of DHIN-EMR Interfaces

iKnowMedMicroMD

PhysiciansXpressSequelMed

Varian

ADSAllscripts (Including Eclipsys)

Bizmatics/PrognosisGE Healthcare (Centricity)

CernerOffice Practicum (Connexin Software)

GEMMSInfoQuest

Med Plus - Care 360NextGen

STI Computer Serviceselectronic Clinical Works (eCW)

McKesson (Practice Partners & Horizon)Elekta

“The Poor Man’s Interface”

A composite Continuity of Care Document

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DHIN Supports “Meaningful Use”

Stage 1• Syndromic surveillance (EH)• Reportable labs to Public Health

(EH)• Immunization reporting (EH, EP)• “Electronic exchange of clinical

information” (EH,EP)• Transitions of Care Summary (EH)

Stage 2• Syndromic surveillance (EH, +/-

EP)• ELR to Public Health (EH)• Immunization reporting (EH, EP)• Patient engagement

(view/download/transmit – EH, EP)

• Summary of Care at TOC (EH, EP)• Access to images (EH, EP)• Cancer registry reporting (EP)• “Other registry” reporting (EP)

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Gray = planned functionality

Near Term Development Initiatives (FY13)

• Additional data senders– Small radiology groups– Prenatal records– State Public Health Lab– Maryland, New Jersey labs

• Data exchange with health plans• Convert to iNexx platform• Radiology image viewing (MU2)• Immunization registry reporting

(MU2)• Bi-directional immunization exchange• eOrders• CCD exchange – (MU2)• Consumer engagement

(view/download/transmit; secure messaging – MU2)

• Connections to Cancer Registry (MU2) and other State registries

• More granular privacy and consent tools to accommodate behavioral health data exchange

• Newborn screening• Quality reporting and population

analytics• Connections to other states, other

HIEs– VA, DoD, SSA– Maryland, Pennsylvania tertiary care

centers– National prescription monitoring

databases• Alerts and notifications

– To PCP for ED visits, hospital admissions/discharges

– To hospitals/EDs regarding 30 day readmissions

• Support for new payment models (PCMH, ACO)

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Long Term Vision: Integrate clinical/financial/patient satisfaction data sources to inform decisions (16 Del Code § 10303)

Benefits Desired• Improved communication within

the healthcare community• Efficiency; eliminate redundancy• Monitor community health status

(population health)• Reduce healthcare costs• Trusted information source for

consumers, purchasers, and providers of care

Users of DHIN• All members of the healthcare

community(Hospitals, labs, pharmacies, imaging

centers, physicians and staff, nursing homes, home health, allied health professionals, etc.)

• Consumers (patients)• Purchasers (to include employers)• Health Plans• Public Health (and other State

agencies)

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A community-based health information network for the benefit of all citizens of Delaware

“The Once and Future DHIN”

Phase 1: The Community Health Record• Transactional, patient-

centric• Supports point-of-care

clinical activities• Supports goals of improved

communication, improved efficiency, reduced duplication, reduced cost

• Supports “Meaningful Use”

Phase 2: Population Level Data Aggregation and Analysis

• Population-centric• Supports analysis, clinical

research, predictive modeling, policy development

• Opportunity to combine clinical and financial/ administrative data sets

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• The highway system across which all health data in Delaware travels

• The post office delivering data where and when it is needed

• A utility cooperative – many users share in the cost of tools needed to support all

• Like a stock exchange brings together buyers and sellers, the HIE brings together data producers and data users

• “Mighty Orbots” – many components connect to form a “superhero” http://www.youtube.com/watch?v=1GzboBND43I&feature=related

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Think of DHIN as…

Questions?