DHIN Update for the Delaware Health Care Commission

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DHIN Update for the Delaware Health Care Commission February 2, 2012 Dr. Jan Lee

DHIN Update for the Delaware Health Care Commission February 2, 2012 Dr. Jan Lee Executive Director Delaware Health Information Network

Agenda • • • Acknowledgements DHIN’s Progress Benefits Realization Current and Future Initiatives A

Agenda • • • Acknowledgements DHIN’s Progress Benefits Realization Current and Future Initiatives A Word about ACOs… 2

Acknowledgements • Legislation established DHIN under DHCC 1997 • Medicity awarded technical contract 2006

Acknowledgements • Legislation established DHIN under DHCC 1997 • Medicity awarded technical contract 2006 • May 2007 Became operational – the first state-wide clinical HIE 2007 • New grants • New data senders 2008 - 2009 • New functionality 3

2010 2011 2012 • Legislation spun DHIN out from under DHCC • New Board,

2010 2011 2012 • Legislation spun DHIN out from under DHCC • New Board, new Executive Director, new CIO • Sustainable business plan • Transition from capitalization to sustainable business operations • State financial support shifts from Bond Bill to operational budget • 4

DHIN’s Progress 2007 Data Senders Data Receivers Functionality Bay. Health Beebe CCHS Lab. Corp

DHIN’s Progress 2007 Data Senders Data Receivers Functionality Bay. Health Beebe CCHS Lab. Corp 5 practices Electronic results delivery (lab, rad, ADT, path reports) 2008 Biosurveillance data to DPH 2009 Quest Drs. Pathology Svc 45% of DE providers RLS, CMPI, Query 2 EMR interfaces 2010 St Francis Hosp 65% of DE providers Reportable labs to DPH Transcribed reports • 80% of DE providers • 52% of SNFs Secure messaging (aka “Direct”) 3 EMR interfaces Goals: • 95% of DE providers • 100% of SNFs 4 EMR interfaces (9 more in beta testing) Immunization reporting to DPH Care Summary Exchange Provider Directory Medication Hx PACS links Claims Data Lab e. Orders 2011 2012 AI du Pont/Nemours Tristate Open MRI Nanticoke Several radiology gps Insurers 5

Current Functionality (as of January 2012) • Community Master Person Index (CMPI) • Record

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 Health. Vault PHR 6

Current Membership in DHIN (as of Jan 2012) Hospitals • Bay Health • Beebe

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 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) Radiology Groups (1) 7

Practice Enrollment 8

Practice Enrollment 8

Provider Adoption of DHIN (as a percent of Delaware healthcare providers) 9

Provider Adoption of DHIN (as a percent of Delaware healthcare providers) 9

EMR Interfaces (results delivery only) # EMR-DHIN interfaces Potential Practice Impact (practices currently enrolled

EMR Interfaces (results delivery only) # EMR-DHIN interfaces Potential Practice Impact (practices currently enrolled in DHIN) 10

EMR Interfaces (lab results only – as of Jan 2012) Certified Interface Beta Testing

EMR Interfaces (lab results only – as of Jan 2012) Certified Interface Beta Testing Under Contract Allscripts Professional Cerner Bay. Health Hospital-based practices STI GEMMS Beebe Hospital-based practices Next. Gen Physicians Xpress CCHS Hospital-based practices e. Clinical Works Info. Quest Mc. Kesson Varian Sequel Systems ADS Connexin GE Centricity Henry Shein Micro MD Care 360 (Quest) 11

Unique Patients in DHIN Database (as of Oct 2011) Delaware District of Columbia 840,

Unique Patients in DHIN Database (as of Oct 2011) Delaware District of Columbia 840, 602 1, 318 Maryland 60, 539 New Jersey 23, 874 Pennsylvania 53, 602 Virginia West Virginia All Other States No State Assigned TOTAL UNIQUE PATIENTS 6, 816 426 22, 772 160, 111 1, 170, 060 Delaware population per 2010 census: 897, 934 12

DHIN Benefits Evaluation Objectives of Measurement Conduct “a rigorous evaluation of the data exchange

DHIN Benefits Evaluation Objectives 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 • Evaluation Performed by Maestro Strategies • Evaluated Reports and Data including – – DHIN Management 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 Leadership 13

DHIN Benefits Evaluation Measurement Findings Cost Reduction Measures: Has DHIN impacted cost of care

DHIN Benefits Evaluation Measurement Findings Cost Reduction Measures: Has DHIN impacted cost of care delivery? • 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. DHIN has helped senders and receivers of data reduce their cost in delivering care 14

DHIN Benefits Evaluation Measurement Findings Care Process Effectiveness & Efficiency Measures: Has DHIN improved

DHIN Benefits Evaluation Measurement Findings Care Process Effectiveness & Efficiency Measures: Has DHIN improved provider workflow? • • • 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 DHIN has become part of the workflow - “Did you DHIN the patient? ” and “DHIN-ing” the patient are common phrases among users 15

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

New Initiatives • Providers as data senders (CCD exchange) • Health Plans as both data senders (claims data) and receivers (clinical data) • Consumer engagement - PHR links - ? Patient portal - Home care medical device links - Patient-specific education - Reminders for prevention & FU • 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 16

Blue box indicates functionality DHIN does NOT currently support A Word About ACOs 17

Blue box indicates functionality DHIN does NOT currently support A Word About ACOs 17

What ought to happen? What could happen? What happened? 18

What ought to happen? What could happen? What happened? 18

Policy Questions… • How much of the infrastructure and supporting services should be a

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? 19

Thank You ? ? ? ? 20

Thank You ? ? ? ? 20