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

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

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

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

5. 5 DHIN’s Progress Data SendersData ReceiversFunctionality 2007 BayHealth Beebe CCHS LabCorp 5 practicesElectronic results delivery (lab, rad, ADT, path reports) 2008 Biosurveillance data to DPH 2009 Quest Drs. Pathology Svc 45% of DE providersRLS, CMPI, Query 2 EMR interfaces 2010 St Francis Hosp65% of DE providersReportable labs to DPH Transcribed reports 2011 80% of DE providers 52% of SNFs Secure messaging (aka “Direct”) 3 EMR interfaces 2012 AI du Pont/Nemours Tristate Open MRI Nanticoke Several radiology gps Insurers 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 eOrders

6. 6 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

7. 7 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)

8. 8 Practice Enrollment

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

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

11. 11 EMR Interfaces (lab results only – as of Jan 2012)

12. 12 Unique Patients in DHIN Database (as of Oct 2011) Delaware840,602 District of Columbia1,318 Maryland60,539 New Jersey23,874 Pennsylvania53,602 Virginia6,816 West Virginia426 All Other States22,772 No State Assigned160,111 TOTAL UNIQUE PATIENTS1,170,060 Delaware population per 2010 census: 897,934

13. 13 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 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

14. 14 DHIN Benefits Evaluation Measurement 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

15. 15 DHIN Benefits Evaluation Measurement 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

16. 16 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

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

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

19. 19 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?

20. 20 Thank You