DHIN Update for the Delaware Health Care Commission February 2, 2012

1. DHIN Update for theDelaware Health Care CommissionFebruary 2, 2012 Dr. Jan Lee Executive Director Delaware Health Information Network

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

3. Acknowledgements

5. DHIN’s Progress

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. 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. Practice Enrollment

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

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

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

12. Unique Patients in DHIN Database(as of Oct 2011) Delaware population per 2010 census: 897,934

13. DHIN Benefits EvaluationObjectives of Measurement • 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 • 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. DHIN Benefits EvaluationMeasurement 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

15. DHIN Benefits EvaluationMeasurement 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

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

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

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

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. Thank You ? ? ? ? ? ? ? ? ? ?