Transcript DHIN Update for the Delaware Health Care Commission 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 Word about ACOs…
2
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, 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
BayHealth
Beebe
CCHS
LabCorp
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 eOrders
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 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
6
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
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 in DHIN)
10
EMR Interfaces
(lab results only – as of Jan 2012)
Certified Interface
Beta Testing
Under Contract
Allscripts Professional
Cerner
BayHealth Hospital-based
practices
STI
GEMMS
Beebe Hospital-based
practices
NextGen
Physicians Xpress
CCHS Hospital-based
practices
eClinical Works
InfoQuest
McKesson
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
840,602
1,318
Maryland
60,539
New Jersey
23,874
Pennsylvania
53,602
Virginia
West Virginia
All Other States
6,816
426
22,772
No State Assigned
160,111
TOTAL UNIQUE PATIENTS
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 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
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
13
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 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 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
What ought to
happen?
What could
happen?
What happened?
18
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