Delaware Health Information Network: A Step Ahead in Healthcare

The Silicon Review

“We have been much focused on creating services that our community values enough to pay for at a price point that enables us to continue delivering the services.”

Delaware Health Information Network (DHIN) is a public instrumentality of the State of Delaware, created by statute in 1997 as a public-private partnership to address the need to securely exchange health data between care settings (hospital to doctor’s office to laboratory to nursing home, etc.) and assist Public Health and other State authorities in collecting and analyzing health data required in the course of their work. Initially established within a state agency, the direction of DHIN was determined by a board representing the various stakeholder groups, with day to day operations overseen by a contracted Executive Director. From 2006, when DHIN first acquired the technology tools to “go live” with health data exchange, through 2010, the funding stream to support DHIN’s work was an almost equal blend of federal grants, a state capital appropriation over five years, and private funding sources. The intent was always that DHIN would develop to a point of financial sustainability without State financial support.

In a Conversation with Dr. Jan Lee, Delaware Health Information Network CEO

Services: That Aid DHIN Outshine Competitors

DHIN’s flagship services are (a) electronic delivery of test results and reports to the ordering healthcare provider, and (b) the “Community Health Record,” which is an aggregated, longitudinal compilation of health data for each patient in the database, regardless of the site where the care was rendered. DHIN employs technical and administrative safeguards to ensure that only those with a legitimate reason to access a patient’s data are able to do so and audits all activity within the network very rigorously.

Going Above and Beyond

Because DHIN receives data in near real time on Delaware residents from hospitals and emergency departments in a six-state region, we are able to provide alerts and notifications to the patient’s primary care provider when a patient is discharged from a participating facility. This enables the primary care provider to reach out to the patient and initiate early follow up, which has been shown to improve health outcomes and reduce the number of readmissions or repeat ER visits. The most important benefit is better outcomes for the patients, but it also lowers the total cost of care. DHIN began delivering results and reports on behalf of its first participating hospitals and laboratories in 2007. Nearly every year since then, additional “data senders” have joined the network, and today, over 240 healthcare organizations contribute health data. This has enabled DHIN to develop other services to “make the data useful.”

Taking the Bull by the Horns

The biggest challenge for DHIN was finding a way to deliver a public good within a sustainable business model. The company has always viewed federal and state financial support as a jumpstart, not a source of ongoing revenue. “We have been much focused on creating services that our community values enough to pay for at a price point that enables us to continue delivering the services. In spite of millions of dollars in federal financial assistance, many public Health Information Exchanges (HIEs) across the country have failed to achieve a sustainable business model that would enable ongoing service delivery without government funding.”

Leading from the Front

DHIN is a leader, absolutely. “We were the first state-wide HIE in the nation, and have numerous other firsts to our credit. We are seen as a leader within our industry. We do formulate our own core values. Several years ago, we sought direct input from our employees to articulate what makes someone a ‘DHIN person’.”

Committed to Staying Ahead of the Curve

DHIN seeks feedback from its customers through periodic surveys of satisfaction, but also through site visits and face-to-face encounters from C-suite down to end users. “We seek internal feedback regarding how each work group within DHIN supports the others. Our managers do peer reviews for each other annually. We require formal written performance feedback from managers to employees at least once during each reporting cycle before end-of-year performance reviews.”

Products: To be Launched

DHIN has been authorized by the Delaware General Assembly to administer an All Payer Claims Database in addition to the clinical data services that the company has provided for over a decade. “As far as we know, Delaware is the only state in which the clinical HIE and the APCD are administered by the same organization. This provides a unique opportunity to combine clinical and claims data in ways that can help answer questions of both total cost of care and total quality of care across time and care settings. We believe that the analytics service line will get a big boost from the addition of claims data.”

About | Dr. Jan Lee

Dr. Jan Lee is a Family Practice physician with over 30 years of leadership experience, including 23 years in the US Air Force, from which she retired at the rank of Colonel in the unexpected position of Chief Information Officer of the Air Force Medical Service, where she helped steer the management of a $3.2B IT portfolio supporting military health activities worldwide. Following retirement from the Air Force, she served five years first as a physician consultant and then as Vice President in charge of clinical content development for NextGen Healthcare’s electronic health record. Dr. Lee left NextGen to assume her current role at DHIN in March 2011. Under her leadership, DHIN has become the hub of a health information ecosystem in Delaware, and participation in one or more DHIN services is nearly universal across the Delaware healthcare community.