DHIN Update

1. DHIN Update Jan Lee, MD Executive Director 12.06.2012

2. Agenda • The “Community Health Record” • Continuing Growth of DHIN • DHIN and “Meaningful Use” • A Word about ProAccess • Near Term Development Initiatives (FY13) • Vision and Strategic Direction

3. The Community Health Record • Clinical data sent into DHIN hosting center from many sources • Aggregated into a longitudinal Community Health Record • Information may be accessed in several ways: • Directly populate a practice EMR through interface • Auto-print for inclusion in a paper record system • View over a web portal (ProAccess) • May be incorporated into a patient-controlled PHR

4. Data Receivers Data Senders DHIN Auto-print Aggregates all known data about each patient or Populate EMR • Lab results • Radiology reports • Pathology reports • Hospital ADTs • Transcribed reports • +/- Medication Hx or View data via web portal

5. Provider Adoption of DHIN(as a percent of Delaware ordering providers – Oct 2012) 64% of these receive results exclusively through DHIN Denominator = 2,746

6. Current Membership in DHIN (as of November 2012) Red = new in past year Gray = strong prospect • Radiology Groups (75% by #, ~95% by vol) • Tri-State Open MRI • Papastavros • Ocean Medical • Imaging • Mid-Del Imaging • DE Diagnostic Gp • Health Plans (~43%) • Medicaid • State Employees • BCBS Hospitals (100%) • Bayhealth • Beebe • Christiana Care • St Francis • AI duPont • Nanticoke • Atlantic General (MD) Labs (99%) • Lab Corp • Quest • Drs Pathology Svcs • Med Labs Diagnostics (NJ) • Accu Reference Labs • Ameritox (B’more) Providers (96%) • Over 6,000 users in 616 practices FQHCs (100%) Skilled Nursing (100%) Assisted Living (62%) Home Health (4) Hospice (3) Pharmacies (5) Division of Public Health

7. Unique Patients in DHIN Database(as of June 2012) Delaware population per 2010 census: 897,934

8. # EMR-DHIN interfaces (one-way results delivery) Potential Practice Impact (practices currently enrolled in DHIN) • Major Challenge: • 62 EHRs used by members of DHIN • 47% of these are in only one practice • Interest in interfacing to DHIN is low for the vendors with small footprint

9. Status of DHIN-EMR Interfaces McKesson (Practice Partners & Horizon) Elekta iKnowMed MicroMD PhysiciansXpress SequelMed Varian ADS Allscripts (Including Eclipsys) Bizmatics/Prognosis GE Healthcare (Centricity) Cerner Office Practicum (Connexin Software) GEMMS InfoQuest Med Plus - Care 360 NextGen STI Computer Services electronic Clinical Works (eCW)

10. “The Poor Man’s Interface” A composite Continuity of Care Document

11. DHIN Supports “Meaningful Use” Stage 1 Stage 2 Syndromic surveillance (EH, +/-EP) ELR to Public Health (EH) Immunization reporting (EH, EP) Patient engagement (view/download/transmit – EH, EP) Summary of Care at TOC (EH, EP) Access to images (EH, EP) Cancer registry reporting (EP) “Other registry” reporting (EP) • Syndromic surveillance (EH) • Reportable labs to Public Health (EH) • Immunization reporting (EH, EP) • “Electronic exchange of clinical information” (EH,EP) • Transitions of Care Summary (EH) Gray = planned functionality

12. Near Term Development Initiatives (FY13) • Additional data senders • Small radiology groups • Prenatal records • State Public Health Lab • Maryland, New Jersey labs • Data exchange with health plans • Convert to iNexx platform • Radiology image viewing (MU2) • Immunization registry reporting (MU2) • Bi-directional immunization exchange • eOrders • CCD exchange – (MU2) • Consumer engagement (view/download/transmit; secure messaging – MU2) • Connections to Cancer Registry (MU2) and other State registries • More granular privacy and consent tools to accommodate behavioral health data exchange • Newborn screening • Quality reporting and population analytics • Connections to other states, other HIEs • VA, DoD, SSA • Maryland, Pennsylvania tertiary care centers • National prescription monitoring databases • Alerts and notifications • To PCP for ED visits, hospital admissions/discharges • To hospitals/EDs regarding 30 day readmissions • Support for new payment models (PCMH, ACO)

13. Long Term Vision: Integrate clinical/financial/patient satisfaction data sources to inform decisions (16 Del Code § 10303) A community-based health information network for the benefit of all citizens of Delaware Benefits Desired Users of DHIN All members of the healthcare community (Hospitals, labs, pharmacies, imaging centers, physicians and staff, nursing homes, home health, allied health professionals, etc.) Consumers (patients) Purchasers (to include employers) Health Plans Public Health (and other State agencies) • Improved communication within the healthcare community • Efficiency; eliminate redundancy • Monitor community health status (population health) • Reduce healthcare costs • Trusted information source for consumers, purchasers, and providers of care

14. “The Once and Future DHIN” Phase 1: The Community Health Record Phase 2: Population Level Data Aggregation and Analysis Population-centric Supports analysis, clinical research, predictive modeling, policy development Opportunity to combine clinical and financial/ administrative data sets • Transactional, patient-centric • Supports point-of-care clinical activities • Supports goals of improved communication, improved efficiency, reduced duplication, reduced cost • Supports “Meaningful Use”

15. Think of DHIN as… • The highway system across which all health data in Delaware travels • The post office delivering data where and when it is needed • A utility cooperative – many users share in the cost of tools needed to support all • Like a stock exchange brings together buyers and sellers, the HIE brings together data producers and data users • “Mighty Orbots” – many components connect to form a “superhero” http://www.youtube.com/watch?v=1GzboBND43I&feature=related

16. Questions? ? ? ? ? ? ? ? ?