State and Regional Demonstration in Health Information Technology: Delaware

The Delaware Health Information Network (DHIN), a public-private partnership implemented a real-time electronic method for health care providers to obtain information about their patients. This project is one of six AHRQ-sponsored State and Regional demonstration projects that began in late 2004 and early 2005 to create a State or regional health information exchange (HIE).

The DHIN exchanges data among hospitals, reference laboratories, physician practices, and public health agencies through the State. Partners include consumers, physicians, hospitals, businesses, payers, government agencies engaged in health care, and reference laboratories. The DHIN board of directors is comprised of diverse organizations representing the primary stakeholders of the HIE. They include consumers, physicians, hospitals, health plans, business, higher education, and State government agencies responsible for population health and information technology.

The objectives of the project were to:

• Improve care of patients served by Delaware’s health care system, and reduce medical errors associated with inaccurate or incomplete information available to providers.
• Reduce the time and financial costs of HIE by reducing the complexity of current distribution methods and increasing use of electronic means.
• Improve communication between health care providers and patients to provide appropriate, timely care that is based on the best available information.
• Reduce the number of duplicative tests and expedite the reporting of consultant opinions and tests/ treatments between specialists and the referring physicians.
• Improve the efficiency and value of electronic health record (EHR) systems in physicians’ offices, and assist physicians that do not have an EHR to better organize and retrieve test results.

Through implementation of technology, commitment of hospitals and reference laboratories that submit results data to the DHIN, and systematic enrollment of providers, DHIN established the infrastructure and data penetration required to carry out the objectives of this project. The reach of the project is significant and has included 75 percent of Delaware hospitals and all major reference laboratories that provide results data to over 435 provider practices with multiple users.

Both the quantitative and qualitative measures demonstrated that while DHIN continues to push data to providers, those same providers are retrieving data from the DHIN at increasing rates. End users interviewed indicated that using the DHIN information was a consistent part of their workflow. Provider use of the DHIN to access information on patients presenting for treatment where a prior clinical relationship was not established in the DHIN increased ten-fold. This data, combined with interview information, demonstrates the DHIN is searched for results and reports to support effective and efficient care. Among health care providers interviewed, there was consensus that data provided in the DHIN will have an impact on care delivery including reduction in duplicate tests. This was supported with an analysis of results for tests that are often high cost and high volume. 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 also had an effect on cost for both providers and data senders beyond those recognized from workflow improvements related to patient care. Compared to the average cost to send results using traditional methods of fax and mail, data senders serving providers who utilize the DHIN as the primary method for receiving results have saved more than 2 million dollars. Additional savings of 1 million dollars could have been realized for the same period if all DHIN member providers were committed to use the DHIN as their primary source of results reporting. By comparing the cost to interface via point to point methodology versus through the DHIN, an estimated implementation cost savings of between $18,500 and $28,500 can be realized by each provider practice.