Data Sharing Tech Cuts Costs, Bolsters Innovation

Jen Rini, The News Journal, 4/11/16 

When Joann Hasse’s husband slammed his head and started having concussion symptoms, she knew exactly what to do.

The Hasses sped to Wilmington Hospital for an evaluation. Hasse was so eager to have her husband seen by a doctor she parked her car in an spot reserved for ambulances.

But when the doctor began asking questions about her husband’s medical and health history, something Hasse knows intimately, she said she froze.

“I’m so concerned I put my car in an ambulance spot. I dole out his medications every week and put them in little containers,” she recalled. “He doesn’t do it; I do it it. I’m totally blanking on what he’s on.”

That was over 10 years ago. Today, Hasse would have faced an entirely different scenario, one that didn’t rely on her memorizing her husband’s medications.

The Delaware Health Information Network, the first statewide community health record, contains up-to-date patient clinical histories that are synced with electronic medical records. Doctors can pull up a person’s medication history, lab results or hospital admission data in seconds, so the patient doesn’t have to. It shares data between providers on 2.2 million patients, including more than 800,000 Delawareans.

The network, known as the DHIN, will celebrate 10 years in 2017, as such data-sharing technology is exploding in the healthcare sector, driving work to improve patient and physician experiences and clamp down on excess cost and medical testing.

When faced with a stressful situation like a hospital admission, “you are lucky you can remember your own name,” said Hasse, a patient advocate and healthcare chair for the League of Women Voters of Delaware.

Now, records are at the practices’ fingertips, added Randy Farmer, DHIN’s chief operating officer.

“The (healthcare) ecosystem benefits,” Farmer explained, from insurers to patients to doctors. “Healthcare knows no borders.”

Investing in technology is a large component of Delaware’s innovation work to achieve the “triple aim” – improving health, making the health care system work better and lowering costs. The overarching goal of the triple aim is influencing health care systems around the country

Delaware has a lot of work to do in that regard; the state spends $8 billion on healthcare each year, which is about 25 percent more per capita than the national average.

“We have to use every tool,” said Delaware Health Secretary Rita Landgraf.

But there are some challenges with using the data, she explained. Due to Delaware’s small population patients are easily identifiable. Still, data is finally catching up to inform healthcare providers about how to better care for patients, she said, in a way that is “population based.”

For instance the state health department mined Medicaid data in conjunction with emergency department utilization at Christiana Care Health System.

“Everybody assumes people are using the ED for the wrong purposes, for primary care, so we did a deeper dive,” Landgraf said.

They drilled the data down and discovered a trend for women enrolled in Medicaid and who lived on Wilmington’s East Side. Women were more likely to come to the emergency room for treatment of child and maternal issues related to fatigue, premature labor or decreased fetal movements

The women were in fact going to the emergency department for a legitimate reason, Landgraf said, but the visit could have been prevented if they had seen a primary care doctor. The data also showed, she added, how the state could leverage or increase child and maternal health programs.

“It’s how do we use these tools in a way, that we consistently mine them in a way, that informs us and tells us there is a gap in service…how do we bring a solution to the community,” Landgraf said

Dial-up beginnings

Lawmakers signed a bill to authorize the creation of the Delaware Health Information Network in 1997, but it didn’t fully get off and running until 2007.

It started as a “pie in the sky idea,” explained Dr. Joseph Rubacky, of Dover Family Physicians and member of the Medical Society of Delaware, but had immediate benefit.

Back in what he refers to as the dark ages, if one of his patients had blood work done about 50 miles away at Christiana Hospital near Newark, Rubacky would not have had access to the reports.

“We’d have to send them to get blood work again. Same thing with X-rays,” he said.

Now he can search a patient’s medical history with one click.

“It’s been a Godsend for practicing clinicians,” Rubacky added.

Information sharing networks generally struggle, said John Graham, senior fellow for the National Center of Health Policy analysis.

“There is no competitive reason for a hospital to share information with another hospital,” Graham explained.

The DHIN, however, is different: all six statewide hospital systems participate in the network, including 99 percent of laboratory and 95 percent of radiology groups. Three Maryland hospitals also share patient data with DHIN, and Farmer said there are contracts with DC hospitals and MedExpress: Urgent Care Centers in the works as well.

Initially, however, there was some concern about the competitive nature of the data, said Dr. Michael Katz, an anesthesiologist and former state senator who led the effort to create the DHIN.

Katz, who at the time was also active in the Medical Society, said that there was a shift in thinking that moved people from focusing on data as a competitive advantage to one that would link systems to ultimately improve patient care.

“We really realized that we needed to get all the players around the table,” he said.

There were also some issues with funding, since the DHIN was, at first, funded by the government. Katz penned legislation to transition the business to a public-private entity and it has been self-sustaining since 2012.

“We get paid for the products and services we deliver and we use the money from the revenue from those services and products to pay our operating costs as well as to stock away capital reserves,” Farmer explained.

Eventually the organization wants to expand so that hospitals would not have pay a fee for services. Individual practices do not have to pay, they can join for free.

There was talk of implementing a tax on providers to join the DHIN years ago to add to it’s bottom line, but conversations on the topic have since stalled.

“Success of the DHIN depends on 100 percent adoption,” Katz said. “Anything that would be a hindrance or barrier to entry on the provider side would not be beneficial to the DHIN in my opinion.”

New innovation, cost-saving

Between 2009 and 2013, the DHIN reduced duplicate ordering of radiology and lab tests by 21 percent and 64 percent respectively, which saved consumers and insurance companies $10 million annually, Farmer said.

It also has saved practices $885,000 that would have been put toward changing over paper records to an electronic health record interface.

Electronic systems are expensive, said Michael Maksymow, vice president and chief information officer of Beebe Healthcare, and there are only so many certified software companies.

“The gamut can run form the thousands to the millions,” Maksymow said.

The American Recovery and Reinvestment Act of 2009 offered funding to the heathcare industry that included about $25 billion for technology investments, Maksymow explained. The incentives helped implement electronic medical records and the death of paper files.

Since that time, the DHIN has secured a $4.1 million grant and $2.7 million grant from the feds.

Aside from cost-saving, the bigger picture encompasses utilizing tech to provide and transform the way patients are cared for, Maksymow said.

Systems, at least at Beebe Makdymow said, are made for clinical staff not IT gurus, but staff are still explicitly trained before any new system goes live.

“We are implementing new systems every day,” Maksymow said. “The software and the systems can see things sometimes before humans can.”

For instance, it’s possible to plug in an algorithm that can tell when someone is going septic by their changing vital signs.

Electronic medical records can also capture population health trends, for higher risk patients. Now doctors can track whether a diabetic patient saw a primary care, is tracking glucose levels and gotten a foot exam.

“We can intercede in many cases before the patient becomes chronic,” he said.

DHIN’s grant dollars will be used to launch a new smartphone app and a patient portal, which would give patients access to all their medical information from doctors, specialists and hospitals.

DHIN is partnering with mPulse Mobile to develop a two-way mobile messaging solution to connect consumers to their own and loved ones personal health information. Text messages would alert patients when their medical results have been delivered and when records have been accessed, and by whom. Farmer said the new programs hopefully will be available by the summer.

Early focus group data shows that people want a peace of mind when it comes to healthcare tech, Farmer said, which is why advancement of a portal and consumer monitoring system is crucial.

“We are going to be more on the radar for consumers,” Farmer said. “It’s data as a service.”

Challenges

The future of technology seems bright, but there are major challenges to address along the way.

“It’s kind of a perfect storm because as we all implemented electronic medical records now the cyber criminals are really discovering how lucrative identity theft has become,” Maksymow said.

Healthcare data is more valuable that credit cards, he said, because there are credit limits and typically a crunched amount of time before the lost card gets discovered. Patient data contains demographic, personal and insurance information.

“That is much more lucrative for criminals,” he said.

Data is potentially easier to access, too. A Christiana Care Health System customer recently discovered a flaw in the hospital system’s online payment method, but officials have said there is no evidence patient information was compromised.

Previously someone would need to go into an office and physically pull medical charts in order to steal patient information, Maksymow, the Delaware Healthcare Association appointee to Gov. Jack Markell’s Cyber Security Council, explained.

Now hackers can tap into online databases and some hospitals have over 100 systems.

The good news is most organizations go through rigorous review processes and train staff on how to scrutinize basic things like their emails.

“We have to change our culture. We must improve our cyber hygiene,” Maksymow said.

“We don’t educate them (staff) in a way that is just because it’s hospital policy. If we did that it would just set us sup for failure. We can’t rely on memory. We have to make it intuitive.”

If people take the lessons homes to their family and share the information it is a success.

The DHIN has not had a security breach, but the organization has had its share of issues with network speed. Sometimes there are issues with a physician office’s internet service provider, other times it’s an issue on our end, Farmer said.

Recently DHIN had a software upgrade through its vendor Medicity to get a new slicker interface, he said, but it made the server slow in retrieving records and increased error messages. It was nothing like the epic Obamacare healthcare glitches, but for a large catalog it would take up to 45 seconds before records would appear.

“We are well past that point now, but we are still quite vigilant to get the remaining echoes of problems resolved,” Farmer said. “It’s a complex ecosystem. We are grateful to have these problems in a way because it means we have a network that is worth accessing.”

Jen Rini can be reached at (302)324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.


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    “The Medical Society of Delaware has long supported the DHIN and recognizes the critical importance of health information exchange as a foundation to high quality and coordinated care. Ensuring that Delaware physicians have the critical information they need at their fingertips and enabling them to coordinate care across providers is a critical step toward supporting positive health outcomes and healthier Delawareans – a goal we are all working toward.” 

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