Delaware: An HIE Leader in ROI, Performance & Design

Despite an initial round of federal funding to develop state health information exchanges (HIEs) as part of Obamacare, these clearinghouses were challenged to develop a financially sustainable model. Because it addressed sustainability early, the Delaware Health Information Network is viewed by many as a template for HIE success.

Delaware recognized early on that being a pure exchange would not provide sufficient financial value for hospitals and healthcare providers, Michael Sims, CFO, told me when we met recently at the World Health Congress 2013. In fact, the state’s HIE needed to provide services that went far beyond data transport; it had to replace other costly service alternatives for providers so it would be a win for everyone.

DHIN must enroll and engage as many of the Delaware provider population as possible into the HIE. Enrollment meant providers could receive timely and accurate results, which could also be fed into their electronic health records — thereby optimizing patient care management in an extremely cost-effective way. The HIE planned to pursue volume and drive down the cost per transaction so low that it would be too attractive for physicians and practices to turn down. In fact, DHIN drove down the cost of each transaction to a mere 25 cents.

DHIN delivered value to the public and Delaware’s healthcare providers by creating a safe and secure data location, with 24×7 accessibility of medical test results and other important health information throughout the state. The organization also created easy to understand communications materials, held regular public meetings, and conducted communications campaigns.

In a follow-up conversation with me, Sims explained that he was fortunate to have acquired the skills to develop non-traditional financial sustainability models during his early experience with startups in the financial sector during the early part of his career.

Randy Farmer, director of provider relations and business development at DHIN, joined the conversation and gave me an overview of DHIN’s leadership. Sims and Farmer agreed that one key organizational value shared by the leadership team is “doing the right thing for the citizens of Delaware.” Another key value of DHIN is transparency: The HIE welcomes constructive criticism so it can continue fine-tuning and improving its model over time. In my opinion, these two values make a solid foundation for any organization.

In 2007, the Delaware HIE became the first statewide HIE in the country. The market penetration results are impressive: 100 percent of hospitals and long-term care/nursing facilities and almost 100 percent of physicians who make orders are connected to the HIE. The DHIN holds records of 1.4 million people from all 50 states. Growth has been geometric, with 1 percent adoption in 2007, and about 10 percent in 2008 — until the HIE reached the sustainability tipping point of 42 percent in 2009, Sims said.

Sims and Farmer cited an array of major cost reductions and health benefits, including a 33 percent reduction in high-cost, high-volume lab tests and a 30 percent reduction in radiology tests.

Recently, DHIN received a $2.48 million innovation grant from the federal government to develop a new model focused on better health and lower costs, the executives told me. DHIN is also reaching out to nearby hospitals in Maryland and looking for collaborative, mutually beneficial partnerships with nearby HIEs such as CRISP in Maryland.

DHIN features a community health record with six years of clinical health records. The Maryland HIE does not have this feature yet. I believe a longitudinal health data warehouse could be a vital resource for states and the nation to help improve public health and reduce healthcare costs. To solve privacy concerns, the data could be de-identified using stronger de-identification techniques that are currently being developed. HIEs could actually generate additional revenue by charging fees for sharing the data warehouse. HIEs could approach foundations interested in various causes to help defray the costs of these investments. It will be very interesting to follow how the DHIN success story continues to unfold. 

– Mansur Hasib has served in CIO/CISO and other leadership roles in the public, private, and education sectors.

Written by Mansur Hasib for Internet Evolution,
4/22/2013. https://www.internetevolution.com/author.asp?section_id=1815&doc_id=262341