Delaware Health Information Network

Statewide medical record system touted

(May 24, 2012) – Randy Gaboriault’s mother, Kathleen “Kay”, came down with pneumonia about two months ago, went to a “stand-alone” hospital in Florida, and was prescribed an antibiotic and discharged. She followed up with a primary care doctor. Within a matter of days, she went into cardiac arrest, suffered brain damage and died. Ten days earlier, she had been on the golf course.

Gaboriault, who is chief information officer for Christiana Care Health System, believes her outcome could have been different had the hospital known about the cancerous tumor removed from her lungs years earlier. Maybe it would have kept her instead of sending her home.

But the staff didn’t have access to her medical records and couldn’t better tailor her care to her medical history. As his mother’s health was failing, Gaboriault and his family scrambled to pull all her records together. They were still receiving them four days after she died.

“It was a nightmare,” Gaboriault said.

As Gaboriault’s family learned, a lifetime of health records can become fragmented without a central place to keep them. Often, accessing these records means waiting for phone calls, faxes, records requests and the mail.

But that could change in Delaware. The state has a centralized, electronic warehouse for health information – the Delaware Health Information Network, or DHIN – and the country’s first statewide health information exchange has been going for five years. The concept was born 15 years ago, under the auspices of the Medical Society of Delaware, now-Sen. Mike Katz and then-Gov. Tom Carper, among others.

All of Delaware’s hospitals, nursing homes and federally qualified health centers are enrolled in DHIN, as well as several of Delaware’s hospices, health insurers, imaging centers, pharmacies and nearly all medical laboratories. When patients receive care at any of these places, their health information is fed into the DHIN. Physicians who are enrolled in the DHIN – currently 92 percent of Delaware’s medical providers – can then sign on and access patient health information.

“If a patient came in and said, ‘I had a blood test done by the cardiologist,’ rather than calling and asking them to fax it over, we can access it directly through DHIN very quickly – and we do that every day while in front of the patient,” said Dr. Jerome Abrams, a family practitioner at Dover Family Practice.

People don’t need to be, as Gaboriault put it, integrators of their own care because doctors can use the DHIN to access their information, even if they went to Nanticoke Hospital for a procedure and Lab Corp for tests.

Abrams was one of the beta testers for the DHIN, helping develop the tool to suit the needs of a primary care practice. Others, like the Division of Public Health, use DHIN to track disease outbreaks and to improve surveillance and monitoring. DPH Director Dr. Karyl Rattay said the DHIN could be used to maintain the cancer registry and newborn screening data.

According to Dr. Jan Lee, executive director of the DHIN, it was a place where health information, like test results, landed back in 2007 and fewer than 10 percent of health providers used it. But in 2009, when a search function was added so doctors could find health records, that number jumped to 45 percent. In 2012, that number has more than doubled again.

Dave Walczek, chief information officer at Bayhealth Medical Center and a member of the DHIN board of directors, said they also created a portal that allows DHIN information to automatically feed into physicians’ electronic health records, if they have them. Providers do not need to have electronic records to access information through the DHIN.

Electronic health records adoption is a goal of the 2009 American Reinvestment & Recovery Act, pushing for their “meaningful use” to maintain and utilize health information. Mark B. Thompson, external affairs officer for the Medical Society of Delaware, said 78 percent of society physicians – nearly 75 percent of Delaware’s doctors – have adopted some form of electronic health records. The U.S. average is only as high as 35 percent of hospitals and 46 percent of physicians.

A report this month from the Kaiser Family Foundation states that at least 20 percent of health care expenditures are due to waste, including overtreatment and failure to coordinate care. Kaiser asserts that a lack of efficient, integrated systems to electronically store and transmit health information contributes to higher costs and lower efficiency in health care.

The DHIN may prevent doctors from ordering duplicate tests or prescribing unnecessary medications, and may help them better direct their treatments. This could translate to cost savings and more efficiency, as well as better patient care. The current challenge is getting everyone on board and everyone connected across different technology platforms, though the DHIN has health IT teams on the job.

“Eventually, they say, we will be able to get reports from other physicians, but that hasn’t quite happened yet,” said Abrams.

Randy Gaboriault is also chair of the DHIN and recently experienced firsthand the effectiveness of the network he has helped create. Not long after his mother’s death, the fit man experienced chest pain, which he initially attributed to a pulled muscle, but eventually he was prompted to visit a cardiologist at Christiana Hospital. Because all of Delaware’s hospitals are part of the DHIN, the physician had access to Gaboriault’s blood work from a recent health screening.

After an EKG and a check of the stored blood work, Gaboriault had piece of mind that he had not experienced a heart attack. He also avoided unnecessary tests.

Walczek is excited to see competing health organizations in the state coming together toward DHIN’s common goals, and for the possibilities the DHIN affords Delawareans with respect to managing population health.

“It’s a conduit to bring information back and forth, to see what’s going on with patients, so care is not so fragmented. DHIN is really the glue that can bring it all together.”



“I think it has saved a lot of money particularly for my practice. I’m not getting duplicate faxes sent to me and from other facilities and that’s been a huge resource in terms of time. My staff is not spending time on the phone trying to get results sent. Instead we can just log onto DHIN, verify the patient, and have access to all of that in less than 30 seconds.”

– Sherin Ibrahim-Howett, DO, Sleep and Internal Medicine – The Pearl Clinic

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