First Again

Among other things the healthcare system seems to need is a standardized system of electronic record keeping. It so happens Delaware has developed one.

Gina Perez (left) is executive director of the Delaware Health Information Network. Rob White is chairman of the board. Photograph by Christian KayeThe first state to sign the U.S. Constitution is also the first to drag its sharing of medical information into the new century. The Delaware Health Information Network, a collaboration between government, medical practices, hospitals and the insurance industry, allows for efficient and private transfer of medical information among those who need it most.

That means healthcare providers, specialists and technicians can dramatically cut the time it takes to access forms, films, lab results and other documents. And that’s good news for everyone.

DHIN basically acts as a post office for healthcare and insurance professionals, allowing them to share vital information about patient treatments, insurance coverage and medical benefit payments, says Gina Perez, executive director of DHIN.

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And much like the post office, DHIN ensures privacy by serving as the conduit for information. Medical and insurance records are still maintained by physicians’ practices, hospitals and insurance companies, but once those records have been digitized and transmitted through DHIN, they become instantly accessible to anyone who needs them. Access is controlled at every turn to ensure privacy, in accordance with the Health Insurance Portability and Privacy Act.

Easy sharing provides many benefits, Perez says. Not only does it save doctors valuable time in accessing reports, but the format of the reports is uniform, thus reducing mistakes made due to variations in forms or other paperwork. Improved accuracy and reduced paper use means reduced costs for everyone—patients included—because there will be fewer instances of repeated tests, unnecessary medications or unnecessarily extended hospitalizations.

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“All that happens in real time,” Perez says. “As soon as the result is complete at the lab or hospital, the information gets right to the doctors.”

Delaware may have been the first of the 50 states to implement such a program, but DHIN was no overnight success. Seeds for the program were planted in 1997, when the prospect of large-scale Internet connectivity still seemed a long way off.

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That year, during the administration of then-Governor Tom Carper, the General Assembly passed legislation to form a statewide network that would link all players in the exchange of medical records, results and other information. The law allowed Delaware to organize those parties that would be essential to the result.

Through Delaware Health Information Network, doctors will dramatically cut the time it takes to receive patient results and reports. The format of those reports is uniform, thus reducing mistakes made due to variations in forms or other paperwork. Improved accuracy and reduced paper use means reduced costs for everyone—patients included—because there will be fewer instances of repeated tests, unnecessary medications or unnecessarily extended hospitalizations.

“The state during Tom Carper’s administration was very interested in promoting the concept,” says Rob White, chairman of the DHIN board and CEO of Delaware Physicians Care, an AETNA Medicaid health plan that serves more than 80,000 Delawareans. “We were kind of ahead of our time. We created this thing legislatively at a time when the technology didn’t exist to connect all the providers.”

Early participants included the Medical Society of Delaware and Blue Cross/Blue Shield of Delaware. During initial meetings, it became clear that the potential stakeholders were moving—though independently—in the same direction as the state.

The primary task for Delaware then became convincing all parties that a centralized, uniform system would benefit them more than a system of their own.

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“People were competing based on how fast they adopted the technology and using the technology to create their competitive edge and marketing strategy,” White says. The state emphasized the need for a common technological basis for DHIN, as well as an agreement that the system would be accessible to everyone.

That required all the groups that would join DHIN to agree on document formats and procedures that would make the information clear and consistent for all. Laboratory companies such as LabCorp and Quest Diagnostics Corp., for instance, had to commit to a standardized lab results form that would be used in both hard copy and electronic formats.

By 2006 the effort evolved to the point where participants could envision the network as something more than conceptual. The secret ingredient to moving things forward? Money.

“From 1997 to about 2004 or 2005, we had lots of conversations about how [DHIN] would happen and what we would take on first,” White says. “It wasn’t really until Senator Carper got us some funding through the federal government that we had the opportunity to map out what we wanted to accomplish, to get that on the street and get responses from vendors.”

In that year, Carper, who had since been elected a U.S. senator, teamed with fellow U.S. Senator Joe Biden and U.S. Representative Mike Castle to secure $4 million in federal funding for the project. The cash enabled the state to hire Medicity Inc., a Salt Lake City, Utah-based health information networking firm, to create a system for Delaware’s health information. Medicity teamed with Perot Systems of Plano, Texas, to provide infrastructure basics such as data center services, help desks for providers and outreach service.

The two companies working in tandem allowed Delaware to keep costs low, Perez says, because the systems and technology were essentially “off the shelf,” with some customizing based on Delaware’s specific needs.

One of the primary challenges in setting up the DHIN, White says, was getting all the players into a room to decide on what documents, forms and reports should look like. It was a situation where Delaware’s size served it well.

“The main advantage we’ve had over other states is that our small size in Delaware has enabled us to coalesce very complicated issues and get [the players] to agree on them,” White says. “It’s been a very big key to our success. When other states visit us—and we’re far enough ahead that we’ve actually been visited by seven other states and the Emirate of Dubai—the one thing that they’re all amazed with is the extent to which we’re speaking with one voice.” 

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