The Value of Health Information Exchange: Creation of a Health Information Ecosystem

Dr. Jan Lee, CEO, Delaware Health Information Network

The Delaware Health Information Network (DHIN) is the first live, statewide health information network in the nation.  Among its significant accomplishments are financial self-sustainability, near universal participation in core services, connectivity beyond the Delaware state boarders and Stage 7 of 7 on the eHealth Initiative HIE Maturity Model.  In 2011, Maestro conducted “a rigorous evaluation of the value DHIN’s data exchange program to assess the nature and extent to which DHIN had impact on important patient, safety, quality, processes and outcomes within the state”.   Recently, we invited Jan Lee, MD, CEO of DHIN to share the broader Vision, lessons learned and value of health information exchange. 

Over time, I’ve come to define HIE less as a health information exchange and more as a ‘health information eco-system.’  While many in healthcare view the benefit of health information exchange from a cost savings perspective, I view HIEs as a biosphere, where everyone contributes and everyone receives value.  Now it certainly doesn’t happen overnight.  As an early pioneer, there wasn’t a playbook.  We had one chance to get it right, no chance for a do-over.  We were customer focused and tied our business model the needs of our market.

Delaware’s visionary leadership – at the state level and in its health systems started with an environment of collaboration not found in many other states.  Participants focused on finding what is best for patients, even if that means giving away a perceived competitive advantage by sharing data.  Leaders recognized they would have to find other ways to differentiate their organizations.  Sadly, other communities have created their own market barriers by making data sharing difficult.

There was a large list of potential offerings we could provide our stakeholders.  We focused initially on clinical results delivery on behalf of sending organizations and found a return on investment through cost reduction.  We built critical mass, and the momentum grew from there.  Over time the data exchange became the standard for the safe and secure delivery of clinical results (lab and pathology), reports (both radiology and transcribed), and face sheets (hospital admission, discharge, and transfer data, including demographic and billing information).  DHIN has accomplished full participation of all acute care hospitals and skilled nursing facilities in the state.  In addition, the number of providers enrolled as end users of the HIE now exceeds the number of practicing providers in Delaware.  We have a number of practices with affiliations to Delaware hospitals across the Maryland and Pennsylvania borders who have enrolled.  We also have the three Maryland hospitals closes to our borders enrolled as full up data senders, sending us data on both Delaware and Maryland patients.  The value proposition to them comes from our ability to deliver the results to their affiliated practices, which is not a service offered by the Maryland HIE.   Patients have come to expect local and regional organizations to use DHIN’s community health record and because of that, hospitals and other healthcare organizations feel the pressure to participate in the ecosystem or lose business.

We have a number of new initiatives on the drawing board including expanding the ability for ambulatory providers to contribute data, exploring ways to use the data beyond point of care decision making at the population level, developing quality measures and dashboards, and considering options to engage patients in data contribution.  Each new effort is being designed to drive value from the perspective of key customers and stakeholders.  We have learned patience is the key.

Many across the country are acquiring physicians and affiliates, and trying to put all the players on the same EHRs.  The reality is that patients don’t stay in walled gardens, they are mobile and seek care where they choose to seek care.  Even in Delaware, which is a small state, we have over 60 EHR vendors represented.  Often patients cross state lines.  We have found that about 13% of our ADTs come from Pennsylvania and 14% come from Maryland.  Delaware healthcare organizations would be missing out on critical information if they didn’t link to entities outside their own systems.

Why is DHIN so successful?  It’s important to note that DHIN was very deliberative in its development – Return on investment and value did not emerge on day one.  Many, many meetings were held with the stakeholders.  It took over 10 years for DHIN to reach the place where it could begin business and the road to get there was painful.  Organizations approaching HIE today now have best practices available that can shorten the time – but it’s important to recognize that it will take time, there is no magic wand.   Layer on activities, demonstrate their value and then add the next targeted offering.

Jan Lee, MD, currently serves as the Chief Executive Officer of the Delaware Health Information Network (DHIN).  Dr. Lee is a board certified Family Practice physician with a Master of Medical Management degree and a wealth of leadership experience.  Prior to joining DHIN, she was Vice President of Knowledgebase and Content for NextGen Healthcare, a leading vendor of health information technology products and services, where she was responsible for the development of clinical content in 26 medical specialty areas for the NextGen electronic health record.