Q&A: Delaware HIE rolls on with the changes
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Since DHIN became the first operational statewide clinical HIE in the U.S., what’s been the biggest change you’ve seen during the past three years?
Everything’s changed at DHIN! We went live three years ago; pretty much it was a startup implementation—growing the user base, adding functionality, adding new data senders—so we’ve been in a continuous phased implementation.
The biggest changes have occurred in the industry. From the early days of the ONC and the impetus that was created through an executive order from President George W. Bush, and then as the new presidential administration took over and really started focusing on HIE being the center of improvement in cost, quality, efficiency. HIEs are at the center of healthcare reform and the HITECH Act. Since then, a real focus has been placed on standards and with stimulus funds infusing the market a lot of HIEs are starting up across the country.
The future is going to be interesting in that all of the federal funds will eventually go away. A big concern for the market is how many of these HIEs will be self-sustaining once the federal funds subside.
Is DHIN self-sustaining?
We are today. We have a diverse model. We get appropriations through the state for supporting … biosurveillance reporting from hospitals to public health, and we’re getting ready to do immunization registry connectivity, Medicaid connectivity … there’s a lot of benefit for the state derived from the health information network, so we will continue to seek state-appropriated funds to support those activities.
Then we have private-sector funds that come from a transaction-fee model from those putting data into the system. We are also expanding private funding sources to health plans and others who derive benefit from the system.
Does this model include physician incentives?
Not at this time. We’re working with health plans to define their financial participation in DHIN, and down the road, those incentives will come, aside from what is being developed under ARRA.
What information is exchanged through DHIN?
We receive results and report from hospitals and labs for laboratory and pathology results, admission/discharge/transfer face sheets and radiology reports. We’re in the process of implementing transcribed reports and radiology images.
DHIN uses one standard format for all data from all sources. What types of technology make that possible?
We selected Medicity to provide the applications and support to implement the system, so we use [Medicity’s] master patient index and record locator service to power the results delivery and patient record-search component of DHIN.
We negotiate discounted interface rates with EHR/EMR vendors, and when they have signed contract with DHIN, we identify beta practices that they must test with. Once the processes have been fully implemented and the practice signs off and says they’re happy with the interface, then we certify that vendor for DHIN and they can sell that interface at the DHIN-contracted rate to any of their other customers.
How does DHIN safeguard privacy and security of the data being exchanged?
We use a federated [data storage] model; we have an opt-out environment, and several layers of security and privacy protocols that we use to maintain and manage patient privacy. From a technical perspective, it’s industry-standard in terms of intrusion detection, encryption, security protocols, etc … Our Consumer Advisory Committee was instrumental in developing our privacy policy.
In terms of actual processes, we register all providers in the system and we ensure their identity and their appropriateness for having access to the system. We verify that they are licensed in good standing and have been credentialed with a DHIN participating hospital. Once a user is enrolled, they are given security and privacy training and [they must] sign a privacy statement.
We monitor usage in the system on a regular basis. We look at patterns of usage and if we identify someone as having unusual usage, we will suspend their access to the system and do an investigation. If we find it’s a training issue, then we work with that provider to get them retrained, or turn it over to legal if we think it’s a malicious intent. We have not had any such cases thus far.
What’s next for DHIN?
We’re working next on exchanging immunizations information as well as other meaningful use support services, such as: CPOE and continuity of care document exchange.