Delaware Health Information Network may be antidote to the rising cost of care

Dr. Jason Silversteen
Dr. Jason Silversteen, D.O. is seen at his desk with the DHIN electronic network info on his computer screens.
Dr. Silversteen is a board-certified neurologist with Christiana Care Neurology Specialists.

By Sam Waltz
Founding Publisher

DHIN — the Delaware Health Information Network — may be the antidote that improves health-care outcomes and reduces costs for Delaware consumers, according to Dr. Janice Lee, president.

Dr. Lee, a former US Air Force physician and medical educator, heads the quasi-state authority set up to design and implement what has become America’s first statewide electronic health records (EHR) platform.

Rolled out in 2007, and substantially completed by 2014, DHIN has received very little visibility among the health-care customers as the health-care establishment that sells services has come to rely more and more on it.

“I’m not certain why we don’t have the awareness yet among the health-care consumers,” said Dr. Lee, “but we’re seeing more and more acceptance and — importantly — usage among providers. We’d like to see greater awareness, too, among consumers, because it’s an important tool to improving their healthcare that they need to understand and use!”

Talked about for nearly a quarter-century, since the emergence of the Internet in the early 1990s, EHRs have been regarded as a panacea to improving health care, replacing actual file cabinets full of paper-laden files with digital files that can offer health-care providers quicker and easier assessments of a patient’s medical history, including recent treatments.

With the emergence of “the cloud” over the last 10-15 years, the vision — along with the tools to implement it — evolved to the concept of an integrated cloud-based system where all of an individual health-care customer’s providers had access to the data, and to store the latest updates.

“On a scale of 1 to 10, where our system is now, we’re about an 8,” she said. “We have all of Delaware’s hospitals, the three Maryland hospitals adjacent to Delaware, and hospitals in the District of Columbia on our platform. We have the chemistry labs, the imaging centers, and a variety of other producers on the system. And we have the ambulatory medical practices, the primary care providers, as well.”

The DHIN system, Dr. Lee said, has enormous potential to improve health-care outcomes via improved patient-monitoring at the micro-level, as well as in an epidemiological sense at the aggregated level statewide. In addition, by bringing those efficiencies, among them increased use of telemedicine, it will also hold potential to decrease costs.

The General Assembly in 2015 approved legislation increasing access to telemedicine services from Delaware providers, assuring that healthcare insurers will pay for them, although some of the implementation details still are being ironed out.

“We don’t have a lot of information yet coming from the individual providers, although we do have about 100,000 care summaries from individual practices, so we’re seeing inroads,” she added.

Admittedly, some MDs resist EHRs for a variety of reasons, among them, lack of familiarity with usage, lack of confidence that they’re as good as paper-based records, and even some fears of increased liability if a lawsuit were to occur. “What happens if I’m checking off a template, and one of the details in the template is something that was not done in that patient visit, but my completion of the form implies that I did it?” asked one primary care physician.

Nevertheless, as such resistance gradually is replaced by increased provider compliance, perhaps encouraged if not required by insurance companies and accountable care organizations (ACOs) mandated under Obamacare to work on quality and cost issues, Dr. Lee is confident that the system will become more robust in usage for virtually every patient.

Improved epidemiological assessments in terms of community health are an added benefit. While individual EHRs remain confidential within the system for the patient and her providers, the system does have enormous potential to aggregate health-care data for news and trend analysis, she said.

That way, the State of Delaware can learn in real time about important emerging diagnoses, e.g., the infection of a patient with a Zika virus, or the rate of STDs in the population, or new flu cases, even health-care trends like smoking incidence and morbid obesity.

Development of the system has taken years and years and benefitted from the help of dozens of health-care and technology professionals, among them Randall Gaboriault, chief information officer (CIO) of Christiana Care.

“DHIN was effectively established as a public-private partnership, chartered by legislation out of the Delaware General Assembly, as a statewide health information exchange,” said Gaboriault. “Dr. Lee is our staff head, and we have a unique governance system with representatives of health systems, private practitioners, representatives from the State Office of the Budget, the Chamber of Commerce, and even Highmark as our state’s largest health insurer.”

“We started it with $7 million to $8 million in funding, using original federal grant dollars,” added Gaboriault who played a critical role in helping lead and manage the DHIN design. “Ninety-eight percent of our state’s providers are registered with their own unique passwords for DHIN. For security purposes, we have a ‘break glass’ setting, because it’s a crime to look at data that you’re not supposed to see, and all ‘broken glass’ triggers an audit review.”

“This really is part of the ‘Internet of things’,” he said. “It will deliver value-based medicine by assuring that the patient has a successful outcome,” bringing together the various suppliers into a unitary system.

“Navigating health care really is hard. I went through it with my own father, for his back paid, orthopedic issues and neuropathy,” Gaboriault said. “His PCP referred to orthopedic surgeon for spinal fusion, and the complexity of trying to navigate this is hard, and it’s hard for people.

“At Christiana Care, with our hubs, guardian angels and navigators, with this network now, we’re helping organize the clinical network around the progression of disease.”

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