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Delaware became the first U.S. state in 1787, and its health information exchange, the Delaware Health Information Network (DHIN), became the country’s first statewide HIE in 2007.
Today, DHIN is kind of pushing the bounds of HIE by creating business lines with insurers and the government, offering new data analysis services and apparently offering a guide to states with still-nascent HIE systems.
About 95 percent of Delaware providers are DHIN participants, as are all the state’s acute care hospitals. Of course it’s a tiny state, with three counties and 907,000 residents. But others are watching. Health IT policy makers and researchers from 25 states have sought DHIN’s advice on HIE policy and systems, said Michael Sims, DHIN CFO.
Created as a public-private HIE in 1997 and funded pretty much equally in thirds by the state, the federal government and providers and insurers, DHIN is being transitioned off state funding by Delaware lawmakers and transitioning itself off federal funding.
“Generally,” Sims said, “we are a small business,” except with state protection against lawsuits. “We’re expected to generate revenue and turn a profit,” Sims said. “Our goal is to be really self-sustaining.”
In 2011, 50 percent of DHIN’s revenue came from service fees. This current fiscal year, ending in June 2013, DHIN wants to generate 100 percent of its revenue from service fees.
Providing direct delivery of lab results, radiology reports and clinical data, DHIN also transmits immunization records to the state’s registry. DHIN charges up to $0.25 for a data transaction and doesn’t collect membership fees from providers. Health plans also make up a part of DHIN’s revenue base and are driving its foray into new data services, Sims said.
DHIN sends hospital reports to patients’ insurers — “the same process that happens today, except it’ happening electronically,” Sims said. DHIN also lets case managers search for member information in a database and packages non-financial claim information from insurers, so that it can be analyzed in tandem with medical information.
As of June, between Highmark Blue Cross Blue Shield members, Medicaid members and Delaware state employees, close to half of Delaware residents are in a health plan participating in DHIN. Insurers pay a per-member, per-month fee, as does the state of Delaware for Medicaid recipients and state employees.
“This is kind of another pillar of health information,” Sims said. “We want to be that pipe of information for the payers.”
DHIN has some ideas for new services — potentially doing hospital readmission analysis, for instance — and pilot projects. DHIN is going to do a five month medication history pilot service for providers, using ONC funding to study medication history of patients in the DHIN system, which includes almost every Delaware resident and a few thousand from neighboring states. DHIN is letting providers try it free for five five months, and after that they’ll have to pay.
In addition to immunization registries, DHIN is working on setting up data transfer to the state’s cancer registry and considering connecting to the state’s newborn screening registry.