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the U.S. Department of Health and Human Services (HHS) must encourage partnerships between health information exchanges and others to offer patients access to their electronic health information, educate providers on health information exchanges, and promote policies to facilitate patient communication with providers.9 On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) announced include adding “measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical 10
DHIN has implemented and is making available a state-wide personal health record (PHR) and patient portal as a consumer empowerment tool. This tool can be used as a practice-branded patient portal that will provide patients with access to all the clinical data about themselves in the DHIN data repository from all sources. For practices that already have a patient portal, an application programing interface (API) between that portal and DHIN’s data repository can yield the same net result — patients have access to all their health data through a single “meaningful use” consumer engagement objectives.11
DHIN has made progress in expanding the clinical data available through the Community Health Record, and continually
seeks to add new sources of data. Currently, in addition to receiving data from all Delaware hospitals and laboratories
and the majority of imaging centers, DHIN also receives care summaries from six skilled nursing facilities, six urgent-care
or walk-in clinics, and two telehealth providers. More than 100 practices send encounter-level care summaries to DHIN from their EHRs. Having this information readily accessible through the patient search and data aggregation tool that is already in near universal use by providers across the state and around our enhances the potential for patients to be able to access all their health data from a single login, and creates the potential for a future service involving reporting of clinical quality measures on behalf of a practice. There are more than 100 National Quality Forum (NQF)-endorsed clinical quality measures that could be calculated from continuity of care documents (CCD).
Finally, DHIN is on the very brink of starting up a health
care claims database. The claims data will be housed on the same platform and in the same database as the clinical data. Certain elements of claims, such as pharmacy information, dates, locations, and providers of services, procedure codes, etc., will be exposed in the patient’s chart in the Community Health Record and in the personal health record of that patient.
A common set of analytic tools will be used to develop insights into both cost and quality of care across the state. Providers considering entering into risk-bearing contractual arrangements will be able to use the claims database to assess and manage risk. The statutory authority for this work comes from Senate Bill 238, enacted by the 148th General Assembly.12 Unfortunately, the statute did not come with a funding source. Currently, DHIN is aggressively seeking a funding mechanism so it can execute the technology contracts that will allow us to take this from a small- scale proof of concept to the full claims database envisioned.
As Charles Dickens put it in A Tale of Two Cities, “It was the best of times, it was the worst of times.” We may not be living through the French Revolution, but it sometimes feels like the pace and pressure of change is not far short. I don’t think we
can yet claim success on the “plus one” goal of restoring joy to the practice of medicine. There are still crushing administrative prospect of spending money on additional technology is daunting and, for many, distasteful. The plain fact is that technology does have a cost. Sharing that cost broadly reduces the cost for all participants. In the end, I submit again my yardstick questions. “Will this help me do something I care about faster, with less effort, more accurately, or at lower cost? Will this help me do things I care about that I simply couldn’t do before?” Only if I can answer “yes” is it worth the expense and the learning curve. Technology is an enabler, not an end in itself.
CONTRIBUTING AUTHOR
■ JANICE L. LEE, MD is a Family Practice physician currently serving as the Chief Executive Officer of the Delaware Health Information Network.
REFERENCES
1. http://dhss.delaware.gov/dhss/dhcc/cmmi/files/choosehealthplan.pdf
2. https://innovation.cms.gov/initiatives/state-innovations/
3. State Innovation Models Test Grant Abstract, http://dhss.delaware.gov/ dhcc/sim.html
4. DE Model Test Application Operational Plan, January 2015, pages 7-8 5. Choose Health Delaware: Delaware’s State Health Care Innovation Plan,
December 2013, pages 67-75
6. Personal notes from public meetings throughout 2013
7. Personal notes from Technical Advisory Group meetings throughout 2014
8. Delaware Health Information Network management report, April 2018
9. Summary: H.R.34 – 114th Congress (2015-2016), www.congress.gov/ bill/114th-congress/house-bill/34
10. www.cms.gov/newsroom/mediareleasedatabase/press- releases/2018-press-releases-items/2018-04-24.html
11. https://mydhinphr.com/#!/login
12. Title 16 Delaware Code, Chapter 103 Subchapter II
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