How the Nation’s First HIE Pioneered a Digital Highway for Clinical Event Notifications

A Healthy Exchange Between Ai and DHIN

When the Delaware Health Information Network (DHIN) went live in 2007, it was the first operational statewide health information exchange (HIE) in the nation. Since then, DHIN has been setting a course for the future of HIEs and has maintained a consistent track record of safe, secure delivery and query capability of critical health information, including lab and pathology results, radiology and transcribed reports. Beginning in 2013, DHIN began leveraging the power of Audacious Inquiry’s (Ai) Encounter Notification Service® (ENS®). DHIN also provides secure ADT-based notifications to providers and health plans across the state.

DHIN’s Early Days: A Pioneering Era in HIE

DHIN pioneered the early days of HIE. Their work helped set the stage for the strategic architecture, platforms, and objectives of patient matching and care coordination-enabling technology that are a few of the hallmarks of today’s health industry interoperability and care coordination initiatives. The story of DHIN is one of impressive statistics—the metrics for performance and turnkey service speak for themselves. More than 96 percent of Delaware providers are enrolled in the exchange—this includes over 5,000 health care professionals and more than 600 Delaware practices that are “live” and using DHIN services. Today, more than 2 million patients are represented in DHIN’s master patient index, from which more than 14 million clinical results and reports are generated each year. DHIN is a role model for health care information sharing, and that means within the State of Delaware, and across state lines to include Washington DC and Maryland.

Delaware patients that are hospitalized in most Maryland or Washington, DC hospitals now have their clinical information shared among DHIN’s network. The HIE has grown into a robust, value-added partner for providers looking to improve patient care, optimize care coordination and workflows, reduce avoidable readmissions, and prevent duplicate lab and diagnostic tests

Marc Jacobs at Ai’s Headquaters in Baltimore,MD.

Choosing a HIE Technology Partner: Things You Can’t Live Without

But it wasn’t always that way. According to DHIN Chief Information Officer Mark Jacobs, “Four years ago, there was hardly any notification solution for any HIE. The only thing close was what Ai was doing for CRISP (Chesapeake Regional Information System for our Patients).  Ai had proven its ability to put the robust ADT connectivity that CRISP had to good use by providing event notifications to Maryland providers and health plans, and so [Ai] was selected to bring notification services to DHIN.”

“Our ENS deployment started out to provide notifications of patient events to managed care entities,” says CIO Mark Jacobs. “Meaningful use has expanded, transitions of care have become more important, ACOs—all these things have evolved and they all now make use of DHIN’s readily available notifications.”

“DHIN recognized the value in working with Ai’s solution. They saw that we had a proven track record in a neighboring state. Finally, DHIN really recognized the value of ENS’s unique patient attribution method, that is, not relying on the provider of record in the ADT,” explains Ai Principal Rob Horst. “That is how we won the business,” he says. It was “the beginning of a great relationship.”

ENS is flexible and is designed to work within a health information organization’s existing technology framework. Ai adds value by filling in important gaps that some larger HIE vendors overlook, or ignore completely.  “When DHIN implemented ENS, we didn’t have to recreate the wheel. We took their existing ADT connections and put them to work rapidly. Start to finish, DHIN was live and sending notifications in about three months,” he explains.

Mark Jacobs adds, “For an HIE like DHIN, the ability to offer high-value services like notifications is key. While results delivery and query portal services represent the core of DHIN’s business, notifications were being asked for and were a rapid time-to-value service that we could offer quickly.” DHIN also recognized that flexibility in how practices and health plans receive notifications was important. ENS has met those needs by being able to securely deliver notifications to match subscribers’ workflows. Delivered via Direct Secure Messaging, secure FTP, or directly into an EHR, ENS notifications match a variety of needs.

ENS Is Ready to Serve Stakeholders in the Age of Value-Based Healthcare

Currently in use by HIEs across the mid-Atlantic and elsewhere, ENS handles some 850,000 event notifications each month and includes over 12 million total patient subscriptions. It has more than 600 subscribing organizations in five states, and these numbers are growing.

“There’s a misconception in healthcare that when a patient leaves a care setting such as an urgent care center, hospital, or nursing home, that the family physician knows what’s happening,” says Jacobs. “The reality is unless the patient tells their physician, it’s very difficult for the physician to know anything.”

ENS fills those critical gaps in care by notifying the patient’s provider(s) and care team when the hospitalizations are occurring, which makes it particularly valuable for HIEs seeking to offer added value to network participants in the HIE.

“ENS automates a process that we all thought was going on in health care for years,” he notes. Now that this critical information is readily shared, the question often becomes “how will providers learn how to react?” The best workflows for making use of ENS information differ by stakeholder, but the data it provides is valued by all.

  • Patients appreciate quicker follow-up from providers regarding interactions with hospitals and clinics. In turn, improved follow-up has demonstrated reduced readmission rates.
  • Payers can more clearly track and contact plan members.
  • Hospitals and health care systems can more readily comply with increasingly stringent meaningful use transition of care requirements.

DHIN has worked closely with CRISP in Maryland to provide important cross-border data exchange to benefit Delaware residents seeking care in neighboring Maryland. “The collaboration with CRISP has been valuable for both organizations,” says Jacobs. Because Maryland and Delaware both have only one health information exchange in each state, “and we both use the same vendor for notifications,” explains Jacobs, “we can share information about residents that have been admitted in each state.”

The relationship with DHIN has been invaluable for Ai “They have had lots of great ideas for us and keep us on our toes.” says Horst, “They push us for richer functionality to meet the needs of their community.” In addition to hosting and supporting ENS and a master patient index for DHIN, Ai recently began hosting DHIN’s primary interface engine. “This allows DHIN to be more self-sufficient with their most important asset—their data feeds. They avoid the dreaded ‘vendor lock’ and no longer have a need for a vendor to perform integration tasks, or to be able to route new sources of data. We have done a significant amount of knowledge transfer with the DHIN technology team that has allowed them to now do most of their integration work themselves,” explains Horst.

Healthcare reform is increasingly shifting responsibility for care management onto care providers. “Physicians need to know where their patients are seeking care and when. ENS provides our customers with more insight into where their patients are at any given time,” says Jacobs. It all starts with timely notifications to patient activity, and the Ai team keeps the technology simple, stable and scalable. Using ENS, HIEs can capitalize on their most basic data assets: ADTs. Explains Jacobs, “Ai provides a unique foundation to be able to do that successfully.”