Delaware in the vanguard

When it comes to health information technology, Delaware is way out in front. Delaware developed the first health information exchange in the nation and its physicians are in forefront of converting their paper health records into electronic ones.

How did it all happen? 

Jan Lee, executive director of the Delaware Health Information Network

Last week, I had lunch with the who's-who of Delaware health information technology. Over tuna and chicken salad sandwiches, they laid out the menu for success. 

Back around 1997, when the concept of email was just beginning, some health geeks and politicians got interested in the idea of an electronic exchange of patient information to provide seamless care for Delaware's residents.

One of the earliest backers was U.S. Sen. Tom Carper, a Democrat who was then serving as Delaware's governor. Another early leader was Robert White, the then chief executive officer of Delaware Physicians Care Inc., one of the biggest physician practice groups in the state. David Walczak, a top IT official at Bayhealth Medical Center, still serves on the board.   

Various hospital and physician groups were contemplating building electronic systems, but decided, "we can either each spend our money, or we can pool our resources and create it for the greater good," said Jan Lee, who is now executive director of the Delaware Health Information Network, the fruit of their efforts, known as DHIN. For years, White served as chairman of the board.

These days, 75 percent of Delaware's hospitals are connected to the DHIN and there are serious talks with one of the largest, Alfred I duPont Hospital for Children in Wilmington. That hospital, and one other, are the only two in Delaware that are not enrolled in the DHIN. DHIN players account for 79 percent of all emergency room visits, 75 percent of all hospital beds and 76 percent of all outpatient visits, DHIN's website said. The network delivers 7 million clinical reports a year. Eighty percent of the state's healthcare providers are able to access information through the network and one million people's information is in the database in a state that has a population of 900,000.

"If it's not 100 percent of the population, it's darn close," said Lee. 

In 2001, planning began in earnest, with funding from the state contingent on raising matching funds from the private sector, particularly hospitals, insurers and doctors' practices. Blue Cross, Blue Shield of Delaware kicked in some money to make it happen. "It's truly been a public private partnership from the start," Lee said.

It helped that Delaware is a small enough state that people tend to know each other. "Delaware is three counties and there's one public health department," said Lee said. "It is easier to get things done when you have one sandbox to play in.

"The mere fact that we're all sitting around the room - friendly - is proof that there's a shared vision of what we want to see happen for the state of Delaware," she said.

Sitting around the table with Lee on Wednesday was Susan M. Mateja, planning and policy administrator for the Delaware Department of Health and Social Services. Also representing the department's division of Medicaid and Medical Assistance was Troy E. McDaniel. Marcy Parykaza, chief information officer for the state's department of public health, loved the way a network could expose early warning signs of impending outbreaks of, for example, swine flu.

By the time the system went live in 2007, Beth Schindele, who was also at lunch, had joined Quality Insights of Delaware, a nonprofit that had federal Medicare contracts to do quality oversight reviews in Delaware. The nonprofit, headquartered in West Virginia, now has a federal contract to run Delaware's Regional Extension Center, dedicated to helping physicians convert their paper medical records to an electronic database. While the doctors can tap into the DHIN network, they can not contribute to it until their offices' records are electronic and their systems are in sync with the DHIN network. You can read my Sunday Inquirer story about her work by clicking here. Also read more about her efforts in my Tuesday and Wednesday blog posts. 

"Being small, we can work together," Parykaza said. "Most of us here are either decision makers or influencers of decision makers. That enabled us to move quickly and made it easier to get the various components done."

It also helps that Delaware is a small enough state that its state-level politicians need to hold down regular jobs. Among the current backers of health IT in Delaware is state senator Michael Katz, an anesthesiologist.

It's already been effective for the families of the movers and shakers in the room. McDaniel had an elderly relative who had to be admitted to a hospital -- much information was already available.  Mateja's father had a stroke. "Personal data got to the hospital in real time from his cardiologist," she said. 

In an emergency situation, Parykaza said, the hospital's ability to find out that a person is allergic to a drug could be essential in saving that person's life.

Nearly five years after it went live, Delaware's Health Information Network is at a crossroads now. Most of the state government's funding will go away and it will be up to state's healthcare providers and insurers to underwrite the network. Even though there are plenty of anecdotal stories like the ones from McDaniel and Mateja, hard evidence of the network's successes and challenges is essential. An outside party has been hired to assess the program and provide a report.

"We're trying to create a world where the data follows the patient," Schindele said.