Delaware Health Information Network(DHIN): Effective Alliance for Enhanced Healthcare

Delaware Health Information Network (DHIN, pronounced “DIN”) is a public instrumentality of the State of Delaware, established by legislation in 1997 as a public-private collaboration to resolve the need to share health data between care settings securely and to assist Public Health and other state authorities in the collection and analysis of health data needed during their work. Initially formed within a State agency, a board representing the various stakeholder groups decided DHIN’s course, with day-to-day operations supervised by a contracted Executive Director. From 2006, when DHIN first acquired the technology tools to “go live” with health data exchange, through 2010, the funding stream to support DHIN’s work was an almost equal blend of federal grants, a State capital appropriation over five years, and private funding sources. The intent was always that DHIN would develop to the point of financial sustainability without State financial support.

DHIN’s mission is to make health data available when and where it is needed and to make the data useful through innovative solutions

In 2010, DHIN’s enabling statute was amended to spin Delaware Health Information Network (DHIN) out from under the Health Care Commission as a semi-autonomous public instrumentality functioning as a not-for-profit business. The governor appointed a new board of directors, and Dr. Jan Lee was hired as the CEO. Under her leadership and vast work experience, DHIN has become the hub of a health information ecosystem in Delaware, and participation in one or more DHIN services is nearly universal across the Delaware healthcare community.

“DHIN’s mission is to make health data available when and where it is needed and to make the data useful through innovative solutions,” said Dr. Jan Lee, CEO of DHIN. The services at DHIN revolve around three key capabilities:

• Securely moving and delivering data where it needs to go: DHIN offers reports and test results on behalf of the performing entity to the doctor who ordered the test, or to the Public Health authority who must be informed of new cases of reportable diseases, or to population health monitoring systems of subscribing hospitals or practices.
• Securely aggregating, normalizing, enriching, and organizing health data from disparate sources so that they can be viewed and used together without loss of meaning.
• DHIN makes health data useful through value-added services such as Event Notification and analytics services, which help to subscribe customers to see patterns in their data that enable them to become more efficient or help them manage costs while still delivering high-quality care.

DHIN’s services have fulfilled many missions and solved problems for the customers and the end-users of the organization’s services. “With the onset of the COVID-19 pandemic, DHIN has provided real-time test results to hospitals and physicians as well as to Public Health. When the issue of racial disparities in incidence and survival of COVID-19 became pressing, DHIN was able to assist Public Health in a retrospective analysis of all COVID-19 tests, both positive and negative, and enrich those results with data on race and ethnicity of those patients that DHIN already held in its database,” states Dr. Jan Lee.

DHIN is assisting with the “gating” strategies of returning the State to normal following the first wave of the coronavirus pandemic. DHIN receives real-time notifications of admissions, discharges, and transfers from every acute care hospital in the state of Delaware, plus the out-of-state hospitals closest to the borders and so they can provide daily reports on the volume of new hospitalizations for COVID-19.

DHIN is also assisting Public Health with contact tracing through the Event Notification Services. Public Health authorities need to follow all contacts of known COVID-19 cases for at least 14 days to ensure that they aren’t developing symptoms and possibly spreading the disease. Because DHIN receives real-time data from area hospitals, walk-in clinics, laboratories, and doctor’s offices, the organization can provide Public Health with real-time notifications if any COVID contacts they are tracking present for care in any of these settings.

As steward of the largest and most complete repository of clinical and claims data in the state, DHIN can provide targeted information to assist the state in COVID recovery efforts. For instance, as vaccines begin to become available, there will not immediately be enough to vaccinate the entire population. DHIN can use its data and analytics capabilities to identify those at the highest risk and provide highly-targeted outreach for early vaccination of Delaware’s most vulnerable citizens. This will be essential in blunting the impact of the second wave of infections once restrictions are eased. DHIN is playing a pivotal role in diminishing the effects of COVID-19 in Delaware.

DHIN views innovation less like an event and more as a mindset. DHIN is one of the first organizations in the health information exchange industry to move to open architecture using cloud-based technology solutions, and one of the first to move to the use of Application Programming Interfaces (APIs) as the way to exchange data between systems and platforms.

Delaware Health Information Network (DHIN) maintains a rolling three-year technology roadmap and considers this roadmap as a general business plan, taking account of expiration dates of existing contracts, maturation of emerging standards and technologies, and evolving consumer and organizational needs. DHIN is collaborating with its counterparts in contiguous states on some cooperative undertakings where each party can expand without competing with the other, focusing on the unique mix of services and business model of each organization. DHIN intends to be a part of the national health data ecosystem and serve humankind for the better.

A challenge for all non-profit entities is how to provide a public good within a sustainable business model.  Despite millions of dollars in federal financial assistance, many public health information exchanges (HIEs) have struggled to develop a viable business model that would enable sustained service delivery without government funding. DHIN has been financially self-sufficient, since FY 2012, with operating costs entirely covered by operating revenues. DHIN is the hub of a health knowledge network in Delaware, and participation in one or more DHIN services in the Delaware healthcare sector is almost universal.