CRISP: Maryland’s Health Information Exchange

1. CRISP: Maryland’s Health Information Exchange September 21, 2012

2. What is CRISP? CRISP (Chesapeake Regional Information System for our Patients) is Maryland’s statewide… • Health Information Exchange (HIE) allows clinical information to move electronically among disparate health information systems. The goal is to deliver the right health information to the right place at the right time—providing safer, more timely, efficient, effective, equitable, patient-centered care. • Regional Extension Center (REC) is a program created by the ONC that is funded through the stimulus bill. RECs offer technical, implementation, and educational assistance to facilitate providers’ adoption and meaningful use of electronic medical records (EMRs).

3. Current Five Areas of Focus • Query Portal Growth • To give providers access to prior hospital and medication record • Direct Secure Messaging • To enable referrals and other care coordination • Encounter Notification System (ENS) • To notify in real time about patient visits to the hospital • Encounter Reporting System (ERS) • To help hospitals understand readmission patterns • Health Benefits Exchange • To help with specific services related to the health benefits exchange

4. Encounter Notification/Reporting System – Technical Design

5. Health Information Exchange - Query Portal

6. Connectivity Progress to DateUpdated August 10, 2012

7. CRISP Query Portal The CRISP Query Portal can make clinical information available • Access must be part of a treatment encounter or approved use case • Available information generally includes: hospital transcribed reports, labs, radiology reports, and pharmacy dispensed medications. • Single sign on integration can be enabled to transparently pass credentials and patient context to CRISP • $$ No current charge for Ambulatory access • Types of Data Available • Patient demographics • Lab results • Radiology reports • Medication fill history • Discharge summaries • History and physicals • Operative notes • Consults

8. Direct

9. CRISP Direct Secure Messaging Direct Secure Messaging Usages: • To communicate referrals and visit summaries between Ambulatory practices • To send relevant patient clinical information between ambulatory practices and hospitals • To make formal medical records requests from Ambulatory practices to the hospital • To receive encounter alerts from CRISP’s Encounter Notification System when a patient is hospitalized

10. CRISP Direct Secure Messaging • CRISP can help operationalize a Direct infrastructure in different ways: • Assign staff and physicians @crispdirect.org secure Direct addresses • Work with our Direct solution provider to implement your own Direct Domain. (@direct.myhospital.com) • CRISP Direct is available via webmail, a local client, and download to a folder • $15 a month per address, with some subsidized pilot opportunities • Your EMR vendor may offer other options for Direct

11. CRISP Direct Login Page

12. CRISP Direct Care Manager

13. Encounter Notification System

14. Encounter Notification System • The Encounter Notification System (ENS) was built by CRISP to notify participants in real time when one of its patients has an encounter at any hospital in Maryland. • CRISP receives real time notifications for any patient admissions, intra-facility transfers, and discharges in Maryland. • Enables sending notifications of hospital events to participants who are tracking certain patient populations

15. Encounter Notification System Alert Options: • Direct: Alerts sent via the Direct standard to a Direct inbox or an application that supports Direct messages. • HL7: Alerts sent in HL7 format to an end user application that can consume these alerts or to the CRISP portal inbox; email alerts could also be sent notifying providers to check their CRISP inbox. The process of attributing a patient to a doctor or care coordinator will be different depending on the situation, and will need to address certain patient privacy concerns.

16. ENS Trigger Event Selection Trigger Events Frequency In real time Once a day Once a week Once a month • ER admission • Inpatient admission • Intra-hospital transfer • ER discharge • Inpatient discharge • Cancel admission • Cancel transfer • Cancel discharge

17. Encounter Notification System - Future Roadmap • Ability to send secure text notification (with patient info) • Ability to send unsecured alert to any email address • Work with hospitals to include chief complaint, discharge diagnosis, and discharge disposition in notifications • Incorporate past hospitalization history (location, data, type of visit, and discharge diagnosis) in notifications

18. Encounter Reporting System

19. Encounter Reporting Service • Readmission Reports • Inter-hospital readmission reports distributed to half of Maryland hospitals • Working with hospitals to address variation in admission data produced by financial versus registration system data • Variation generally due to patient class identification, HL7 message type variation, observation patients, etc • Combining with claims data could make reports more valuable to hospital partners • GIS Mapping • Generated proof-of-concept GIS maps to visualize utilization as hot-spots • Valuable to public health officials and hospitals

20. Health Benefits Exchange

21. Health Benefits Exchange Services CRISP was included in the HBE Level 2 funding request to support 3 specific services: • Provider Information Management • Partnering with Optum, CRISP will offer a verified provider demographics source (fed by the HBE Qualified Health Plans) to enable HBE customers to search for plans by providers in the network • Master Patient Indexing Services for All Payer Claims Database • Using the Initiate MPI, CRISP can enable insights into member churn between QHPs and Medicaid plans as member eligibility status changes over time • Clinical Summary Care Coordination Service • Based on a triggering event, CRISP will compile a time-banded summary of data (starting with just encounter data) to forward to care coordinators