CRISP

1. CRISP Maryland’s Health Information Exchange State Drug and Alcohol Abuse Council June 23, 2010

2. What is CRISP? • CRISP (Chesapeake Regional Information System for our Patients) is Maryland’s statewide health information exchange (HIE) and Regional Extension Center (REC) • Health information exchange, or HIE, allows clinical information to move electronically among disparate health information systems. The goal of HIE 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 will offer technical, implementation, and educational assistance to facilitate providers’ adoption and meaningful use of electronic medical records (EMRs). 1

3. Mission Statement Our mission is to advance the health and wellness of Marylanders by deploying health information technology solutions adopted through cooperation and collaboration.  We will enable the Maryland healthcare community to appropriately and securely share data, facilitate and integrate care, create efficiencies, and improve outcomes. 2

4. Guiding Principles • Begin with a manageable scope and remain incremental • Create opportunities to cooperate even while participants still compete in other ways • Affirm that competition and market-mechanisms spur innovation and improvement • Promote and enable consumers’ control over their own health information • Be flexible to support both distributed and data bank models • Use best practices and standards • Serve the entire Maryland healthcare community 3

5. CRISP History Evolution of CRISP as Maryland’s HIE 4/10 7/09 6/06 6/07 2/09 5/09 8/09 3/10 4/10 Erickson, UMMS, MedStar, JHMI begin conversations Group agrees to pursue Med History pilot CRISP is awarded only REC in state of Maryland MHCC unanimously designates CRISP the statewide HIE CRISP submits final planning report to MHCC HSCRC approves CRISP to receive $10M in funding CRISP files for incorporation as a not-for-profit organization MHCC receives $9.3M implementation grant from ONC for CRISP implementation CRISP procures core infrastructure technology vendor 4

6. Governance Structure 5

7. Funding • MHCC/HSCRC Award • Leverage all-payer system to award $10M in seed funding for statewide HIE implementation • ONC HIE Grant • Roughly $9.3M in ARRA funding awarded to MHCC to support the CRISP statewide HIE effort • ONC Regional Extension Center Grant • Roughly $5.5M in ARRA funding awarded to CRISP to establish and operate the only REC in the state of Maryland 6

8. Infrastructure Design Standards-based, SOA, distributed infrastructure model with the ability to store data in local edge devices, shared edge devices, consumer driven health record banks, and/or hosted repositories. 7

9. Technology Approach • 5-month, rigorous, transparent, and open technology procurement process 8

10. Technology Approach • Contract recently signed with core infrastructure technology partner Axolotl Axolotl • Privately held company located in Silicon Valley, California • Providing HIE solution since 1995 • Elysium exchange solutions are used by nearly 30,000 physicians, 100,000 healthcare professionals, over 200 hospitals, 20 RHIOs, 3 Statewide HIEs  • Demonstrated ability to facilitate a rapid roll-out of the core infrastructure • Proven strategy for dealing with paper based physicians 9

11. Exchange Services Available at Launch • Patient Demographics Lookup • Lab Results, Radiology Reports, Transcribed Reports (Discharge Summaries, History, OP Notes, etc.) • Clinicians can query the exchange to find recent results for a patient • Clinicians can push reports from their offices to a hospital or other clinician's office, and vice-versa • Clinicians can subscribe to a patient, and be alerted when a new result for their patient exists in the exchange • Referrals • Clinicians can refer patients by pushing patient demographics and their relevant medical information to another doctor • Secure Clinical Messaging • Clinicians can securely push messages and other medical data to other physicians in the exchange 10

12. Transport Approaches & Their Clinical Applications: Query • Primary care physician looks up historical health information on new patient • New patient arrives for appointment at primary care office. • Physician queries HIE for historical health information. • A list of documents and results relevant to that patient are presented to the physician. • Physician reviews available documents to gain an understanding of the patient’s health history. 11

13. Transport Approaches & Their Clinical Applications: Push • Doctor sends specific patient information to point of care • Patient is referred by PCP to Cardiologist. • PCP pushes patient health information through exchange to cardiologist. • Cardiologist’s office receives information & prepares it for visit. • Cardiologist can review results • and notes prior to visit. 12

14. Transport Approaches & Their Clinical Applications: Subscribe & Alert • Doctor subscribes for information about specific patient, and is alerted when new data is in the exchange • Patient visits ER where a discharge summary is created. • Hospital publishes summary to HIE. • PCP is alerted of new discharge summary for his/her patient for review. • PCP notices harmful new prescription in summary, warns patient. 13

15. Roll-Out Strategy • We are pursuing an incremental roll-out strategy that focuses on geographic areas • CRISP considers a county’s technical readiness, willingness, impact, underserved population, and other factors unique to the area • Roll-out to hospitals will occur in parallel with ambulatory providers most relevant to each organization in terms of connectivity 14