Chesapeake Regional Information System for our Patients

Last updated
Chesapeake Regional Information System for our Patients (CRISP)
Nonprofit corporation
Founded USA (2009)
Headquarters Columbia, Maryland, U.S.
Number of employees
100+ employees
Website www.crisphealth.org

The Chesapeake Regional Information System for our Patients (CRISP) is a nonprofit organization created to function as Maryland's state-designated health information exchange (HIE), by the Maryland Health Care Commission. CRISP currently serves as the HIE for Maryland and the District of Columbia. CRISP is advised by a wide range of stakeholders who are responsible for healthcare throughout the region.

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. In practice the term HIE may also refer to the organization that facilitates the exchange.

Contents

Health information exchange allows clinical information to move electronically among disparate health information systems. The goal of the HIE is to deliver the right health information to the right place at the right time – providing safer, timelier, efficient, effective, equitable, patient centered care. In doing so, CRISP offers a suite of tools aimed at improving the facilitation of care for their service region's providers. CRISP was created by Johns Hopkins Medicine, MedStar Health, the University of Maryland Medical System and Erickson Retirement Communities, [1] and receives input from a wide range of sources, including clinicians, hospitals, patients, privacy advocates, payers, and regulators and policymakers.

MedStar Health is a not-for-profit healthcare organization. It operates more than 120 entities, including ten hospitals in the Baltimore–Washington metropolitan area of the United States. In 2011 it was ranked as the employer with the largest number of local employees in the region.

The University of Maryland Medical System is a private, not-for-profit corporation founded in 1994 and based in Baltimore, Maryland. It owns and operates eleven hospitals in Maryland and has more than 1,700 licensed beds, 83,000 annual admissions and gross patient revenues of $2 billion annually.

Audacious Inquiry is one of several contracted service providers and developers that works with CRISP to enable and manage exchange services and initially served as the program director for the effort. [2] Initiate Systems (IBM) and Axolotl Corporation (Ingenix) were selected in 2009 to provide software as a service to enable clinical information exchange via CRISP. [3] CRISP replaced Axolotl with Mirth Results (NextGen) in 2011.

Audacious Inquiry American health information technology company

Audacious Inquiry (Ai) is an American company founded in 2004 and with headquarters in Baltimore, Maryland. The company deals in provision of health information technology solutions, including cloud-based software, med tech consulting and strategy services.

IBM American multinational technology and consulting corporation

International Business Machines Corporation (IBM) is an American multinational information technology company headquartered in Armonk, New York, with operations in over 170 countries. The company began in 1911, founded in Endicott, New York, as the Computing-Tabulating-Recording Company (CTR) and was renamed "International Business Machines" in 1924.

Mirth Connect, also known as Nextgen Connect, is a cross-platform interface engine used in the healthcare industry that enables the management of information using bi-directional sending of many types of messages. The primary use of this interface engine is in healthcare.

History

In 2006, CRISP began at a Spring meeting between John Erickson and the CIOs of Maryland's three largest hospital systems, asking how to make medical records for seniors available when they visited the hospital. By 2008, CRISP had partnered with MHCC to plan an HIE for Maryland, the processed engaged dozens of healthcare stakeholders. CRISP received $10 million in seed funding through an adjustment in the reimbursement rates for participating hospitals. [4] The Office of the National Coordinator awarded Maryland $9.3 million to implement statewide health information exchange through CRISP. [5] In the 2009 legislative session, Governor Martin O’Malley signed into law House Bill 706, which gives the Maryland Health Care Commission (MHCC) the authority to regulate the state's insurance industry to provide incentives for doctors to connect their practices to CRISP's health information exchange. [6] Maryland's Health IT Extension Center became a reality in 2010 with a grant from the department of Health and Human Services for $5.5 million. [7] Today, CRISP has connected with all of the acute care hospitals in Maryland and DC, and has rolled out several new services, and dozens of new features. CRISP has even expanded their connectivity through partnerships with neighboring HIEs.

Martin OMalley American politician

Martin Joseph O'Malley is an American politician and attorney who served as the 61st Governor of Maryland from 2007 to 2015. He previously served as Mayor of Baltimore from 1999 to 2007, and was a councilman from the Third Council District in the northeast section of the city on the Baltimore City Council from 1991 to 1999.

Governance

At CRISP's inception, an HIE Policy Board was convened by the MHCC. The board has oversight authority for establishing the policies that govern the statewide HIE. For more information about the Policy Board click here. Additionally, CRISP, in coordination with the MHCC, has developed a governance model that includes a Board of Advisors to provide guidance and input to the CRISP Board of Directors on certain key decisions during the development and operations of the HIE. The Board of Advisors is intended to be broad-based to ensure that a breadth of interested organizations have the opportunity to participate and represent their constituencies. There are currently over 30 organizations represented.

The Board of Advisors is organized into five committees:

Clinical Advisory Board
Committee reviews and provides guidance surrounding CRISP’s plan for exchange service implementations. This includes providing a clinical perspective on CRISP activities, and helping to prioritize HIE service deployments. The committee also assists in gathering information and perspectives from the broader stakeholder community pertaining to HIE services, assists in garnering support and use of HIE services, and assists in assessing the value associated with various CRISP service offerings in terms of clinical relevance and service value in various care settings.
Technology Advisory Board
Committee reviewed and commented on the exchange technology request for proposal, participated in the RFP response evaluation and selection process, and provided guidance and expertise on infrastructure and other technology related decisions. Responsibilities also include: providing guidance on network security and data encryption best practices; providing oversight of the performance of technology solutions, once deployed; assessing specific technology solutions surrounding areas such as single sign-on, audit protocols, role-based access, and master patient indexing; and assisting in the development of strategies for integrating end-point.
Finance Advisory Board
Committee reviews and provides guidance on CRISP revenue and pricing models. It is refining and modifying assumptions associated with the CRISP revenue model, evaluating how federal funding requirements impact existing revenue planning, evaluating how federal funding opportunities tie into CRISP financing, and assessing specific HIE services with regards to financial sustainability.
Privacy & Security Advisory Board
The Committee provides guidance on privacy and security issues related to clinical data managed through CRISP and works regularly with the Privacy & Security Officer (PSO) who is responsible for all such matters as they pertain to CRISP’s daily operation. Additionally, the Committee serves as a resource for best practices and recommended policies for HIPAA data security, data use, and data sharing, and provides continual guidance on internal and external HIPAA audits as well as any HIPAA security-related incidents that may occur within CRISP.
Reporting & Analytics Advisory Board
The Committee develops, guides and prioritizes reporting and analytics services designed to support statewide efforts of improving care and reducing costs. Additional Committee responsibilities include assessing the value and relevance of reports for a wide array of users, providing guidance on data tools for report dissemination, such as user guides and other information to enhance understanding of the analysis, and to provide direction and vision in short, mid, and long-term planning of services. CRISP has developed basic reports to support initial hospital needs in monitoring performance on readmission goals.

Related Research Articles

Health informatics discipline at the intersection of information science, computer science, and health care

Health informatics is information engineering applied to the field of health care, essentially the management and use of patient healthcare information. It is a multidisciplinary field that uses health information technology (HIT) to improve health care via any combination of higher quality, higher efficiency, and new opportunities. The disciplines involved include information science, computer science, social science, behavioral science, management science, and others. The NLM defines health informatics as "the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning". It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and bio-medicine. Health informatics tools include computers, clinical guidelines, formal medical terminologies, and information and communication systems, among others. It is applied to the areas of nursing, clinical medicine, dentistry, pharmacy, public health, occupational therapy, physical therapy, biomedical research, and alternative medicine, all of which are designed to improve the overall of effectiveness of patient care delivery by ensuring that the data generated is of a high quality.

Medical privacy

Medical privacy or health privacy is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act of 1996 was enacted by the United States Congress and signed by President Bill Clinton in 1996. It was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and address limitations on healthcare insurance coverage. It has been known as the Kennedy–Kassebaum Act or Kassebaum–Kennedy Act after two of its leading sponsors. The Act consists of five Titles. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title III sets guidelines for pre-tax medical spending accounts, Title IV sets guidelines for group health plans, and Title V governs company-owned life insurance policies.

Electronic health record a program used to document a patients medical history on a computer

An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

A Regional Health Information Organization, also called a Health Information Exchange Organization, is a multistakeholder organization created to facilitate a health information exchange (HIE) – the transfer of healthcare information electronically across organizations – among stakeholders of that region's healthcare system. The ultimate objective is to improve the safety, quality, and efficiency of healthcare as well as access to healthcare through the efficient application of health information technology. RHIOs are also intended to support secondary use of clinical data for research as well as institution/provider quality assessment and improvement. RHIO stakeholders include smaller clinics, hospitals, medical societies, major employers and payers.

Canadian Institute for Health Information

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada's health systems and the health of Canadians. CIHI provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. Stakeholders use the broad range of health system databases, measurements and standards, together with evidence-based reports and analyses, in their decision-making processes. CIHI protects the privacy of Canadians by ensuring the confidentiality and integrity of the health care information.

Adventist HealthCare Shady Grove Medical Center Hospital in Maryland, U.S.

Adventist HealthCare Shady Grove Medical Center is a 266-licensed bed acute care facility located in Rockville, Maryland. Shady Grove Medical Center provides a range of health services to the community such as high-risk obstetrical care, cardiac and vascular care, oncology services, orthopedic care, surgical services and pediatric care. Opened in 1979 as Shady Grove Adventist Hospital, Shady Grove Medical Center operates as part of Adventist HealthCare, a health-care delivery system that includes hospitals, home health agencies and other health-care services. Adventist HealthCare is headquartered in Gaithersburg, Maryland.

Protected health information (PHI) under the US law is any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity, and can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.

WEDI, pronounced "wee dee", is a not-for-profit user group in the United States for users of Electronic Data Interchange (EDI) in public and private healthcare. The organization is sometimes referred to by other names that include some or all of the words: Workgroup for Electronic Data Interchange.

The Mental Health Commission of Canada (MHCC) is a national non-profit organization created by the Canadian government in 2007 in response to a senate committee tasked to study mental health, mental illness, and addiction. The committee appointed Michael J. L. Kirby as the first chairperson. The MHCC was endorsed by all the provinces and territories with exception to Quebec. The Commission is funded by Health Canada and has a ten-year mandate enforced through a sunset clause. On 21 April 2015, Minister of Finance Joe Oliver announced that the 2015 federal budget calls for the renewal of the MHCC for another ten-year mandate starting in 2017-2018.

The Office of the National Coordinator for Health Information Technology (ONC) is a staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services. ONC leads national health IT efforts, charged as the principal federal entity to coordinate nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

Texas E-Health Alliance

Texas E-Health Alliance is a 601(c)(6) corporation founded in 2009 that brings together the provider, corporate, non-profit and academic health care communities with policymakers in order to create an effective e-health policy for Texas.

eMix, which stands for Electronic Medical Information Exchange, is a cloud computing-based technology for secure sharing of medical imaging studies and reports between disparate healthcare facilities and physicians. eMix was developed to address a challenge in medical imaging: How to exchange medical imaging data between proprietary information technology (IT) systems that do not "talk to each other", The service also provides an alternative to legacy solutions typically used for sharing medical imaging data. Examples of such legacy methods include:

The Electronic Healthcare Network Accreditation Commission (EHNAC) is a voluntary, self-governing standards development organization (SDO) in the United States established to develop standard criteria and accredit organizations that electronically exchange healthcare data. These entities include electronic health networks, payers, financial services firms, health information exchanges (HIEs), management service organizations and e-prescribing solution providers.

The Health Information Technology for Economic and Clinical Health Act, abbreviated HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services is spending $25.9 billion to promote and expand the adoption of health information technology. The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records." At the time it was enacted, it was considered "the most important piece of health care legislation to be passed in the last 20 to 30 years" and the "foundation for health care reform."

Medical image sharing

Medical image sharing is the electronic exchange of medical images between hospitals, physicians and patients. Rather than using traditional media, such as a CD or DVD, and either shipping it out or having patients carry it with them, technology now allows for the sharing of these images using the cloud. The primary format for images is DICOM. Typically, non-image data such as reports may be attached in standard formats like PDF during the sending process. Additionally, there are standards in the industry, such as IHE Cross Enterprise Document Sharing for Imaging (XDS-I), for managing the sharing of documents between healthcare enterprises. A typical architecture involved in setup is a locally installed server, which sits behind the firewall, allowing secure transmissions with outside facilities. In 2009, the Radiological Society of North America launched the "Image Share" project, with the goal of giving patients control of their imaging histories by allowing them to manage these records as they would online banking or shopping.

Health care analytics is the healthcare analysis activities that can be undertaken as a result of data collected from four areas within healthcare; claims and cost data, pharmaceutical and research and development (R&D) data, clinical data, and patient behavior and sentiment data (patient behaviors and preferences,. Health care analytics is a growing industry in the United States, expected to grow to more than $31 billion by 2022. The industry focuses on the areas of clinical analysis, financial analysis, supply chain analysis, as well as, fraud and HR analysis.

Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and behavioral information pertinent to health and wellness. A plurality of health data are collected and used when individuals interact with health care systems. This data, collected by health care providers, typically includes a record of services received, conditions of those services, and clinical outcomes or information concerning those services. Historically, most health data have been sourced from this framework. The advent of eHealth and advances in health information technology, however, have expanded the collection and use of health data—but have also engendered new security, privacy, and ethical concerns. The increasing collection and use of health data by patients is a major component of digital health.

Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.

References

  1. Sentementes, Gus G. (2009), Md. takes lead in electronic medical records , retrieved 2009-11-26[ permanent dead link ]
  2. Howard County Economic Development Authority, Audacious Inquiry Partners with CRISP on State-wide Health Information Exchange , retrieved 2010-12-22
  3. Axolotl PR, archived from the original on 2010-05-09, retrieved 2010-12-22
  4. Goedert, Joseph (2009), Maryland OKs $10 Million for State HIE, archived from the original on 2009-10-23, retrieved 2009-11-26
  5. Finney, David (2010), Maryland Receives $9.3 Million in Health Information Exchange Funding, archived from the original on 2011-07-07, retrieved 2010-07-07
  6. HOUSE BILL 706 , retrieved 2010-03-02
  7. Horst, Rob (2010), Maryland's Health IT Extension Center Becomes a Reality, archived from the original on 2011-07-07, retrieved 2010-05-25