Checking in with CRISP, Maryland's HIE

I had a conversation recently with David Horrocks, president of Chesapeake Regional Information System for our Patients (CRISP), Maryland’s statewide HIE based in Catonsville, Md., and one of his main concerns was the fact that physicians today are getting mixed messages on what health IT to adopt.

CRISP, which went live last October, was funded from $10 million in seed funding through an adjustment in the reimbursement rates for participating hospitals and a $9.3 million ONC grant to implement a statewide HIE in Maryland. Last year CRISP received letters of intent from all 46 acute care hospitals in the state, and has since hook up nine of them. CRISP is also the state’s regional extension center, having received $5.5 million in funding from HHS, and has so far helped outfit 500 physicians with EHRs and is in the process of hooking up 250 more, which is 75 percent toward their goal of 1,000 physicians.

One surprise Horrocks encountered as president of CRISP is the way physician practices have been connecting to the HIE. He noted that there were four ways that physicians could connect to CRISP—via direct connections, through large multi-site practices, through a EMR vendor hub, or through managed service organizations (MSOs). Early on he predicted most physicians would make direct connections, but he said, “we’re finding it’s much harder to convince physicians to move down that path of direct connections. I think part of the reason for this is that physicians are receiving multiple messages about what technology to adopt.”

Horrocks says doctors are being bombarded with tons of technology, with payers telling them about patient-centered medical home portals they should adopt, and hospitals suggesting they use their portals, and messages from the state and federal level on incentives for MU and EMR adoption. “[Physicians] are being careful to not just jump on every one of those things, and taking a more careful approach,” Horrocks said.

Future Plans
In the future, Horrocks hopes CRISP will share EKG images and be a resource for public health for reportable conditions and vaccinations. He also hopes to demonstrate progress toward sustainability and become a venue toward building accountable care organizations. “Our hope is that as we drive connectivity that there will be uses for the exchange to various stakeholders whether its public health or state government or the hospitals or even ACOs as those are spun up that there will be services they value enough to justify those participation fees,” he said.

Horrocks says CRISP has approached payers, but hasn’t had much substantial engagement from than more than representation on the CRISP board. Horrocks does plan to explore use cases with payers to find ways of meaningfully engaging them to take part in the exchange.

“Some lessons learned out of Maryland is a good partnership with the state and the other stakeholders is very important for these efforts to move forward successfully and that has been a good hallmark,” Horrocks said. “The state invested funds have let us go much further than the ONC dollars.”

Challenges
Although he says his exchange has a solid approach, and ONC has promoted standards that have been helpful, Horrocks wishes there was a better national consensus on the best ways to approach patient consent and data security. And he also sees legislative proposals to repeal incentive funding as ever-pressing challenges that could change the business case for projects CRISP might embark on.