CRISP OverviewLeveraging Maryland’s HIE to Support Health Care Payment and Delivery Reform

June 21st, 2013

General Roles of an HIE / HIO

CRISP is Maryland’s State Designated Entity for Health Information Exchange.

CRISP, and Health Information Exchange Organizations in general, act as a “hub”, or central agent, for many things…

Technology Hub Contracting Hub (e.g. participation agreements, funding agreements, vendor

agreements, etc) Relationship Hub

As a relationship hub we are a body that can bring together organizations to cooperate on a specific set of data sharing activities while still continuing to compete in other ways, including on health IT (just not on the availability of data itself). 

3

CRISP Background and Status

Evolving Financial Motivation to Coordinate Care

The Affordable Care Act and other Maryland payment initiatives have promoted a level of care coordination that will be reliant on accurate patient identity management and exchange processes...that is, having an awareness and an understanding of an individual’s identity and clinical data beyond a single facility/encounter…

Admission Readmission Revenue (Maryland Specific) Total Patient Revenue (Maryland Specific) Accountable Care Organizations Patient Centered Medical Homes Bundled Payments CMS Readmission Reduction (MI, CHF, Pneumonia)

4

Patient Identity Management

The Challenge: Accurately and consistently linking identities across multiple facilities to create a single view of a patient.

A near-zero tolerance of a false positive match rate with a low tolerance of a false negative match rate.

Accurate cross-entity patient identity management is a fundamental requirement for population-level measurement, utilization trending, and care coordination.

6

CRISP Query Portal

Encounter Notification Service

7

ENS enables CRISP participants to receive real-time notifications when one of their patients or members is hospitalized.

The alerts are generated from the “ADT” messages CRISP receives from all Maryland hospitals.

Participants can only subscribe to “active patient or members”

If an individual has opted out of the HIE, an alert will not be triggered.

There are currently over 800,000 patients subscribed to with in ENS resulting in over 1,250 notifications per day.

8

Hospital Services Utilization Reporting

As encounter messages flow into CRISP, reporting on aggregate hospital services, regional or community utilization, and trending analysis becomes possible.

By consolidating, correlating, and reporting against real-time encounter data CRISP can produce rapid and comprehensive views of hospital data for purposes such as identifying (to the appropriate entity) “super-utilizers” in targeted geographies.

GIS Mapping Capability

9

Based on the indexed utilization information CRISP can produce visualizations of hospital utilization data in near real time.

CIMH can leverage geographic data to better understand localized use of services and opportunities for the most efficient / targeted interventions.