The Chesapeake Regional Information System for Patients (CRISP) will select the technology vendors by the end of the year to help it build Maryland's statewide health information exchange (HIE).

With a quarter-million-dollar grant awarded from the Maryland Health Care Commission (MHCC) and the Maryland Health Services Cost Review Commission (HSCRC) three years ago, CRISP helped create a roadmap for designing and building a statewide HIE. In September CRISP was awarded $10 million through an adjustment in hospital reimbursement rates to see that vision become a reality.

CRISP is also currently pursuing HIE funding opportunities through the American Recovery and Reinvestment Act. The organization has been designated as the HIE for the state and will be the mechanism that will receive and distribute the funds, but MHCC will apply directly for the funds, said David Horrocks, president of CRISP.

CRISP is working with MHCC to represent Maryland's interests. It is also applying for federal grants to serve as a health IT regional extension center, as part of the HITECH Act under ARRA. "We're making sure that Maryland captures the federal funds for health information exchange," Horrocks said.

CRISP's early beginnings can be traced to Erickson Retirement Communities, whose founder and former CEO had a vision to provide electronic medical records of its patients in its assisted living and skilled nursing facilities and at home and connect them to the providers at St. Agnes Hospital, Horrocks said.

Erickson wanted to do something for residents outside of the retirement communities and three years ago enlisted Horrocks to bring the CIOs of the local large health systems together to achieve that goal.

"That was the starting point," Horrocks said. The collaboration comprises John Hopkins Medicine, MedStar Health and the University of Maryland Medical System, along with Erickson Retirement Communities.

With in-kind member contributions and funds from the Erickson Foundation, the collaborative implemented a medication history pilot in ambulatory locations and emergency departments. In parallel, CRISP won the planning contract from MHCC and HSCRC. MHCC's leadership has been very important to CRISP's success so far, Horrocks said. He also credited the willingness of the early partners to participate despite the market competition among the health systems.

Maryland's HIE was not created out of a need to address an identified health status deficiency as is the case with some HIEs in other regions of the country.

Maryland is a national and global leader in quality healthcare.

 "We certainly do harbor ambitions of improving the health status of Maryland's residents," Horrocks said. The plight of seniors is a focus. Getting valuable information on seniors' chronic conditions, multiple physicians and specialists and multiple medications when they are admitted to a hospital or emergency department was "an important part of getting the conversation going" with participants, he said.

In fact, that use case helped galvanize the early partners.

 "We're most excited about the statewide approach and the good spirit of cooperation in Maryland," he said.

CareFirst, the largest payer in the state and the largest in the Mid-Atlantic region, was part of the advisory board for the planning process.

To date, CRISP has created its technology committee, which will oversee the procurement of the technology and the infrastructure build out. CRISP is in the process of putting together its clinical use case and finance committees. The biggest challenge is sustainability, Horrocks said.

 "We think we have a plan without being an ongoing burden to providers and other stakeholders," he said. "We know we need to do it in an efficient way," he said.