1. CRISP InContext September 28th, 2018 The Ronald Reagan Building
1300 Pennsylvania Avenue NW Washington, DC 20004

2. Vision – Mission – Guiding Principles
HL7® and FHIR® are registered trademarks of Health Level Seven International. The use of these trademarks do not constitute a product endorsement by HL7.
Vision – Mission – Guiding Principles
CRISP is a non-profit health information exchange (HIE) serving Maryland, the District of Columbia, West Virginia, and the region.
Our Vision To advance health and wellness by deploying health information technology solutions adopted through cooperation and collaboration. Our Mission We will enable and support the healthcare community of Maryland and our region to appropriately and securely share data in order to facilitate care, reduce costs, and improve health outcomes.
Our Guiding Principles
Begin with a manageable scope and remain incremental.
Create opportunities to cooperate even while participating healthcare organizations 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.
Use best practices and standards.
Serve our region’s entire healthcare community.

3. HL7® and FHIR® are registered trademarks of Health Level Seven International. The use of these trademarks do not constitute a product endorsement by HL7.
CRISP Service Area
Chesapeake Regional Health Information System for our Patients
West Virginia
Infrastructure for WVHIN
via DHIN
Delaware
State-Designated HIE
HIE
Maryland
via Virginia Connect
District of Columbia
Virginia

4. CRISP by the numbers (as of 9/20/18)
HL7® and FHIR® are registered trademarks of Health Level Seven International. The use of these trademarks do not constitute a product endorsement by HL7.
CRISP by the numbers (as of 9/20/18)
CRISP receives inbound data feeds from many provider organizations across the region, including all acute care hospitals in Maryland, D.C., and West Virginia. This powers CRISP services, putting clinical information in the hands of those with treatment and care coordination responsibilities.
Data source or attribute #
Hospitals
106: 48 in MD, 9 in DC, 29 in WV
Long-term and post-acute care facilities
134
Standalone labs and radiology centers
3 Lab 13 Rad
Unique patients in our index
+18.3 million
Encounter alerts sent
<3 million / month
Provider Orgs using ENS or Query Portal
>1,500
Clinical Data Feeds
>300
ADT
20 million/m
Labs/Rads/ Transcriptions
8,240,000/m

5. Goal
CRISP’s goal is to make information available to providers within their workflow. Strategy 1: Incorporate discrete pieces of information into native workflows within an EHR Strategy 2: Develop user workflows using CRISP tools and determine efficient ways to integrate these into EHRs. 5

6. Understand what’s valuable
Care Alerts (CA) High priority care coordination information meant for the most complex patients who frequent hospitals and practices. These are generally written by physicians or care managers who have previously seen the patient. Maryland Prescription Drug Monitoring Program (PDMP) Data The PDMP monitors the prescribing and dispensing of drugs that contain controlled dangerous substances (CDS). For each prescribed CDS drug that is dispensed in Maryland, the dispenser must report information for the Drug, Patient, Prescriber, and Pharmacy. Includes Interstate PDMP data for neighboring states. Overdose Alerts (OD) Informs providers of previous overdose events based on information received from syndromic surveillance feeds. Infection Control Public Health Alerts. Including – CRE flag, Zika, TB, C. difficile Advance Directive (AD) Lists URL directing to the patient's Advance Directive document which specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. Care Team Alerts (TEAM) Provides a list of organizations that are currently receiving information about the patient. Prior Visit Alerts (PV) Provides a list of a patient’s previous care encounters by date and location. 6

7. Impact: 1000% utilization increase
CRISP Infrastructure
Impact: 1000% utilization increase

8. Develop new ways to deliver data – CRISP InContext
Leverages SMART on FHIR® launch sequence
Provider-facing
Resources
Reads /Patient and /Practitioner resources to understand context
Writes currently not supported – in the road map

9. Status Lessons Learned Important to understand trigger events
User training helps
Deployed in Production with 4 health systems
~1400 launches/week
Feedback
“…pretty slick”
Providers appreciate being able to see information from the HIE and still document within their medical record
Providers would appreciate if it were “smarter” about launching – specific trigger conditions, etc.
Working towards deployment with two additional EHRs

10. Supported Resources
FHIR® Diagnostic Report Observations Specimen Medications Medication Statement Image Encounter
FHIR®-like
Alerts
Prescription Drug Monitoring Program Data 10

11. Way-Forward Integrate into more EHRs!
Understand appropriate /write scopes
Incorporate Image Exchange
Open Source!

12. Thank You! Mike Banfield | Director of Innovation
HL7® and FHIR® are registered trademarks of Health Level Seven International. The use of these trademarks do not constitute a product endorsement by HL7.
Thank You!
Mike Banfield | Director of Innovation
Ryan Bramble | Senior Director of Product Development
Markeya

13. CRISP InContext - Text Alerts
Text Alerts are displayed in tab view. With the exception of PDMP, tabs are only displayed if data is available for that alert. The number of each alert is noted at the top of every tab. 13

14. CRISP InContext - Flag Alerts
Flag Alerts are displayed above the tabular text alerts. Each alert is grouped in a category bucket, like “Public Health Alert”. Binary flag alerts are clinical yes/no answers. If they exist (yes), the flag displays. 14

15. CRISP InContext – Flag Alerts
Hoover over the flag with your mouse to reveal special instructions. 15

16. Care Alerts
Care Alert: a short description of critical information for patient care generated by CRISP participants within their EHR.
“This patient has a MOLST. Please note: DNR, DNI, no feeding tube, no antibiotics.”
“Mr. Stevens has CHF exacerbations that typically and rapidly respond to 40 mg IV furosemide in the ED with close follow up the next day in the office. Call/text Dr. Diur FIRST at if you are considering admission.”
“Mr. Jones has dementia, diabetes, and COPD. His baseline, every day exam is notable for wheezes and rales and there is a stable finding of a LLL ‘infiltrate’ on his CXR. Typically his COPD exacerbations are due to anxiety and to not using his maintenance medications. Please securely text his primary care physician, Dr. Smith, if admission or testing is considered.”
“Mrs. Franklin’s pain medications are managed entirely by Dr. Dolor. Securely text him prior to prescribing any controlled substances.”

17. CRISP InContext – Overdose Notifications
Overdose Notifications report when a patient has experienced a drug-related overdose. The alerts are triggered based on coded diagnoses sent by hospitals in Maryland and West Virginia. 17