Chesapeake Regional Information System for our Patients (CRISP), www.crisphealth.org, is a not-for-profit membership corporation advised by a wide range of stakeholders responsible for the healthcare of Maryland’s citizens. CRISP is formally designated Maryland’s statewide health information exchange (HIE) by the Maryland Health Care Commission (MHCC), as directed by the state’s legislature and its governor.
CRISP’s mission is to advance health and wellness of Marylanders by helping healthcare providers to adopt and use electronic health records (EHRs) in a meaningful way and by enabling those providers to share clinical data with other providers and hospital systems across the state. HIE is the infrastructure that supports the flow of health information between physician practices, hospitals, labs, radiology centers, and other healthcare institutions. The CRISP HIE allows delivery of the right health information to the right place at the right time providing safer, timelier, efficient, patient-centered care.
CRISP and its multitude of stakeholders had envisioned an HIE that would support a wide range of use cases from enhanced care coordination and public health reporting to telemedicine. The medium- and long-term benefits will include improved administrative reporting and clinical information exchange across state lines. More broadly, the CRISP HIE helps physicians to make more informed decisions about patient care and treatment with accurate, up to date information. It also helps to eliminate repeated testing, allows for easier second opinions, reduces the risk of adverse drug reactions,
and minimizes errors caused by hard-to-read handwriting and transcriptions. By allowing providers to work more efficiently, the HIE can help moderate the growing cost of healthcare.
CRISP Master Patient Index Challenge
Bringing together Maryland’s hospital systems posed a real-life change. In having such a large amount of disparate medical record repository systems, CRISP sought a large-scale enterprise solution to help solve their master data management (MDM) problems and to enable accurate patient identification. Specifically, CRISP sought a solution that was highly scalable and a robust product was sought to ensure compliance with a zero-tolerance policy for “false positive” patient matches while also enabling a near-zero tolerance for “false negative” patient matches.
“The combination of expertise and experience at Audacious Inquiry and the Initiate MDM solution by IBM has been powerful for CRISP and for Maryland. Ai’ s experience in the world of HEI, MDM and healthcare has allowed the patients in our state to begin to realize the investment in – and vision for – health information exchange,” said David Horrocks, president of CRISP.
The IBM Initiate MDM Solution
With consulting services from Ai, the MPI solution, to solve CRISPs Master Patient Index challenge, which was chosen was the IBM Initiate’s Master Data Management tool. IBM Initiate’s matching algorithm more accurately identifies unique patients across various sources of patient information in the state, including hospitals and other healthcare providers, by minimizing the false positive outcomes and reducing to near-zero the false positive correlations.
Within unique challenges, the CRISP HIE went live in September 2010 by initially bringing five Montgomery County hospitals, three major radiology centers and two national lab connections online. Hospitals began submitting demographic information (ADT); lab results and radiology reports (ORU); and a subset of clinical documents, which included discharge summaries, history and physicals, operative notes, and consultations (ORU or MDM) at that time. Data flowed into the MPI solution allowing for 360 degree view of the patient.
The IBM Initiate (MPI) relies on a highly configurable probabilistic matching algorithm that allows CRISP to refine the scoring of different matching scenarios. The MPI allows CRISP to assign weights for various data elements which uniquely identifies an individual allowing for the creation of a new identity (if the individual is “new” to the HIE) or association with an existing master identity for that individual. The data elements used for matching are extensible, they can be expanded upon, but generally include first name, last name, address, phone number, date of birth, and facility specific medical record number (MRN). Points are assigned for exact match of each data element but partial points are also given for partial matches such as shorted names and transposed dates. The final matching score will determine if the identity in question is associated with an existing patient identity, routing to a queue for manual intervention, or results in the creation of a net new patient.
In early 2011, the CRISP MPI and core infrastructure were fully integrated. As of December 2011, the MPI contains over 2 million unique identities, reflecting patients of connected entities in Maryland and all 46 of the state’s hospitals are sharing data via the exchange, making the CRISP HIE one of the largest and most comprehensive health information exchanges in the United States.
During the implementation, Audacious Inquiry provided program management, technical architecture and a range of support services for CRISP. Ai served as the functional and technical project manager for the effort and was responsible for establishing and maintaining a working relationship with key HSCRC staff; ensuring accurate and specific functional requirements are documented; defining the key milestones and dates for the project; acting as the project manager and the Initiate project teams where aware and executing against their tasks; designing and testing the MDM and business intelligence infrastructures appropriate for the use case; providing quarterly reports to participants; and positioning CRISP for long-term success.
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