Q&A: Ben Steffen of the CSMC on the future of CRISP and the exchange of health information – Status of the reform
Ben Steffen is the executive director of the Maryland Health Care Commission (MHCC), an independent regulatory body under the Ministry of Health. MHCC stands for Maryland Health Information Exchange (HIE), the Chesapeake Regional Information System for our Patients (CRISP).
In this Q&A, Steffen reflects on the role CRISP has played in mapping the COVID-19 pandemic and how HIEs are critical to strengthening Maryland’s public health infrastructure.
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State of the reform: What role does MHCC play in Maryland’s health information technology landscape?
Ben Stefan: “The Health Care Commission has a long-standing interest in health information technology, which stems from our statutory power to develop a claims database for all payers and to provide some oversight to health care centres. State Health Electronic Exchange. Starting with the passage of [Health Information Technology for Economic and Clinical Health Act] and the federal government’s investment in electronic health technology, we have also expanded this to look more broadly at the exchange of clinical information to deepen and enable clinical care. This was commemorated from 2008-2009, when the health commission was given the power to designate a statewide health information exchange, CRISP.
This allowed the health care commission to build a much more engaged relationship with health care providers, particularly as we first worked closely to establish what in 2008-2009 was a fledgling organization. CRISP is now prominent throughout the state, continuing to be the state’s designated health information exchange.
The commission works in two areas. One is to promote the exchange of clinical information. We are certainly not the only entity doing this — the federal government has an important role to play. Our role is to complement what the federal government is doing to build the capabilities and protections that are valued in Maryland. We are active in this regard to drive adoption of electronic health records, promote interoperability and, at the same time, ensure that Maryland law aligns with the privacy concerns of Maryland stakeholders, including not only the interests of suppliers, but also consumers. So the commission has a unique perspective, in that we see enormous value in the sharing of clinical information, but we’re also keenly aware of the importance of protecting that information and ensuring that patients have their say. to say about how information can be shared.
OR: How do the commission and CRISP balance health information for providers and consumers in the same system, while addressing privacy concerns?
SB: “In terms of what CRISP offers, it is now a provider-centric environment… What is publicly available is the ability to opt out of sharing information about CRISP and a description of the information shared. So far, a relatively small number of Marylanders are withdrawing from CRISP, about 10,000 people. What providers see are a number of CRISP personalization portals that relate to the use of clinical information and some administrative information that is packaged in a way that has some clinical significance. This includes certain claims administrative information, clinical information, lab results, etc.
In addition, certain information contained in electronic health records may be exchanged with the CRISP infrastructure. This is probably the most valuable feature of the CRISP framework, the HIE framework in general. So that was the original vision [for CRISP] when information was held in silos by health systems and providers. Health information exchange allowed information to appropriately move out of these information silos and be shared by other clinicians who needed the information.
OR: How have the responsibilities of CRISP and CSMC evolved during the pandemic? What impact will this have on the role of HIEs in the future?
SB: “The value of health information exchange has taken on a new dimension with the outbreak of COVID. Often it was not possible to provide real-time access to outbreak information. At the start of the pandemic, Maryland, like virtually almost every state, was sort of flying blind. The ability to collect and collate public health information and outbreak information was initially extremely important during the first nine months of the pandemic when vaccines were not available and testing was quite limited.
CRISP was able to intervene in all these dimensions and set up easily accessible portals that public health and clinical staff could use. [They could] access information about the level of outbreaks, test availability, and test results to a wider audience than necessarily the rendering provider. Like many other states, CRISP has taken on a role in the sphere of public health that had really not been envisaged.
Before the pandemic, CRISP was going to facilitate the exchange of information from one clinician to another, all the more useful when these two clinicians were affiliated with different health systems… But following COVID-19, and because the public health data infrastructure was so inadequate, HIEs at all levels were able to – because they had this one-to-one data exchange framework that had been established – recover the infrastructure from public health relatively quickly… The ability of CRISP to collect information on the whole clinical landscape and put it together in a way to help decision-makers more broadly, has been truly recognized.
OR: Are there any plans by the legislature or other stakeholders to further develop the state’s health information system?
SB: “The big question for the Legislative Assembly is how formally do they want to enshrine a state-appointed, non-profit information exchange into the public health infrastructure. CRISP has been a very competent and practical partner at this stage, but I think it is important for the State to reflect further on the types of investments it is going to make in terms of public health, and in particular surveillance and public engagement. We will certainly face other epidemics. Hopefully they won’t reach the level of the pandemic that we’re struggling through, but we need to have capacity in place.
I think we are redefining and thinking more broadly about how [CRISP’s] role can expand, move forward, but also recognize that there are private companies that offer capabilities that also need to be considered. It is up to state agencies to weigh this balance carefully. On the one hand, I think your public data service has enormous value, but you also lose some flexibility by not fostering creativity in the broader private sectors of health technology. Really, the winning formula is one where you try to combine the capabilities of organizations, but recognize that some shared infrastructure is likely very valuable to Maryland residents in the future.
This interview has been edited for clarity and length.