Health info exchange’s data innovations take the ‘detective work’ out of public health

When public health investigators in Maryland want more information about overdose fatalities and survivals, they tap into the state’s designated health information exchange, the Chesapeake Regional Information System for Our Patients (CRISP).

The independent nonprofit, which also serves as the state’s Prescription Drug Monitoring Program (PDMP) and health data utility, collects a lot of data. For instance, from Maryland hospitals it gets clinical documents, lab results, radiology reports, discharge notes, diagnostic-quality images and data on real-time admission, discharge and transfer fees. CRISP is also connected to about 600 ambulatory health practices, skilled-nursing facilities as well as the state and local departments of health.

“Lots of data flows through us, and then we’re really good at linking it, dropping it into a data lake and making it useful in different contexts,” said Craig Behm, CRISP’s executive director. A provider at a hospital or ambulatory practice queries CRISP data about 200,000 times per week.

When the medical examiner wants to learn more about someone who died of a drug overdose, they can log into CRISP’s portal using multifactor authentication and pull up data they need, such as whether the patient had prior hospitalizations, their lab results and past radiology reports. They can also check the PDMP for dispensing patterns to determine what drugs and what dosages the person was taking. 

“We’ve heard a lot of folks who do this type of use case compare it to detective work,” Behm said. “They’re flipping through records and different views that are linked…. Back in the olden days – 10 years ago – the medical examiner would have been calling each health system and trying to get the records office to fax over the records, and they wouldn’t have even known what to ask for. Now we have such a broad perspective of a patient’s series of care. It’s all in one spot.”

The Health Department publishes an annual report on unintentional drug- and alcohol-related intoxication deaths, but a key indicator of a fatal overdose is a nonfatal one, Behm said. That’s why CRISP developed an alert system. Now, when a patient with a history of overdoses arrives at a Maryland hospital that has the alert configured, doctors and nurses will get “stop-you-in-your-tracks-type alerts” so that they can treat the patient accordingly, he said.

Additionally, drug prescribers and dispensers must check CRISP records before dispensing a controlled substance, so the organization added alerts to its portal and through application programming interfaces that warn that the patient had a previous nonfatal overdose on a particular date at a particular place. The prescriber or dispenser must acknowledge seeing that alert to proceed.

Additionally, a disproportionate number of those overdose patients are Medicaid beneficiaries, and because CRISP has the Medicaid beneficiary files, it can link beneficiaries with their managed care organizations (MCOs) to make them aware of an overdose history.

“We are so good at linking information and we’re so good at providing it to the point of care for services that what I really want to do is get more and more information that is relevant and useful both to policymakers and to providers,” Behm said. “For example, we’re getting immunization data now. It started with just COVID and moved on to all immunizations, and it’s been really helpful because we can provide gaps in immunizations to Medicaid MCOs or primary care doctors and pediatricians to help them call patients in before the start of the school year to get vaccinated.”

CRISP also wants to link additional data on social determinants of health to help improve care. For instance, it’s important for a care team to know if a patient is homeless and about to be discharged to the streets.

“By linking this data, we can aggregate it, give it to policymakers, help them make better decisions that are based on data, but also give it to the actual people at the point of care so they can affect these things in real time,” Behm said.

What’s more, CRISP is sharing the technologies it has developed through CRISP Shared Services, a separate nonprofit. So far it has partnered with affiliates in Alaska, West Virginia and Washington, D.C., to provide services such as a clinical query portal, encounter notification service, a master patient index as well as networking and infrastructure support.

“In each of those places, they have their own nonprofit, state-designated health information exchange, and they contract with our shared services group, so they own their own data, they control their own fate, they have their own funding and tell us what to invest in,” Behm said. “The whole idea behind it is the technology is very scalable and repeatable…. We don’t need three or four master-person indexes and data lakes and all the things that you’d do if you were starting from scratch.”

One benefit of this is cost savings. “The cloud resources to add another million lives are essentially zero, and so it’s very easy to scale this in a cost-effective way,” he added.

Another is that it’s a shared investment. For example, CRISP D.C., a separate nonprofit, is investing in community exchange initiatives such as a resource inventory and directory that includes  what places are involved in health care-related services, such as housing and food assistance. The District got grant funding to build out some of those resources and pays CRISP Shared Services through project dollars to build out the technology. CRISP Shared Services can then share that feature with all affiliates. 

“The D.C. investment in their community inventory will help Maryland out,” Behm said. In return, Maryland is working on closed-loop referrals between a care manager and community service, and D.C. can use that tool, just as work on behavioral health in Alaska can support the other states.

“The other really major benefit of it is we get to learn from each other,” Behm said. “Every state is different, we all have our own quirks, but the innovation and the general direction of the industry will be determined by all these different groups, so if we’re working with others to figure it out, I think it’s always good to build that kind of diversity and input.”

Stephanie Kanowitz is a freelance writer based in northern Virginia.