Health information technology (HIT) can help improve health care quality, prevent medical errors, and reduce health care costs by delivering essential information to the time and place of care. There are two crucial components of effective health information technology – widespread use of electronic health records by providers and the ability to exchange health information privately and securely.
While both are challenging projects conceptually, technologically, and economically, the development of secure information exchange poses special challenges. Trusted health information exchange requires the involvement of a broad range of stakeholders – patients, providers, payers, purchasers, and health agencies – and the consideration of a broad range of policies, principles and designs.
To address these challenges, the MHCC and the Health Services Cost Review Commission (HSCRC) have proposed a two-phase strategic plan involving several parallel planning projects followed by a single implementation project. Primary objectives of this strategic plan for private and secure health information exchange include:
1. Building a statewide clinical data sharing utility for data exchange in Maryland.
2. Identifying private and public policies regarding privacy, confidentiality, and access.
3. Implementing projects connecting disparate health information technology systems.
4. Determining an appropriate financial and business model for sustainability of a Maryland RHIO.
5. Ensuring that Maryland’s clinical data sharing application and data exchange process is consistent with national standards.
6. Identifying legislation necessary to support the voluntary exchange of clinical data.
7. Encouraging business, health care, and policy leaders to create agendas and funding for clinical data exchange.
8. Facilitating creation of common governance, process, technology, and other elements needed for implementing a statewide
clinical data sharing utility.
Planning Projects
The HSCRC plans to fund up to three planning projects through hospital rate adjustments of up to $250,000 each. The Request for Application (RFA) is being developed by the MHCC, and will be shaped by extensive stakeholder input through informal and formal comment periods open to all interested parties.
Each applicant for the planning project was a multi-stakeholder group that included at least one Maryland hospital. From November 2007 through July 2008, each project developed a strategy for phased implementation of a statewide health information exchange. The plan included proposed solutions to a specific series of issues: governance, privacy and security, role-based access, user authentication and trust hierarchies, architecture of the exchange, hardware and software solutions, costs of implementation, alternative sustainable business models, and strategies to assure appropriate patient engagement, access, and control over information exchange.
Planning Team Reports
Chesapeake
Regional Information System for Our Patients (CRISP) 
Montgomery County
Health Information Exchange Collaborative (MCHIE)
Implementation Project
The challenge at this implementation phase will be to bring together the results of the Maryland planning and pilot projects with information from exchange projects nationwide to craft an RFA for an implementation project in Maryland. The RFA will be drafted following extensive consultation and open comment from Maryland organizations. HSCRC anticipates making as much as $10 million available through rate adjustments to hospitals.
Although structured as a competitive application for an implementation project, great weight will be given to:
• A demonstrated ability to bring multiple stakeholders together to resolve policy issues and to craft creative solutions to technical
and operational challenges;
• The functionality, scalability, and cost-effectiveness of the proposed project for the private and secure exchange ofclinical information;
• The capacity of the exchange to serve additional public purposes, including public health, post-marketing drug surveillance, andhealth services research;
• The ability to engage consumers and develop trust in the privacy and security of the system; and
• The long term financial viability of the exchange.
Request for Application
for A Consumer-Centric Health Information Exchange for Maryland
Addendums:
Responder
Notification - May 8, 2009
Responder
Notification - June 3, 2009
HIE RFA Questions:
Discussion Points from Responder Conference - April 28, 2009
Recommendation for a Statewide HIE: Commissioner Presentation Materials
HIE
Recommendation Presentation
For more information about CRISP click here.