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Health IT Policy Reports

The Maryland Health Care Commission’s (MHCC) Center for Health Information Technology & Innovative Care Delivery (Center) publishes various documents related to advancing the adoption and use of health information technology (health IT).  Below is a list of publications organized by topics (i.e. Health Information Exchange, Electronic Health Records, Health Information Technology Survey Reports, Health Information Technology State Plan, and Other Health Information Technology Reports).


Health Care Data Breaches:  2017 Findings (2018)

The MHCC analyzed health care data breaches reported in 2017 to the Department of Health & Human Services Office for Civil Rights.  The report assesses the number of breaches reported and records compromised, and key trends in Maryland and the nation. 

Health Care Data Breaches: How Maryland Compares (2017)

The MHCC analyzed health care breaches reported to the Department of Health & Human Services Office for Civil Rights from 2013 through 2016.  This report presents Maryland's ranking in relation to other states and provides a more detailed evaluation of records compromised and location of breached information. 

Health Care Data Breaches:  A Changing Landscape (2017)

The MHCC analyzed health care breaches reported to the Department of Health & Human Services Office for Civil Rights from 2010 through 2016.  This information brief discusses the increasing prevalence of health care breaches, and includes recommendations on enhancing security processes to prepare for and mitigate the effects of new and evolving cyber threats.

Hospital Cybersecurity:  Evolving Threats Require New Approaches (2016)

The MHCC conducted an assessment of hospital cybersecurity to assess how hospitals are preparing for and managing cyber risks.  This information brief highlights key findings from the assessment.

Electronic Health Records

Accelerating Meaningful Use in Maryland:  Strategies Aimed at Eligible Providers (2013)

In an effort to advance the Meaningful Use (MU) of electronic health records (EHRs), the American Recovery and Reinvestment Act of 2009 established incentives for Medicare and Medicaid eligible professionals (EPs) who adopt certified EHR systems and meaningfully use them to improve patient care quality and satisfaction, increase population health, and reduce health care costs. In the spring of 2013, MHCC collaborated with Maryland stakeholders to assess the challenges experienced by EPs as they worked toward practice transformation and to develop strategies contained in this report to accelerate the achievement of MU.

Dental Electronic Health Record Adoption (2018)

The MHCC conducted an environmental scan to assess electronic health record (EHR) adoption among Maryland dentists.  This information brief provides key findings on the benefits and barriers to EHR adoption, top vendors, and areas of opportunity. 

Electronic Health Records:  An Environmental Scan of Local Health Departments and State Hospitals (2015)

This information brief presents findings from an EHR Environmental Scan (scan) on EHR adoption in local health departments (LHDs) and State hospitals.  The scan assessed EHR technology in place today, identified LHD EHR implementation challenges, and explored opportunities where collaboration could enhance user capabilities among LHDs. 

Electronic Health Records - An Update on Adoption and Incentives Paid by State-Regulated Payors (2018)

The MHCC analyzed payor submitted data on EHR incentive payments made to primary care practices.  Data from the Maryland Board of Physicians was used to assess EHR adoption.  This information brief provides details on the total incentives disbursed by payors and the growth in EHR adoption among primary care physicians. 

Electronic Health Records:  Incentives and Program Progress (2015)   

The Maryland General Assembly passed a law in 2009 that requires certain State-regulated payors (payors) to offer incentives for providers to adopt electronic health records.  The MHCC worked with the six largest payors and provider representatives in the State to establish an incentive program, which requires payors to provide incentives to primary care practices (family, general, geriatric, internal medicine, pediatric, or gynecologic practices), including nurse practitioner-led practices.  This information brief provides an update on the impact of the State incentive program and the initiatives aimed at encouraging program participation among eligible practices.

Electronic Health Records:  State Incentive and Usability Across Hospital Settings (2013)

At the request of leadership from the General Assembly’s Maryland House Health & Government Operations (HGO) Committee, MHCC evaluated the State-regulated Payeo EHR Adoption Incentive program (State incentive program) to determine if changes are necessary to ensure that the intent of the law is met. In collaboration with the State incentive program workgroup (workgroup), this report includes the recommended program enhancements. The MHCC was also asked by the HGO Committee leadership to explore provider challenges involving the usability of EHR systems across hospital settings and provide recommendations contained in this report that mitigate these challenges.

House Bill 736:  Electronic Health Records - Incentives for Health Care Providers - Regulations (2013)

House Bill 736, Electronic Health Records – Incentives for Health Care Providers – Regulations, amended the law, Md. Code Ann., Health-Gen. § 19-143 requiring Maryland payors to pay cash incentives to certain providers for the adoption and use of EHRs. The amendments also require MHCC to study and submit recommendations to the Senate Finance Committee and the House Health and Government Operations Committee as to whether the scope of health care providers that may receive the incentives from payors should be expanded beyond primary care practices.

HB 706:  Electronic Health Records - Regulations and Reimbursement (2012)

The Maryland General Assembly passed House Bill 706, Electronic Health Records - Regulation and Reimbursement, (HB 706) during the 2009 legislative session with the purpose of advancing health IT adoption and use among Maryland providers. The law requires MHCC to report to the Governor and General Assembly periodically on implementation of the law.

Physician Adoption of Electronic Health Records - An Information Brief (2017)

The MHCC conducted an assessment of EHR adoption among practicing physicians in the State. The brief highlights growth in EHR adoption since 2011 by specialty, geography and practice ownership type. 

Health Information Exchange

Hospital Image Exchange: Exploring Opportunities for a Statewide Image Repository through the State-Designated Health Information Exchange (2016)

The MHCC conducted an environmental scan (scan) that identified benefits, challenges, and financing opportunities for an image sharing repository managed by the State-Designated health information exchange, CRISP. The scan assessed hospital interest in expanding a use case where images could be made available through the CRISP Query Portal.

Ensuring the Privacy and Security of Electronic Health Information:  Keeping Pace with an Evolving HIE Landscape (2016)

This report was developed in collaboration with stakeholders and highlights the need to amend the current definition of a health information exchange (HIE). The definition of an HIE in law has not kept pace with the changing HIE landscape, creating gaps in privacy and security of electronic health information. An increase of HIE services is being offered by health IT vendors. Only select HIEs are subject to the existing regulations, COMAR 10.25.18: Health Information Exchanges: Privacy and Security of Protected Health Information. Revising the HIE definition ensures that enhanced privacy and security standards apply to all HIEs operating in Maryland, which could increase consumer trust and information integrity.
CRISP Connectivity - Ambulatory Practices (2017)

The MHCC conducted an analysis of ambulatory practices' connectivity to CRISP.  This information brief offers insight on connectivity through various EHR integration levels and assesses progress towards enabling bidirectional exchange of clinical data among ambulatory practices and CRISP in the State.

CRISP Plan for a Citizen-Centric Statewide HIE in Maryland (2009)

A comprehensive planning report that highlights strategies for implementing a statewide HIE. The Chesapeake Regional Information System for our Patients (CRISP) planning report oulines a detailed approach to building the HIE infrastructure, data management, use case deployment, engaging stakeholders in the decision-making process, developing HIE policies, governance, finance and sustainability, and community outreach and education.

CRISP Response to the Request for Application for a Consumer-Centric Health Information Exchange for Maryland (2009)

CRISP presents a response to MHCC's request for application (RFA) to build and implement a statewide HIE. The document details CRISP’s approach, principles, organizational infrastructure and plan for policy development.

Electronic Data Interchange - An Information Brief (2016)

Provides an overview of the 2015 electronic data interchange (EDI) activities of government and private payors. EDI is the exchange of standardized electronic documents between organizations from one computer application to another. The health care industry has used EDI for more than 30 years as a way to exchange medical, billing and other administrative information. Maryland law requires certain payers to annually report on their EDI activities.

Health Information Exchange Challenge Program - Funding Opportunity Announcement Response (2011)

The MHCC proposed to address Challenge Theme Two, under the HIE Challenge Program and pilot the electronic exchange of clinical documents between pairs of long term care (LTC) centers and proximate hospital emergency departments. The pilot centers on six large LTC facilities across Maryland, with some services being offered to every facility in the State; the duration of the project is about 36 months. The project aims to improve long term and post-acute care transitions by leveraging Maryland’s operational HIE to electronically share clinical information in real-time, including information on advance directives, where they exist.

Maryland HIE Evaluation Results Report (2014)

The MHCC compiled this report for Maryland under the State HIE Cooperative Agreement Program to meet the requirements in the program information notice issued by the Office of the National Coordinator (ONC) for Health Information Technology; the plan was approved by ONC.  The report describes the approaches and strategies used by the State-Designated HIE to facilitate and expand HIE in priority areas; identifies conditions influencing implementation of program strategies; assesses how HIE performance has progressed in key program priority areas; and assesses how key approaches and strategies implemented by the State-Designated HIE contributed to progress.

Health Information Technology Survey Reports

Comprehensive Care Facilities:  Adoption of Health Information Technology (2018)

Summary of the Comprehensive Care Facilities:  Adoption of Health Information Technology (2018)

Comprehensive Care Facilities (CCFs) provide services for residents presenting with disease, disability, or advanced age.  The MHCC collects data on health IT adoption from CCFs through its Annual Long Term Care Survey.  The survey data is used to assess health IT adoption trends, including electronic health records (EHRs), health information exchange (HIE), and telehealth.

Ambulatory Surgical Center Electronic Health Record Adoption (2017)

In the fall of 2016, MHCC assessed Maryland Ambulatory Surgical Centers (ASC) Electronic Health Record (EHR) Adoption.  Included in the assessment is the identification of leading benefits and barriers to EHR diffusion in ASCs.

Health Information Technology:  An Assessment of Maryland Acute Care Hospitals (2018)

Summary of the Health Information Technology:  An Assessment of Maryland Acute Care Hospitals (2018)

The MHCC conducts an annual Hospital Health Information Technology Survey that provides information regarding current trends and the future direction of health IT adoption among all acute care hospitals in Maryland.

Health Information Technology State Plan

Describes a strategic and operational plan that includes the efforts to implement a private and secure consumer centric statewide HIE in Maryland. Topic areas include plans for policy development; governance; finance and sustainability; technical infrastructure; business and technical operation; coordination with Medicaid, Medicare and federally funded State programs; among others. The Health IT State Plan is updated annually. The initial four-year plan for 2010-2013 and the plan for 2011-2014 are included below.

Health IT State Plan (2011-2014)

Health IT State Plan (2010-2013)     Appendices

Other Health Information Technology Reports 

Controlled Dangerous Substance Permit Distribution - A Physician Assessment (2017)

The number of deaths nationally from opioid drug overdoses more than tripled between 2000 and 2015.  In recent years, Maryland has seen an increase in opioid related deaths of 75 percent from 2007 to 2015.  Opioid abuse mortality rates statewide parallel cancer, strokes, and heart attacks.  The Maryland Health Care Commission assessed the Maryland Department of Health’s, Office of Controlled Substances CDS database to gauge CDS permit distribution among physicians statewide.

Health Information Technonology Consumer Awareness & Education Brief (2012)  

Effective consumer awareness and education programs related to health IT are expected to bolster public trust and confidence with the goal of empowering patients to manage their health care by increasing patient access to their health information. This report presents findings from seven consumer focus groups convened by MHCC to assess consumer awareness and trust in health IT. Consistent themes that emerged from the focus group discussions include: consumers prefer to control who has access to their electronic health information; community based organizations are concerned about the risk of electronic health information being lost or stolen; and concern regarding the lack of health IT awareness and education activities in the State.

Health Information Security and Privacy Collaboration Consumer and Provider Education "Challenge Report" (2009)

Health Information Security and Privacy Collaboration (HISPC), established in 2006 through a contract with the U.S. Department of Health and Human Services, comprised of 42 states and territories, collaboratively aimed to effectively address privacy and security issues pertinent to electronic health information through a multi-state collaboration.  A project extension began in 2009 and focused on consumer and provider outreach and education.

ICD-10 Readiness - A Summary of Payors Testing Efforts (2015)

The International Classification of Diseases (ICD) is a standardized coding system for medical conditions, diagnoses, and institutional procedures.  ICD-10 consist of a new set of codes that will replace the previous ICD-9 codes, which contain outdated and/or obsolete terms that are not longer consistent with current medical practice.  The Maryland Health Care Commission surveyed the five largest payors in the State inquiring about the status of their ICD-10 preparedness activities and this brief includes those findings.   

Independent Nursing Home Health Information Technology Grant Program Assessment (2015)

The Maryland Health Care Commission (MHCC), in collaboration with the State-Designated health information exchange (HIE), the Chesapeake Regional Information System for our Patients (CRISP), implemented an Independent Nursing Home Health Information Technology Grant Program (grant program) between May 2013 and March 2014.  The grant program aimed to facilitate the adoption and use of health information technology (health IT) among independent long term care (LTC) facilities, with a focus on HIE, to support improved transitions of care between hospitals and the LTC facilities.  This report presents the findings of the grant program assessment (assessment). 

Management Service Organizations – A Vision of State Designated Organizations for Physician Practices (2009)

Management Service Organizations (MSOs) have emerged as a way to address the critical challenges of widespread use of EHRs. This report identifies the critical infrastructure requirements for MSOs that seek State Designation. For a presentation summary of the MSO State Designation Program year one accomplishments (May 2010 – May 2011), click here.

Maryland Medical Assistance Program Health Information Technology Planning Advanced Planning Document (2010) 

Describes how the Maryland Medical Assistance Program will develop a high-level management statement of Maryland’s vision, needs, objectives, plans, and estimated costs that will result in a State Medicaid Health IT Plan.

MCHIE Strategies for a Person-Centric, Inclusive Maryland HIE (2009)

One of two comprehensive statewide HIE planning reports submitted at the request of MHCC. The Montgomery County Health Information Exchange Collaborative (MCHIE) findings were consistent with the CRISP planning report, and focused on community hospitals and the low income uninsured rather than the urban, large hospital system representation in the CRISP planning report. The report recommendations address key decision elements regarding governance, financing, privacy and security, technical architecture, and community engagement with the ultimate goal of interconnectivity of improved health care outcomes for all those in Maryland.

Recommendations for Implementing Electronic Prior Authorizations (2011)

In July 2011, the Maryland General Assembly Joint Committee on Health Care Delivery and Financing requested MHCC to develop recommendations around best practices for prior authorization of prescription medications and medical services. This report details the recommendations of a multi-stakeholder workgroup convened by MHCC. The recommendations focused on short-term solutions that incrementally reduce the burden on providers, payors and third-party administrators, and require minimal rework once national standards are adopted.

State Health Information Exchange Cooperative Agreement Program: Funding Response (2009)

Outlines the strategic approach to implementing a private and secure statewide HIE by building trust and engaging numerous stakeholders to address fundamental policy issues and a planned course of action. The funding response outlines a four-year plan to advance the necessary governance, policies, technical services, business operations and financing mechanisms for HIE. This document was submitted to the ONC in response to State Cooperative Agreements to Promote Health Information Technology: Planning and Implementation Projects funding announcement.

The Statewide Health Information Exchange: Technology to Support a Prescription Drug Monitoring Program (2009)

In June 2008, the Advisory Council (council) on prescription drug monitoring was authorized by Maryland law to study the establishment of a prescription drug monitoring program (PDMP) that electronically collects and stores data concerning monitored prescription drugs. The council proposed an efficient approach to deploying a PDMP in Maryland as a service of the statewide HIE.

Strategy for Implementing Electronic Advance Directives & MOLST Forms (2012)

Making advance directives and Medical Orders for Life Sustaining Treatment (MOLST) forms legal documents electronically at the time and place of care may help ensure that a patient’s wishes are known and honored. This report identifies recommendations for a framework for storing and exchanging advance directives and MOLST forms as follows: create a patient managed registry for advance directives, where patients can make their own health documents available to treating providers via the statewide HIE through use of a personal health record system connected to the HIE; and develop a registry for electronic MOLST forms that is also accessible via the statewide HIE.


State-Regulated Payor and Pharmacy Benefit Manager Preauthorization Benchmark Attainment (October 2016)

Health General Article 19-108.2 established four benchmarks with the aim of creating administrative efficiencies in the preauthorization process.  The MHCC was required to report annually to the Governor and General Assembly through 2016 on State-regulated payors (payors) and pharmacy benefits managers (PBM) implementation of the benchmarks.


Advancing Population Heath and Primary Care Transformation via Telehealth:  A compilation of 2015 & 2016 Telehealth Grant Final Reports (March 2018)

The MHCC awarded telehealth grants to five organizations in December 2015 and June 2016 to assess the use of telehealth to support population health and primary care practice transformation.  The five awardees were Associated Black Charities; Gerald Family Care, LLC; Union Hospital Cecil County; MedPeds, LLC; and Gilchrist Greater Living.  Telehealth services were provided to patients in a variety of settings, including primary care practices, patient homes, and community centers.  This report provides information on the project implementation, data collection, outcomes, challenges, solutions, lessons learned, and sustainability plans for the grantees’ telehealth projects. Lessons learned include:  1) successful telehealth requires practices to assess the need for telehealth, identify an appropriate modality, and ensure sufficient patient and provider willingness to engage in telehealth; 2) telehealth is generally an effective care delivery method where a multi-disciplinary team can deliver comprehensive patient care; and 3) telehealth reduced barriers to care for patients typically considered reluctant to adopt/accept telehealth services (e.g., the elderly and those with behavioral health conditions).

Adoption of Telehealth - Office-Based Physicians (April 2018)

In the fall of 2017, MHCC conducted an environmental scan of office-based physicians to assess telehealth diffusion.  This information brief highlights key findings from the assessment, including current trends, leading barriers, and adoption by specialty and geography.

Remote Patient Monitoring Telehealth Grants: Brief and Final Reports (2017)

The MHCC awarded three telehealth grants to demonstrate the impact of telehealth using remote patient monitoring devices to support chronic care management of high risk children, adults, and elderly patients.  This document includes a brief by MHCC and project reports by grantees:  Crisfield Clinic in Somerset County, Union Hospital of Cecil County, and Lorien Health Systems in Baltimore and Harford Counties.  The brief outlines lessons learned from these projects and key telehealth implementation considerations to be used by those interested in implementing similar remote patient monitoring projects.  The individual reports include a description of technology infrastructure, implementation and assessment approach, project limitations and challenges, and plans for sustainability of these projects. 

Long Term Care and Hospital Telehealth Project Grants: Brief and Final Reports (2016)

The MHCC awarded three telehealth grants to implement telehealth to improve transitions of care between hospitals and nursing homes. This document includes a brief by MHCC and project reports by grantees regarding the outcome of the projects implemented over 12 months beginning in October 2014. The brief highlights lessons learned from these projects and key telehealth implementation considerations to be used by those interested in implementing similar telehealth projects. The Long Term Care and Hospital Telehealth Project Grant reports include a description of technology infrastructure, implementation and assessment approach, project limitations and challenges, and plans for sustainability of these projects.

Telemedicine Recommendations:  A Report Prepared for the Maryland Quality and Cost Council (2011)

The Maryland Telemedicine Task Force (Task Force) was convened to address challenges to widespread adoption of a comprehensive statewide telemedicine system of care. Recommendations were identified by the Task Force to promote telemedicine in Maryland, which include: reimbursement for telemedicine from State-regulated payeos, establishment of a centralized telemedicine network built on existing industry standards and implementation of changes in licensure and privileging of providers to facilitate the adoption of telemedicine.

Telemedicine Task Force - Final Report (2014)

This report presents the Task Force recommendations for expanding telehealth adoption Maryland. The Task Force consisted of three advisory groups:  Clinical Advisory Group (CAG), Finance and Business Model Advisory Group, and Technology Solutions and Standards Advisory Group.  The CAG recommended 10 use cases for implementation in pilot projects to accelerate the use of telehealth.  These uses cases are intended to have an impact on vulnerable populations; be consistent with the goals of healthcare reform; and be implementable, testable, and cost-effective.

Telemedicine Task Force - Interim Report (2013)

State law requires MHCC to reconvene the Task Force to identify opportunities for expanding telehealth to improve health status and care delivery. The law also required MHCC to update the Governor, Senate Finance Committee, and the House Health and Government Operations Committee on the work (interim report) of the Task Force by the end of 2013. The final report is due December 1, 2014 and will include recommendations aimed at increasing the use of telehealth.


Last Updated: 9/24/2018