Health Information Technology   Electronic Advance Directives  


An advance directive is a useful, legal way for an individual (or declarant) to direct their medical care, particularly treatment preferences in an emergency or near end of life.  An advance directive can also include the name of a health care agent (or proxy) that can make decisions for a declarant if they are unable to do so themselves.  Maryland law permits an advance directive to be in the form of a written or electronic document or a verbal statement made in a video recording.  Increasing accessibility to advance directives has generally been a national priority in health care decision making policy to ensure patients receive medical care that is consistent with their values, goals, and preferences. Over the last several years, the State has prioritized expanding access to electronic advance directives via the State-Designated Health Information Exchange (HIE), the Chesapeake Regional Information System for our Patients (CRISP).  Refer to the background presentation in the Resources section below for more information.

State Recognition Program

State law (2016 Chapter 510 and 2017 Chapter 667) requires the Maryland Health Care Commission (MHCC) to develop a State Recognition Program for electronic advance directives services (also referred to as vendors) to facilitate use of cloud-based technology that supports creation of and accessibility to electronic advance directives.  In the fall of 2016, MHCC collaborated with stakeholders to develop draft regulations and vendor criteria for State Recognition.  COMAR 10.25.19:  State Recognition of an Electronic Advance Directives Service outlines program procedures for State Recognition, a prerequisite for connecting to the State-Designated HIE. 

State Recognition demonstrates that a vendor meets certain criteria or standards for privacy and security, independent audits, education, reporting, and technical provisions, some of which are required by State and/or federal law.  Vendor criteria for State Recognition is available here.

Vendors seeking to apply for State Recognition must demonstrate they meet the required criteria and complete an Application for State Recognition here.  This application serves as both the initial and renewal application.  The completed application and all supporting documentation must be submitted to  State Recognition is valid for three years, unless suspended or revoked by MHCC.

Questions about the State Recognition Program can be directed to Anene Onyeabo by e-mailing or calling 410-764-3285.

State-Recognized Vendors

Electronic advance directives services that have been granted State Recognition from MHCC include:


State Funding for CRISP Integration

Vendors that are granted State Recognition by MHCC may be eligible for State funding to supplement integration costs with CRISP; this funding is made available through the Advance Directives Program Fund administered by the Maryland Department of Health (MDH).  If awarded funding, vendors agree to work with CRISP to establish an interface between their advance directives solution and CRISP to enable authorized health care providers participating with CRISP to view information on advance directives for Maryland residents.


CRISP was designated in 2009 by MHCC and the Health Services Cost Review Commission to build and maintain the technical infrastructure to support the secure exchange of electronic health information statewide.  Various provider organizations throughout Maryland are connected to CRISP, including all acute care hospitals and almost half of long-term care facilities.  Click here for more information on CRISP participating organizations. 


Background Presentation - Electronic Advance Directives in Maryland

Provides historical context on the State’s efforts to increase accessibility to electronic advance directives.

Strategy for Implementing Electronic Advance Directives & MOLST Forms

Workgroup recommendations for increasing accessibility to electronic advance directives and MOLST forms using an HIE.

The Maryland Attorney General

Information on advance directives and available resources in Maryland.  

Summary of Maryland Health Care Decisions Act

Guidance from the Maryland Attorney General about the law as amended through 2017. 



Last Updated: 3/25/2019