MaSSSoftech

The Obama administration's push to create an electronic patient record for every American has gained steam in Washington, with billions of dollars expected to be spent over the next five years.

But in Maryland, the process is ahead of schedule.

That's because Maryland's three largest hospital systems and a large retirement community operator are building a statewide information exchange network that could be up and running before any federal network. The exchange - Chesapeake Regional Information System for Our Patients, or CRISP - was approved for $10 million in start-up state funding. Its purpose: to let hospitals, insurance providers and health care professionals freely and securely share information about the patients that come through their doors.

"For doctors who don't have a prior record, it could be real helpful to get the discharge summary from the hospital down the street, which can bring them up to speed very quickly on a patient," said David Horrocks, president of CRISP.

A piece of the pie
The focus on health information technology is creating a boon for technology companies nationwide who are seeking a piece of the multibillion-dollar pie. In Maryland, several companies have expressed interest in helping to build the state's network, according to officials familiar with the process.

Proponents of moving to an electronic record format say it makes sense for the patient, whose records and treatment history could theoretically be accessed at any hospital or doctor's office. Electronic medical records can be more efficient for medical staff and patient tracking and billing, helping to reduce the clerical work needed to maintain large filing systems.

For one, hospitals and insurance companies hope that easily accessible records will eliminate the need for duplicative and costly diagnostic tests.

"Health care represents some of the most advanced digital technology humankind has ever created," said Todd Johnson, president of Fells Point-based Salar Inc. "But the information flow is often very choppy and obsolete…. Hospitals are more and more ready to tackle some of these hurdles."

With nearly 20 employees and a 10-year track record, Salar makes software that enables physicians, nurses and other medical staff to input their notes directly into a database that essentially creates "electronic paper" that's easily managed by its users. The software fulfills the electronic physician documentation requirement that, at the national level, is scheduled to take effect in 2013.

"On the one hand, that's four years from now," said Johnson, whose company's revenues are up 30 percent in the past year and has been hiring recently. "On the other hand, it's right around the corner."

But building such a system, particularly one that's accessible nationally, involves at least two big hurdles: cost and security. Historically, doctors and hospitals have been reluctant to spend money on electronic systems with no immediate benefit in sight. And the need for tight online security of electronic patient records is of paramount concern for the public.

As part of the $787 billion economic stimulus plan, about $19 billion is being set aside to help the nation's hospitals and physicians' offices make the transformation by 2014. Last month, Vice President Joe Biden announced a $1.2 billion early injection into the effort. Half of the funding will go toward establishing centers that will help hospitals manage the technical aspects of upgrading their systems, while the rest will facilitate information-sharing between hospitals across the U.S.

Before billions of dollars can be spent nationwide, the federal government and industry groups are still hammering out a consensus of what such a national network will look like, how it will function and how secure it will be. Building a national electronic patient record exchange network is a major challenge, fraught with varied technology hurdles and steep financial costs, with a need for uniform standards across a patchwork of states, industries, and public and private medical providers.

According to a study published in the New England Journal of Medicine in March, only 1.5 percent of nearly 3,000 non-federal hospitals in a survey have a comprehensive electronic health record system. Estimates range widely as to the expected annual savings if patient records move completely online, but it could be as high as $77 billion.

In Maryland, the climate appears ripe for building a network that would address the needs of patients, doctors and hospitals in the state. A House bill passed this year sets up a framework for giving hospitals and physicians financial incentives to implement electronic patient records systems by 2015. The Maryland Hospital Association, which represents 67 hospitals and advocated for the bill, would require state-regulated insurers to pass on incentives to hospitals and physicians so they can upgrade from paper to electronic records.

"Ultimately, electronic health records are going to enhance patient care, and bottom line, that's what hospitals want," said Jessica Jackson, a spokeswoman at the association.

Maryland's three largest hospital systems - Johns Hopkins Medicine, MedStar Health and the University of Maryland Medical System - along with Erickson Retirement Communities, are leading the effort to build CRISP. CRISP was approved for $10 million in state funding to start building the exchange over the next two to five years.

Horrocks, the CRISP president, said the exchange will likely be built before any federal network is built. Nevertheless, the goal is to make the state network compatible with the federal one.