CRISP, a regional health information organization that acts as Maryland's state-designated health information exchange (HIE), long recognized the need for a dependable, accurate set of provider data.
COLUMBIA, Md. – August 19, 2021
The Challenge: Maryland’s HIE needed an accurate, fast Provider Directory API
CRISP, a regional health information organization that acts as Maryland's state-designated health information exchange (HIE), long recognized the need for a dependable, accurate set of provider data. Nearly a decade ago, CRISP stood up a provider search portal for the Maryland Health Benefits Exchange (MHBE), but that solution was limited in many ways, and was purpose built for the MHBE’s needs. More broadly, CRISP recognized the need for a solution that could assist clinicians and care managers to better coordinate care for patients and facilitate internal processes by putting actionable care team information at these users’ fingertips. CRISP’s solution would also need to be able to consolidate its proprietary data across the HIE’s area of coverage, to handle multiple instances of the same information from different sources, and to reconcile inconsistencies and inaccuracies in the data.
“Having accurate primary care provider and care team information at the point of care is vital to the role that CRISP plays in care coordination. Given the fragmented and often incomplete provider information that accompanies data like encounters and lab results, HIEs have historically struggled in this area.”
-David Horrocks, President, CRISP
Meanwhile, in May 2020, the Centers for Medicare and Medicaid Services (CMS) established the Interoperability and Patient Access final rule, effective January 1, 2021, with enforcement as of July 1, 2021. The rule requires state Medicaid agencies, Medicaid and CHIP managed care organizations, Qualified Health Plans in ACA exchanges, and Medicare Advantage plans to provide a public provider directory application programming interface (API) as a new condition of participation. Few state Medicaid agencies or health plans were set up to easily comply with the rule.
The Solution: Leap Orbit deployed Convergent to address a wide range of CRISP’s needs
Leap Orbit’s provider directory platform, Convergent, aggregates and algorithmically masters hundreds of national and regional provider datasets to ensure a robust database of provider information, married with a simple-to-digest, CMS-compliant, FHIR 4.0 API and a broader set of proprietary APIs. For example, CRISP requires using a limited set of demographics to search for and return a single unique provider; for this purpose, Convergent’s searchSingleBest API returns details for only a specific provider when given the search parameters associated only with that unique provider. CRISP uses searchSingleBest to enrich encounter notifications with more robust provider data, including Direct secure email addresses. In addition, through its partnership with CRISP, the Maryland Medicaid program used Convergent to stand up FHIR 4.0 provider directory APIs to comply with the new CMS rules.
The Outcome: CRISP now has a single API they can call for all provider data needs
Convergent provided CRISP and its stakeholders with a FHIR 4.0-conformant provider directory API that not only solves for the challenge of aggregating and associating provider data ingested from disparate sources in a variety of formats but also complies with all requirements of the CMS Interoperability and Patient Access final rule. Convergent now supplies enhanced, consistent provider data to a number of CRISP applications and initatives, including the state Prescription Drug Monitoring Program (PDMP), a key tool in mitigating the opioid crisis, its HIE InContext application, which facilitates clinical decision-making at the point-of-care, and for Maryland Medicaid electronic clinical quality measures (eCQMs) submissions.
“Convergent bridges multiple data sources (CDS, professional licensure, NPI, and DEA data) to return an output that includes a single custom identifier per provider. This output enables the Office of Provider Engagement and Regulation (OPER) at MDH to more accurately review compliance with the PDMP mandate, send advisories more appropriately, and support researchers, among other use cases. It is unique in its ability to conceptualize a single provider from multiple divergent data sources.”
Maia Gottlieb, CRISP PDMP Program Manager
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About Leap Orbit
Founded in 2015, Leap Orbit is the trusted innovation partner to many of the market-leading health data networks, including CRISP, Manifest MedEx, and NEHII. Leap Orbit’s philosophy is to run toward healthcare’s biggest challenges, providing technology and solutions to assist with the opioid crisis and patient data privacy. Through its health organization partners, Leap Orbit’s work reaches at least 45 million patients from Alaska to Maryland. Convergent uses the power of its proprietary set of public and private reference data sources to improve accuracy and integrity, eliminating the problem of poor provider directories. Convergent also reduces the traditional data inaccuracies which have proven to have far-reaching consequences that include hindering care for health plan members, loss of revenue for plans, and delayed and denied claims. Convergent is scalable and extensible, future-proofed to ensure continued data accuracy and integrity for users. For more information, visit LeapOrbit.com and follow on LinkedIn.
About CRISP
CRISP is a regional health information exchange (HIE) serving Maryland, the District of Columbia, West Virginia, and the surrounding regions. A nonprofit organization advised by a wide range of stakeholders that are responsible for healthcare throughout the region, CRISP has been formally designated as Maryland’s statewide health HIE exchange by the Maryland Health Care Commission. Health information exchange allows clinical information to move electronically among disparate health information systems. For more information about CRISP, visit http://www.crisphealth.org.