Maryland Clinicians Keep Finding Valuable New Use Cases for CRISP HIE
An April 9 meeting of the Maryland Health Services Cost Review Commission (HSCRC) featured presentations on two projects that aim to take advantage of Maryland’s statewide health information exchange to improve health data sharing for particular use cases. The first seeks to improve methadone dose verification for opioid use disorder patients and the other to electronically transmit asthma action plans to schools.
Both projects are among the winners in the Advancing Innovation in Maryland (AIM) contest, which seeks to surface ideas for potential implementation to advance Maryland’s unique healthcare model, which has the goals of improved patient care and health outcomes, greater equity, and affordability. The AIM contest is supported by a public-private partnership involving the Maryland Department of Health, the HSCRC, and local foundations.
Malik Burnett, M.D., M.B.A., M.P.H., medical director of REACH Health Services, and Will Garneau, M.D., M.P.H., M.H.S., assistant professor in the Johns Hopkins University School of Medicine, discussed their proposal to integrate opioid treatment program data into the state's CRISP HIE to improve methadone dose verification for opioid use disorder patients, aiming to reduce hospital readmissions and mortality.
Garneau explained that in Maryland, patients transitioning between healthcare settings face delays in receiving methadone, which is not currently available in the state prescription drug monitoring program (PDMP). Currently, busy clinicians in the emergency department must reach another provider from an opioid treatment program on the phone to confirm medication maintenance therapy, which is very difficult on weekends and after hours. If they are unable to confirm, the dosage is often capped at 40mg/day, while the common therapeutic dose is around 100mg/day). The delays and stigma in OUD care increase the likelihood of suboptimal medical outcomes and self-discharge from treatment settings, with rates in the 15-20% range.
“We have an environment where we have an inability to quickly document what the dosage is and then get that medicine into the patient so that they can have a successful hospitalization,” Garneau said.
Burnett explained that his organization, REACH Health Services, uses Methasoft as its electronic health record. This system is used by most of the opioid treatment programs in Maryland. NetSmart owns the Methesoft EHR. “We’re hoping to utilize the NetSmart Care Connect system, which is an HIE system where they collect information from all the various subsidiary electronic health record programs that they have, and they use their HIE to integrate into CRISP,” he said. “We’re hoping to build the data integration to be able to extract opioid treatment program data to be able to be integrated into CRISP. Once in CRISP, that data will be able to be shared with hospitals in real time, which will speed up the methadone dose verification process. We're hoping to achieve a bidirectional information flow such that both the hospitals and the opioid treatment programs can understand what's happening on both ends of the spectrum to ensure much greater continuity of care between programs and hospitals.”
A team led by REACH Health Services submitted its plan to pilot integration of methadone data into CRISP to the Maryland Office of Overdose Response for funding in fiscal year 2026. The project implementation timeline is from July 2025 to June 2026.
Successful completion of REACH data integration into CRISP will serve as a model for broader integration of system OTP data. Baltimore hospital systems are the next most logical entities to complete data integration.
Five OTPs have close affiliations with Baltimore hospitals and associated health systems. Additional OTPs can be encouraged to share data via Maryland Association for the Treatment of Opioid Dependence (MATOD).
“Given that all these hospitals have opioid treatment programs, it would be very easy for those programs to be able to piggyback on the work that REACH has done,” Burnett said. “Once we get the hospital-based programs on board, they’ll hopefully, be able to ensure some of the programmatic fidelity between hospital providers and opioid treatment program providers to really streamline this sort of care effort.”
Using CRISP to transmit asthma action plans
Megan Tschudy, M.D., M.P.H., associate professor of pediatrics at the Johns Hopkins School of Medicine, spoke about using CRISP to share students’ asthma action plans across hospital-based, ambulatory, and school-based providers.
She began by noting the prevalence of asthma. In Baltimore City, an average of six children in a classroom of 30 have asthma. It is one of the leading causes of pediatric ED visits and hospitalizations in Maryland. In terms of respiratory distress, it's the leading cause of 911 calls and EMS transports from schools. It is the leading cause of health-related school absences. Children with asthma have a much higher risk of chronic absenteeism.
Tschudy explained the current way that information about students’ asthma is communicated today. Each student is required to have an asthma action plan. The family talks to their clinician, and the clinician then fills out a paper form with the asthma action plan. There also is a prescription that's given for the child to have — whatever their rescue medicine is, most often albuterol, to then also be taken to school. Then the family has to get the prescription filled. Then the family has to take that paper form and the medicine to school. Not surprisingly, for 80% of kids, this never happens, she said. “In many of the school that I work in, 10% of the kids might have it.”
This paper form cannot be seen by emergency rooms, Tschudy added. “When a child goes there, it can't be seen by other providers, like a pulmonologist or pediatrician. All of the amazing home visiting programs we have for asthma set up in the state can't see that either, so they can't tell the family what the family and child should be doing. Also, if the asthma action plan is updated, the family has to go get another form and take it back to school, so it's not able to be updated.”
“So what if we could go from this current asthma action plan, which is paper-based and hard to update, to a CRISP-based asthma action plan?” Tschudy asked.
Under this scenario, the family would talk to the clinician. The asthma action plan would be entered into CRISP and it would go to the school. She explained why this is a great time to make this change. In the 2024 Maryland General Assembly, they passed a law that albuterol is going to be in every school in Maryland starting this fall. “So the whole barrier of a family having to go pick up their albuterol, take it to school, that is gone,” Tschudy said. “This would be the perfect time to be able to do this. If they can electronically transmit that form, it takes out all of the paperwork.”
This also could be big for care coordination, she said. “The emergency room could also see it. A pulmonologist could see it, a primary care doctor could see it, and the home visiting programs could reinforce all that education that's being done with families and with the proper medicines that the kids are actually on. When a child’s asthma gets worse, you can change that asthma action plan. The school will know about it. All the others will know about it, and everyone can be aware at the same time.”
Among the potential benefits, she said, health systems could see fewer ED visits and hospitalizations. School systems could have fewer days missed for asthma. For clinicians, this will decrease the time burden for completing forms and care coordination. And it should make things easier for families.
This could have benefits beyond asthma, she said. “We really don't have a system to communicate effectively with schools in many different ways as clinicians. So if a child gets hospitalized for a suicide attempt or another mental health issue, there is no way now to be able to transmit that data safely to schools who are some of the main people who need to enact the safety plans for those kids. And so this could be one way to do that.”
