Whitman-Walker Health (WWH) is moving to Epic, a new electronic health record system. Epic includes secure information sharing tools called Care Everywhere and Carequality. WWH will continue to share information through CRISP, the regional health information exchange we already use. The information below explains how these applications work and outlines your options for sharing your health information.
What is Care Everywhere? What is Carequality? What is CRISP?
CRISP and Care Everywhere are both health information exchanges. Carequality is a national health information exchange framework.
Care Everywhere is a health information exchange technology that securely connects Epic-based practices together both in the US and internationally. It is an application Epic uses to share patient data between health care institutions. The goal is to provide a comprehensive picture of the patient’s medical information. This feature lets your WWH care team share important parts of your health record with other hospitals and clinics that also use Epic. Relatedly, your WWH provider also can receive key information about care you got externally if that practice also uses Epic. For more information about Care Everywhere, please visit Epic’s website: https://www.epic.com/careeverywhere/?search=&country=&usstate=
Through Care Everywhere, Epic practices are also connected to Carequality. Carequality is a national network that enables different health record systems to share information securely. Carequality isn’t a health information exchange itself—it’s more like the “bridge” that connects many different systems and exchanges across the country. For more information, please visit their website: https://carequality.org/resources/frequently-asked-questions/
CRISP is a regional health information exchange that allows hospitals, clinics, and doctors’ offices to share your medical information with each other electronically. CRISP ingests data from hospitals and outpatient clinics located in the District of Columbia, Maryland, Virginia, West Virginia, and Delaware. For more information about CRISP, please visit their website: https://crispdc.org/for-patients/.
The goal of these platforms is to provide information that will enable better coordination of your care. If your WWH providers can see the care you, your child, or your dependent receives at an outside hospital or clinic, that helps us understand how to deliver the best care for you when you’re with us.
How is Care Everywhere different from CRISP?
CRISP is a regional health information exchange that connects hospitals and outpatient settings in these states: District of Columbia, Maryland, Virginia, West Virginia, and Delaware. Care Everywhere connects Epic practices throughout the entire US.
CRISP ingests health records from a number of electronic medical records systems, of which Epic is only one. Care Everywhere exchanges health records only with other Epic systems.
CRISP is view only, meaning your provider can see information about care you received in other health care settings in the area, but they cannot import that information into your chart. In contrast, Care Everywhere is interoperable, meaning it can both send and receive information. With Care Everywhere, WWH providers can import information from other providers directly into your WWH chart and vice versa.
Who can access my record in Care Everywhere & CRISP?
Your records are only viewable to providers at organizations with which you have established a care relationship. If you do not have a care relationship established with an organization, the care team members at that organization cannot see your records.
What exactly is being shared and how?
In CRISP: The following are exported to CRISP every time any of these data elements are updated in WWH’s EMR: detailed medical summary; encounter history; labs, imaging, and procedures; and demographic information. These data are then accessible to providers who work at organizations participating in CRISP. The providers can access CRISP’s provider platform in order to view your clinical information.
In Care Everywhere: The system automatically searches for your information at surrounding Epic facilities (a 50-mile radius) and displays the results in the WWH chart. This allows anyone on your care team (at WWH or otherwise) to get a better picture of your overall healthcare journey. Right now, local institutions like George Washington Medical Faculty Associates (GW MFA); Inova; and Johns Hopkins utilize Epic. However, providers can use Care Everywhere to search for information outside of the 50-mile radius as well. For example, if you were traveling outside of the 50-mile radius and needed to seek medical care at an urgent care clinic that uses Epic, the provider at the urgent care could search for your records at WWH. Likewise, your WWH provider could also search and view the records from the urgent care.
What practices use Care Everywhere?
Epic maintains an up-to-date list here.
What practices use CRISP?
CRSIP provides information for patients here.
What practices participate in Carequality?
Carequality maintains an up-to-date list here.
Can I turn either HIE off?
Yes, you can take steps to opt out of either exchange.
Washington, DC, is an OPT-OUT model. This applies to both Care Everywhere and CRISP.
This means once your chart is set up at WWH, data is being exchanged.
WWH staff can opt you out of Care Everywhere and Carequality. You must contact CRISP directly to opt out. Please note that if WWH opts you out of Care Everywhere, it will only apply to records originating at WWH.
You may change your mind at any time regarding your record sharing. If you decide to opt out now, for example, you can always opt-in at a later time.
How do I opt out if I wish to?
You must opt out of each HIE individually.
To opt out of Care Everywhere & Carequality: Please see a WWH staff member and request to be opted out of Care Everywhere. You may also write to WWH’s privacy officer at HIPAA@Whitman-Walker.org or call 202.797.4416.
To opt out of CRISP: WWH staff cannot opt you out of CRISP. You have three ways to contact CRISP:
Is it possible to select which parts or codes from my record will be shared without turning off all Care Everywhere sharing from my WWH record?
In the future, with Epic upgrades, it may be possible to control what parts of your record are shareable and when. It is not possible to restrict or share only some of the data at this time.
If you decide to turn off Care Everywhere at WWH, you may want a different way to share your WWH records with appropriate medical providers. You can still access the WWH MyChart and download notes and test results to share with other providers as needed for communication around your care. You can also request your medical records directly from WWH’s Medical Records Department. We require 2-4 weeks to process all requests.
Pros and cons of Care Everywhere for trans patients and their families
You can control the setting in which Care Everywhere is turned on or off. In some circumstances – like with a primary care provider, emergency rooms, surgeons, or a specialist – we think it’s good that these providers can see each other’s charts. It reduces medical errors, shares lab results faster, and increases patient health safety. Having Care Everywhere turned off can be a problem if an outside provider is prescribing an important medication that interacts with another medication that WWH might prescribe, or when a treatment decision is needed quickly due to emergency. In these cases, it’s good to have Care Everywhere in place and functioning.
If you live outside the DMV and your state restricts transgender health care, that may increase risk for you, your child, or home state clinical providers. Care Everywhere would allow any of your providers in your home state who use Epic to see the medical records from WWH.
Specific codes and diagnoses
When updating medical records and sending information out for billing purposes, we use the codes that most accurately describe the issue we’re managing. We have to do that – otherwise, it is insurance fraud.
Insurance will pay for certain codes today – for example, gender dysphoria – that it wouldn’t in the past. That has been part of the evolution of the use of codes in trans health care.
Codes, diagnoses, and billing history from previous visits that are already in a medical chart can’t be removed. Changing the code now to something less “obvious” won’t change the history of a previous code used. In all of these scenarios, your medical records are protected under HIPAA.
I’m worried about who has access to information in my medical records – how is this data kept secure?
Medical records are protected under HIPAA to limit who may lawfully access health data, and to protect against the inappropriate use of health data, government overreach and potential other misuses. Local and federal governments are able to request court orders for medical records in the case of criminal investigations, or if a patient is believed to be a foreign agent. All government requests for medical records are reviewed by WWH’s’ compliance team and, if any requests appear to be suspicious, they will be reviewed with outside counsel and possibly government oversight offices.
HIPAA protects Whitman-Walker medical record information from being shared without your permission. By agreeing to use the HIEs that WWH’s participates in, you have modified those protections, allowing other care providers who have legitimate roles to play in your, your child’s, or your dependent’s care to access those medical records, but they cannot share that information outside that circle of care without your permission.
If you are concerned about other healthcare entities having access to information such as the transgender/nonbinary identity you have shared with us, and/or other details about your identity or health history provided outside of that center, you should consider opting out of both CRISP and WWH’s connection to Care Everywhere. Keep in mind, all staff involved in your care at any entity can look at your chart. However, it is illegal for health center staff to look at your chart out of curiosity.
If you get care at other Epic practices, you have multiple connections to Care Everywhere. Each connection is managed individually. You can maintain a connection to Care Everywhere from records originating at Johns Hopkins but turn off a connection to Care Everywhere from records originating at WWH, as an example.
Turning off Care Everywhere only at WWH:
Care Everywhere and CRISP serve as a helpful tool for efficient communication, improved safety, and comprehensive record keeping of all of your medical care. However, improved communication and data sharing does come with the risk that more clinical sites and providers may have access to your personal health information. This information should only be used for medical purposes and HIPAA continues to protect your privacy, however we also understand the desire for increased personal security at this time. Please consider all of the pros and cons of deciding to opt-out of Care Everywhere before you make this decision. Reach out to your WWH provider or the Department of Specialty Care if you have any additional questions.
