As the CRISP statewide health information exchange (HIE) planning project comes to a conclusion, the planning team celebrates great success and the delivery of one of the most comprehensive reports on the subject of HIE. This success cannot be attributed to the efforts of a few, but rather the collective willingness of many to continually engage and contributed their time and expertise to the effort. One of our key success factors in ultimately arriving at a viable plan for Maryland was the foresight of our CRISP leadership to dedicate leaders and subject matter experts from their organizations to the planning project. We had incredible participants like Jeff Joy, COO ofJohns Hopkins Healthcare; Alex Eremia, Vice President, Deputy General Counsel and Chief Privacy Officer of MedStar Health; and Dr. Mark Kelemen, CMO of The University of Maryland Medical System. We rarely if ever witnessed the uncomfortable silence that often floats in the air when a complex question is asked of a large group of folks who don’t know one another or are not well-informed. Rather, a deep and productive conversation always ensued, challenging me as a facilitator to keep up with the participants.

Another key success factor was the willing help of those who have experienced the difficulty of a planning effort and the highs and lows of an HIE implementation. As our core team prepared for the planning effort, we traveled the country speaking with as many HIE leaders, vendors and government officials as we could. From Greg Farnum with VITL in Vermont, to Micky Tripathi with MAeHC in Massachusetts, to Don Holmquest with CalRHIO in California, to Jan Root with UHIN in Utah or Vicky Estrin with the MidSouth eHealth Alliance in Tennessee, countless HIE veterans were willing to spend a numerous hours with us to help understand the complexities of our undertaking. All of them helped shape our initial and ongoing thinking on this subject.

Our relationship with Vicky Estrin developed from an initial conversation, enabled by our friends at the Markle Foundation, about the RHIO work in Tennessee. Later, at the invitation of two CRISP steering committee members — Stephanie Reel, Vice Provost for Information Technologies at Johns Hopkins University and Vice President for Information Services forJohns Hopkins Medicine; and Patty Brown, President of Johns Hopkins Healthcare — some of the leadership of the Tennessee effort travelled to Baltimore to present to CRISP leadership and other interested parties. Dr. Mark Frisse and Dr. Kevin Johnson, both staff at Vanderbilt and preeminent thinkers and “doers” (the hard part) in informatics and in HIE specifically, spent a full day sharing their experiences, outlining their challenges and lending guidance. The presentation was highly impressive, not because of its content (although much of it was indeed impressive content), but rather because of the simplicity of the message. Drs. Frisse and Johnson are two leaders who have helped this infant industry take its first steps on a critical path enabling improvements in the quality, safety, access, and cost measures.