The implementation of electronic health records across 12 jails in New York City between 2008 and 2011 led to a “significant improvement” in the ability of officials to monitor and safeguard human rights of inmate patients, according to a new study.
In addition to the benefits of being able to track health issues and clinical outcomes, the study, in Health and Human Rights Journal, found that EHRs in a prison setting can gather information related to abuse, neglect and other human rights concerns while allowing for the linkage of outside EHRs through health information exchanges “so that injuries, mental health exacerbations, and other concerns unique to the correctional setting can be followed up in the community.”
But any connection of the EHR, handled by eClinicalWorks, “will require significant educational collaboration with community health providers around the key pieces of information that may indicate jail-based vulnerability,” the report says.
The EHR effort in jails can be particularly helpful for identifying mental health issues among the population, the study notes, and can potentially spot those who should be precluded from solitary confinement or who need hospital transfers.
From the study:
“Our approach has been to identify vulnerable groups of patients (e.g., the injured, those with mental illness) or those in high-risk settings (e.g., solitary confinement) and then adapt the EHR to improve care and monitoring for these patients. A broader set of concerns, including the right to access one’s own health information, the right to confidentiality, and the right to autonomy, is also important in further developing the EHR.
“Patients in jail often avoid care because they fear their information will not be confidential. This fear of engagement also contributes to patients not knowing or learning about their health problems, which are important features of autonomy. As we train our staff about human rights concerns, we plan to broaden the human rights applications that we build into the EHR, as well as increase patient participation in the process. Overall, the EHR has allowed us to promote human rights by identifying vulnerable populations and reporting on adverse outcomes associated with their vulnerability. In addition, this capacity for data aggregation and reporting has allowed us to start the implementation of policies that mitigate some of these vulnerabilities.”
The prison population, according to the study, has “high rates of pre-existing health concerns,” with particular concern from violent injuries and mental health stressors.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Further complicating matters, healthcare in the jail system is overseen by Bureau of Correctional Health Services of the city’s Department of Health and Mental Hygiene while security is handled by the city’s Department of Corrections. It’s also the nation’s second largest prison system, with 12 jails housing roughly 12,000 individuals who represent 80,000 annual admissions.
“Consequently, the jails are chaotic settings where large quantities of information are gathered and care is delivered, and where taking a comprehensive and holistic approach to care is difficult. Without an EHR, it is extremely difficult to pull together sufficient details to detect vulnerability among patients who are subject to abuse or neglect, or to identify those with special needs and to act in a manner to quickly protect them,” the report says.
Accordingly, the EHR infrastructure required “substantial modification” to meet the needs of the system.
“In particular, the EHR was substantially modified for new admission intakes, sick calls, medical emergencies, infirmary care, medication dispensation, hemodialysis, newborn nursery, mental health encounters, and solitary confinement rounds,” the report says.
It goes on to note that the pilot was a success, with EHRs being well received by patients and staff while amounting to about 30,000 documented patient encounters each month.
Healthcare spending in prisons is no small deal — state spending on prisoner healthcare is now at $7.7 billion as of fiscal 2011. Although it’s down from its peak of $8.2 billion in fiscal 2009, that’s still a big number, and “a steadily rising aging prison population is a primary challenge that threatens to drive costs back up,” according to the Pew Charitable Trusts.
