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Best practices in jail-based health care, part II
By Paul Sheehan , COCHS Chief Operating Officer
Published: 09/15/2008

0908ekg Editor’s note: This story is provided by Community Oriented Correctional Health Services, which helps correctional agencies partner with community health providers, from its quarterly newsletter, COCHS Connection

In part one last week, author Paul Sheehan discussed the use of electronic medical record software systems in jails. This week, in the final part, he details how jails can benefit from electronic medical record software systems.

John Abbey, president of Abbey Group Consultants, a consulting firm that specializes in developing and integrating IT for public safety organizations, likes to describe correctional health care in terms of a continuum comprising a series of steps. Ideally, the first step would be to pre-screen inmates in the field before they are booked.

“It is very inefficient to arrest someone and take them to jail, only to find out they have a medical problem and need to go to the hospital,” Abbey says. “If we can do the triage in the field with the arresting officer, we can get the medical clearance first.”

With a properly designed system, options range from cleared to book to cleared for the general population. If there’s a problem, the person being arrested may need to go to the infirmary or to the emergency room to get clearance.

According to Abbey, all this information should be tracked as part of a pre-booking system installed on the police unit or at the station, and that system should be connected to the jail system. Quite often, screening takes place during booking, which can be a chaotic process. At booking, inmates may be disoriented, intoxicated, uncooperative, and even belligerent.

Entering jail is a humbling experience for many people, and frequently triggers mental health problems, such as depression. Not all inmates are forthcoming about their health information at booking, either.

All these factors present challenges to the nurses conducting the screening who are trying to get a complete picture of the inmate’s health. In the best of all worlds, the EMR and clinical reporting system would be integrated with the booking system. In that way, the health screener would be able to view the inmate’s past events and health experiences and recommend appropriate medical, security, and scheduling actions.

This level of IT integration is new to correctional agencies, Abbey says. But he maintains it is absolutely critical if jails are to meet their legal mandates for providing proper health care.

For example, if an inmate has been scheduled for a medical appointment at the same time he’s supposed to be in court, the result could be catastrophic. Like- wise, if an inmate is on a strict medication regimen, he needs to be present for drug rounds when medications are dispensed.

Jails also need a confidential way to accept and respond to medical requests from inmates in a timely fashion. The problem with traditional paper forms is that, even when processed regularly, they’re not processed immediately.

If an inmate has a severe complaint, a delayed response could have serious repercussions. Abbey has developed a touch-screen, interactive wall kiosk for inmates to enter requests about various concerns, from classification appeals to personal finances to commissary items to medical care.

In this way, the inmate can provide important information about his health and make medical requests electronically. The information is secure and immediately accessible to health care providers.

This means that medical events need to be tracked in a master calendar – both to ensure good care and to optimize medical resources, Abbey says. Again, this is difficult to do on paper, but fairly simple with an automated system that provides both case management and tracking.

The system should also be able to produce a report and instructions for the patient that he can take with him to another provider once he is released from jail. The report would document the inmate’s medical problems and the treatment he received in jail so that his new provider could continue appropriate treatment.

Even better, in Abbey’s opinion, would be a system that integrated information about care provided both in the jail and in the community.

“We’re trying to develop a system that could be used as the EMR at community health clinics that have a direct relationship with the jail,” Abbey says.

The jail would use the same system, which would include different functionalities for the two very different health care settings. Such a system would help ensure coordinated, continuous care for inmates both in and out of jail.

Griefinger notes that EMRs can be useful tools for jail administrators. However, he adds, “they have to have a system that defines what they want and they have to measure very carefully what they’re getting.”

But real success, he believes, has more to do with leadership and accountability. Recognizing the liability that jails carry for their inmates, local correctional officials must hold their employees or contractors accountable for their performance.

“They need staff who are able to think critically – accept that everything’s not perfect, identify problems, and find solutions.”

Prior to joining COCHS as chief operating officer, Paul Sheehan was employed by the Hampden County Sheriff's Department and Correctional Center in Massachusetts. There, he developed and managed a wide variety of facility and community-based inmate programs, including education, substance abuse treatment, vocational, and domestic violence.

To subscribe to the COCHS free, quarterly newsletter, COCHS Connection, send an email to newsletter@cochs.org. Please indicate whether you’d like to receive the newsletter by email or in hard copy through the mail.


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