Jails need HIE as a bridge to outside care

Jails tend to be islands as far as healthcare is concerned, with providers inside having no information on care inmates received outside, and community emergency rooms--where most inmates are treated upon release--with no data from treatment provided inside.

Two case studies dissected in an article at Perspectives in Health Information Management discuss the issues.

With the Affordable Care Act expanding coverage and HITECH promoting use of electronic records and the development of health information exchanges, connecting jails with outside providers would seem to make sense. "The developing technological infrastructure would seem to offer the best way to access this information," author Ben Butler, CIO of Community Oriented Correctional Health Services in Oakland, Calif., writes. "However linking the community and jail information systems is not just a technological issue, but requires the cooperation of all stakeholders."

In the first case study, a county jail in California was linked to a local HIE at the insistence of the new medical director--a private practice physician who had participated in the county HIE. The jail used paper records at the time, and had no real-time access to information to outside care.

Joining the web-based local HIE cost just $25 per month, per user. The medical director and jail nurses were trained on the system in less than two hours, and implementation took just two weeks, with no loss in productivity.

After five years, however, the medical director retired and the county failed to make participation in the HIE part of its ongoing strategy. It outsourced healthcare services for the jail to a private vendor, who considered the HIE a legacy system and adopted a commercial electronic health record system instead, breaking ties to the outside. Without a strong champion, the jail largely has reverted to a silo of information.

Meanwhile, at a jail in Camden County, N.J., stakeholders viewed health information exchange as an opportunity to improve the care coordination and management of a high-risk, high-cost population. The effort involved county officials, the non-profit organization Community Oriented Correctional Health Services (COCHS) and the Center for Family Guidance (CFG), the private healthcare contractor for the jail, which agreed to pay the $20,000 licensing fee to connect the jail to the HIE.

The jail, still in the early stages of its participation in the HIE, is being monitored closely for results, according to Butler. The stakeholders are optimistic that they can reduce recidivism by coordinating and improving treatment for people with mental illness and substance addictions, and see the HIE as central to improving care.

"The experiences in these two counties underscore the importance of partnerships among stakeholders who frequently are not accustomed to working together but who share a serious problem: the enormous healthcare needs of the jail-involved population," Butler says. "Jails are part of the community healthcare system. An HIE that leaves out the local or county jail has a gaping hole in its network."

One in 70 former inmates is hospitalized for an acute condition within seven days of release, and one in 12 by 90 days, a rate much higher than in the general population, according to a study published last summer from the Yale School of Medicine.

Many states will save millions of dollars a year on correctional healthcare services by expanding their Medicaid programs, a study by the Pew Charitable Trusts found. A state such as Ohio could save as much as $273 million between next year and 2022 while Michigan would save about $250 million.

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