At long last, the medical records for Oregon’s prison inmates will one day be housed in iPads and computers, rather than file boxes, shelves, rolling carts, fax machine trays and plastic stacking bins.
Gov. John Kitzhaber’s proposed budget for 2015-17 includes $3 million for an electronic medical records system that will eventually replace the files on each of the state’s 14,600 inmates, plus more than 40,000 files the state maintains on former inmates.
Oregon is one among many states, cities and counties that are shifting to digital medical records in their prisons and jails. The new systems are expensive but alleviate an array of logistical problems, and they allow for better inmate health care and more accountable agencies, officials said.
The Department of Corrections has been asking the Oregon Legislature to give them the money for years. However, it wasn’t until 2013 that lawmakers saw the need for the new digital system, said Steve Robbins, head of the department’s health services division.
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They met as part of the Work Group on Corrections Health Care Costs, created in 2013 by Senate Bill 843, and eventually recommended funding this project.
The paper files the prisons have always used come with a list of problems.
First, there is the sheer heft of them.
Each inmate has a file that contains his or her medical, mental health, dental and pharmaceutical information. Many people with serious or chronic problems have files that contain hundreds of pages and must be kept in multiple volumes.
Charts are kept for years after inmates leave the prison system, and they are stored in a warehouse full of shelves opened by crank wheels to fit more into the space.
The pages inside must be faxed if anyone’s doctor needs to see them, Robbins said, and faxing 200 pages is no joke.
They also must be hauled around the state’s network of 14 prisons, as inmates often move from one facility to another. They are also moved among doctors, as each chart contains every type of health care an inmate receives.
The result of all this paper moving around is a logistical nightmare, Robbins said. Files occasionally go temporarily missing, and people must track down where the chart was last seen. Sometimes they don’t arrive at a prison when an inmate does. Sometimes they are with a different doctor.
Digital records don’t come with that problem. The same charts will be available on every computer for every doctor. If a specialist needs a chart at Oregon Health & Science University, which contracts with the corrections department, a doctor can email the information.
The digital files also come with less risk, Robbins said. A fire or a flood could wipe out thousands of paper records, but digital records are much harder to destroy, he said. They do come with the risk of a security breach, he said, but privacy is a concern with medical records no matter what their form.
The paper files will allow staff to focus more closely on inmates who need care, he said, rather than tracking down information.
Oregon is not alone in thinking a digital records system makes sense.
The Federal Bureau of Prisons has used an electronic system since 2006, called the Bureau Electronic Medical Record, according to an audit by the U.S. Department of Justice.
It is now looking for a more advanced system that can manipulate data and track disease outbreaks.
The California Department of Corrections and Rehabilitation went out for an RFP in April 2012, with a max budget of $59 million, to keep track of records for about 120,000 inmates. An electronic system was originally suggested in 2010 as part of a study on how to improve health care quality and cost in the California prison system.
The project began about 18 months ago and isn’t finished, spokeswoman Liz Gransee said. The first test sites will be up and running in October, she said, which is not far ahead of when Robbins hopes to see Oregon’s system running — early in 2016.
California’s system is modeled on the one used in the Los Angeles County Jail, which has been in place since 2000.
L.A. Sheriff’s Capt. Kevin Kuykendall said the system handles about 16,000 jail inmates at any given time, more than the entirety of Oregon’s state prison system.
It has been a big improvement for the sheriff’s office, Kuykendall said.
“Just having instantaneous access to an inmate’s complete medical file is a significant step in improving inmate medical care (and also reducing liability), especially in a system with eight locations and several hundred inmates moving from one location to another on a daily basis,” he wrote in an email.
“Knowing an inmate’s past complaints, treatments, allergies, and medications results in better care and less errors related to ‘not knowing’ something that is buried somewhere in a paper chart,” he said.
The jail is about to upgrade the system to include hospital billing capabilities that will allow the department to track its spending, Kuykendall said.
Tracking trends over time is one benefit of an electronic system that Robbins is most looking forward to.
Right now, there is no simple way to know how many inmates have a broken arm, for example, he said. There is also no way to know how they broke those bones or how many have been broken this year. Tracking diseases or other medical problems is almost impossible, he said.
An electronic system allows that tracking, Robbins said, and it allows the analysis of trends over time. It can show how the number of people in prison have diabetes over time, for example, to show whether that number is growing or shrinking.
Now, any of that information would be anecdotal.
The new system will also benefit people as they leave prison, he said.
It used to be that inmates often had never seen a doctor before their incarceration and likely wouldn’t see one when they left, he said. Today, with the Affordable Care Act in place, it is becoming more common for people to enter prison having already established a history of medical care, and it’s more common for them to see a doctor in the community after they are released.
Electronic records will make it easier for prison doctors to see an inmate’s history, Robbins said, and easier to share it with a community doctor after an inmate’s release.
It will not be a perfect transition.
The corrections department will keep all the existing files in paper form, Robbins said. Only new charts and a few chronic patients will be put into the digital system, which means a full conversion to electronic records will take years.
However, it is a big step forward, Robbins said.
He hopes to go out for bids by the end of the summer, but right now his staff is going through the internal process established by the Department of Administrative Services to make sure large technology projects are sound.
The new records system likely won’t be up and running until 2016, he said.
“I wish we could go faster, but there are enough reasonable requirements in this process that we think (2016) is a fair guess,” he said.
Date: January 5, 2015