Department of Corrections Electronic Medical Record (EMR) Feasibility Study

A State Department of Corrections (DOC) was legislatively mandated to provide medical, dental and mental health care to approximately 16,000 offenders incarcerated in 12 facilities and one work release location across the state. Providing 24 hour per day, 7 day per week health care for an aging, complex, sometimes medically fragile, mobile patient population in a correctional system is complex, with characteristics of both an institutional environment and a health plan.

The Challenge

The Department wanted to understand if an Electronic Medical Record (EMR) would address these and other health service needs and support the Department’s overall public safety mission. Additional external healthcare industry drivers and the fact that about half of peer state correctional agencies had already deployed an electronic health record contributed to the need for an analysis.

What Was At Stake

The existing documentation/data management process was quite fragmented, whereby staff checked a variety of places to ensure they have complete and updated offender information. These needed to be consolidated. The physical facilities ranged widely in age (from 8 to 127 years old), size, and purpose; and some had recent challenges in terms of network capability and other structural issues.

The Solution

OTB Solutions was engaged to perform a multi-faceted analysis process involving management/key stakeholder interviews, document review, business requirement development sessions, workflow examination, site visits for both business process and technical analysis, form and database review, technical analysis and researching external sources (e.g. professional associations) for pricing and other information. Peer correctional state agencies (county, state and federal) were consulted and they reinforced many of the key best practices and were quite consistent in their recommendations and experiences.

Major alternatives were considered with respect to the acquisition of an electronic health record system, including developing a unique system, buying/leasing a public sector system, buying/leasing a commercial system or a hybrid approach (core system plus niche components). The first two options were ruled out and the department decided to pursue a commercial or hybrid EMR system. Other recommendations were made to decommission the existing health services pharmacy systems. Other key initial recommendations included enhancing disaster recovery capability, conducting a pilot at the two facilities and management of existing paper health records. Several interim activities and investments were also recommended, including standardization of documentation forms, continued efforts using Lean tools and techniques, optimizing stationary device locations for ergonomic and safety considerations and conducting further discussions with custody regarding their barcode plans for offender tracking. Finally, strategic opportunities were provided regarding overall health data sharing.

Results

OTB’s recommendations were reviewed by the Department management, the steering team and executive leadership and approved. The proposal is now awaiting funding by the legislature; however, the agency has undertaken some preparatory steps such as process standardization and infrastructure upgrades.