It’s easy to see EHR (electronic health records) as a hero of tech efficiency in the industry, but the concept of patient-centered healthcare is a reminder that patients, including those who are incarcerated, are the drivers behind the design, and implementation of any patient record system.
The U.S. correctional system sees about 10 million people per year filter through its jails and prisons, with 90 percent of those incarcerations in jails, according to the Health And Human Rights Journal.
The majority of that population tends to be poor and racial and ethnic minorities, and have higher rates of medical, mental health, and substance abuse challenges. In addition to their pre-existing conditions, incarceration brings with it new health risks of injury from violence and mental health stressors.
As in other community health settings, EHRs are being used in correctional health systems to bolster safe and productive care. As is true in non-incarcerated populations, EHRs carry advantages:
Specific to incarcerated populations, clinical staff also have access to records from prior incarcerations.
Examples In NYC
In the New York City jail system, treatment of patients falls under the Bureau Of Correctional Health Services (CHS) of the NYC Department Of Health And Mental Hygiene. Jails in NYC tend to be chaotic settings for healthcare, where the average length of stay is 45 days, but the median is eight days — making a comprehensive look at large quantities of information difficult without the aid of a solution like an EHR.
CHS has recently adopted a focus on human rights as a part of its ongoing healthcare mission and the EHR is a key component in implementing that mission.
Adapting The EHR
The traditional EHR has been designed for a general population that does not face the same risks as incarcerated ones. Even within these populations, risks are not evenly distributed, and while most correction facilities have mechanisms in place for protecting vulnerable inmates, patients have reported that they are still repeatedly victimized, even in protective custody. Many health providers have knowledge of individual cases, but tracking trends has been difficult, largely because of a lack of training and technical capacity to aggregate data. The EHR can be adapted to gather information related to abuse, neglect, and other violence, as well as facilitating report generation based on patient demographic profile, time, location, or clinical outcome.
Connection To A Larger System
The connection of jail-based EHR to a state-wide health information exchange is one of the key components in using the EHR in addressing actual human rights issues within the correctional population.
While NYC represents a jurisdiction that is currently using EHR actively to address human rights issues, other states, like Oregon, are implementing EHR systems purely for the sake of efficiency. In the future, these systems could be adapted to address needs that go beyond efficiency and cost savings. The Oregon Department of Corrections issued a budget request of $2.6 million in 2013 to convert their health records to an electronic system. Files are currently spread across 14 prisons, making it impossible for officials to search for trends that might improve inmate health. To make the transition, the state faces the challenge of converting millions of pieces of paper to electronic records, according to The Sun Herald.
You can find more information on EHRs and their use in addressing population health issues in these articles: