Study finds benefits of EHR implementation in NYC jails

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A recent study conducted by the New York City Department of Health and Mental Hygiene's Bureau of Correctional Health Services and published in the Health and Human Rights Journal examined the use of electronic health records in New York City jails.

Incarceration is becoming a bigger topic of conversation as the inmate population in local jails fluctuates at high numbers. In 2011, the U.S. Department of Justice reported that 735,601 inmates were in local U.S. jails. During that same year, the U.S. spent $7.7 billion on correctional health care, which is about one-fifth of overall prison expenditures, according to a Pew Charitable Trusts report. The same report detailed that the spending is due in part to a steadily aging prison population. With such large populations, it can be difficult to maintain healthy inmates. Another contributing factor to health concerns is due to high rates of preexisting health conditions, such as injuries from violence and mental health stressors.

The study's process
The CHS study's researchers sought to improve the quality and continuity of health services throughout 12 jails between 2008 and 2011, in which EHR systems were implemented. The study found that when used in correctional settings, EHRs can benefit clinical staff and patients due to the ability to access records from prior incarcerations.

The NYC jails in the study saw approximately 12,000 inmates on any given day and about 80,000 annual admissions. EHRs were used to document around 30,000 patient encounters every month to monitor aspects of medical and mental health, as well as discharge planning services. However, the EHR system needed to be slightly modified to work in a jail setting. This included adding processes to detail admission intake, sick calls, medical emergencies, infirmary care, medication dispensation, hemodialysis, newborn nurseries, mental health encounters and solitary confinement rounds.

Findings
The data showed that by implementing the EHR programs, there was a significant improvement to the CHS' ability to monitor and safeguard the human rights of patients. Researchers contribute this result to three key elements. First, EHRs can be easily altered to gather information related to neglect, abuse and other human rights concerns. Second, EHRs allow for the generation of reports based on patient profile, time, location and clinical outcome. Third, EHRs enable health information exchanges with external EHR systems, which ensures that injuries, mental health exacerbations and other concerns unique to the jail setting can be followed up by community hospitals and physicians.

Researchers believe that health information exchanges will be crucial to educational efforts in regard to jail-based vulnerabilities. When jails use EHR programs, they can allow the leaders to make better decisions about solitary confinement, mental health units and hospital transfers. Furthermore, the collections of data provide the means to identify vulnerable groups of inmates and give them the care and monitoring necessary to improve health. EHRs can furnish reports of adverse outcomes associated with detected vulnerabilities, as well as yield data aggregates that can benefit the implementation of policies that may mitigate those vulnerabilities.