Vol. 16 •Issue 21 • Page 24
Medical Records Behind Bars: a Closer Look at Correctional Health Care
Electronic medical records are changing health care in all fields and soon prisons nationwide will reap the benefits.
The topic of electronic medical records (EMRs) is one that has remained in the public eye for years. We have discussed how advances are changing the way hospitals, private practices and other health care facilities keep track of patients. There is another area in health care that is beginning to see the benefits of going electronic but its one not commonly discussed.
Correctional health care is a field that is very large yet never really talked about. From a medical standpoint, many prisons are their own little hub with a full medical staff, physicians, mid-levels, nurses, clerical staff, lab technicians and more. Each inmate in the U.S. has a medical record, and just like other patients, they have certain medications and medical history that need to be tracked. Today, a majority of prisons are still using a paper-based system, but some are beginning to see the benefits of EMRs.
Why EMRs Work
It seems obvious and slightly redundant why health care facilities see the move to EMRs as a positive. Many who work in correctional health care agree that moving toward an electronic record is not only beneficial but is crucial to keeping track of inmates.
Consider this hypothetical situation: an inmate has been in the correctional system for more than 8 years and is being transferred to a medium security facility. This inmate has asthma and a heart murmur. When transferred, the new facility must be made aware of these conditions, as well as other medical history. The common method for transporting this type of information is to have the inmate’s medical record in a sealed envelope, which will be carried by the corrections officer escorting the prisoner. But how long would it take to gather the inmate’s history? How long is his or her record? These are complications that waste time and make the whole process much more challenging.
“The longer the electronic system is in place, the more solid the whole system becomes,” stated Bryant Eckman, RN, who has worked as a health services administrator at Bayside State Prison in Leesburg, NJ, for more than 4 years. Bayside is a minimum and medium correctional facility that is highly transient. They can have between 2,200 and 2,300 inmates on any given day. Many inmates are transferred through Bayside to larger facilities, higher security facilities, working farms or halfway houses. Having such an extensive inmate population that is constantly moving, it’s no wonder why EMRs are gaining popularity.
At Bayside, there are five employees who handle the records for all prisoners. The clerk is someone who appreciates EMRs. The clerk will receive information from the Department of Corrections (DOC) in regard to an inmate being transferred. It is the clerk’s responsibility to make sure that the inmate’s charts, medical record, medical history and any other personal information is passed along accordingly.
“My files are kept electronically in Excel files on my computer,” said Tina Holmes, medical records clerk, Bayside. “I get things like pre-parole physical lists or court trips, and every week I get release charts electronically that I report back to the DOC.”
“We have up to 50 or 60 inmates come and go everyday from this facility,” added Eckman. “Tina is probably gathering records everyday for 10 to 60 inmates and those records come and go very quickly. That’s why it is so important that we are in the electronic stage.”
A Few Differences
Those who work in correctional health care speak about it as if prisons are their own worlds. Compared to the “real world,” prisons have a few different rules.
For starters, every single interaction between an inmate and employee is documented. Whether an inmate wants a Band-Aid, has a stomach ache or faints, it is documented.
“It would not be unlikely for an inmate who has been with us for a year or two to have a 500 page electronic record,” Eckman said.
Every encounter, every interaction, every time an inmate meets with a doctor, nurse, technician, etc., everything is documented electronically.
Much like the real world, the inmate is allowed to view their records. But they are often encouraged to request pertinent information needed, rather than the entire record. They are required to pay for copies of their medical record, and it would become too costly to view the record in its entirety.
When an inmate is released from a facility, the hard copy reference file records are archived “Electronic records are here basically forever,” stated George Riehm, RHIT, director of health information, and Correctional Medical Services (CMS), NJ region. “Hard copy reference files go back to the DOC. The records themselves are property of the DOC. CMS is the custodian of the record.
Security Issues
To keep EMRs protected, prisons take precautions that are similar to any other institution. Paper records are kept in a locked and secure room. Those records accessible electronically may only be viewed with the proper user names and passwords.
“Everyone has a password and when you first turn on the computer you have to enter a user ID and password,” said Eckman. For privacy and protection, special terminals are often built for computers. When an inmate meets with a doctor, he or she can sit face to face while the physician records directly onto the computer. The computer terminal consists of a full service desktop PC that is built into a specific security desk. The monitor is below the desk and the physician, nurse or technician can see it through an unbreakable glass cover. This is so the inmate cannot gain access and so that others may not see what is being typed.
Also, while an interaction is taking place, there is an officer close enough for safety yet far enough for privacy.
Not for Everyone
Working in a correctional facility is definitely challenging and certainly not for everyone. Having a broad spectrum of workers, with a variety of experiences and education levels helps generate new ideas and allows for workers to help one another.
Obviously one needs to be comfortable working in close proximity and interacting with prisoners. Although you can choose whether or not you want to work at a maximum or minimum security prison, many times inmates are transferred from all over.
But those who are comfortable seem to be very satisfied with correctional health care.
“One thing I enjoy is that when I am with an inmate, I usually know exactly what’s going to happen,” Eckman stated. “Whereas in an urgent care facility, once you are behind that curtain you have no idea what’s going to happen. You are safer in this environment then in most emergency settings.”
“It is a very unique place where you can use all of your skills,” added Joanne Loppe, RN, CCHP, manager of clinical services, CMS, NJ region.
The Future
Many in the correctional field hope that EMRs will become the norm. Not only does it create less filing duties for clerks, it provides a secure and quick solution to transferring records.
“I hope one day we will have a complete and total EMR,” said Riehm. Certain information such as a medication administration record (MARS), hospital records, X-rays, and anything that an inmate would need to sign, still needs to be in a paper chart. But many are awaiting the day when MARS will go electronic.
“Soon Bayside will be going to an electronic medication administration record (EMAR) to add strength to the overall system,” stated Eckman.
“One thing I hope for the future is that the EMAR will significantly reduce the filing time for clerks,” Riehm added. Correctional health care remains a different side of health care, but one that deserves more attention. Many are hoping that EMRs will strengthen the field and help save time in such a fast-paced environment. Others simply hope that EMRs bring more attention to the field.
“I hope correctional health care is brought into the spotlight for medical records,” stated Riehm.
It is a field not often discussed, but one that deserves acknowledgment as it is a giant part of health care.
“Corrections is a specialty that no one really knows about,” Loppe said. “And I have come to fall in love with it.”
Lauren Himiak is an editorial assistant for ADVANCE.
