Proposed Innovation for Rikers Island Correction Facility

EClinicaWorks at Rikers Island

Rikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use of this electronic health records software at this correctional facility in relation to hospitalized inmates. The author includes an overview of how this software is run by Corizon Health and how the correctional facility works with Bellevue Hospital, which also has eClinicalWorks. The discussion includes an evaluation of how this software has been characterized by a workflow challenge that hinders effective workflows. The use of paper documentation by hospital staff because of inability of this software to visualize findings, discharge instructions or recommendations is discussed. This is followed by discussion of a proposed innovation and how it can be implemented using a project management approach. The final sections discuss strategies for going live and ongoing maintenance of the proposed innovation.

eClinicalWorks at Rikers Island

The modern healthcare environment is characterized by several innovations and technology solutions including eClinicalWorks (eCW), which has emerged as a leader in medical software solutions. One of the contributing factors to eCW's top rating is its newly designed electronic health records software that is top rated in customer satisfaction and usability. This medical software solution is currently used in Rikers Island, which is run by Corizon Health. The healthcare organization, which is one of the leading providers in healthcare in correctional facilities, has adopted eCW in many of its facilities because it's very prison friendly. However, when inmates go to Bellevue Hospital for an emergency or follow appointment there's no place for the hospital staff to visualize findings, discharge instructions or recommendations. While Bellevue Hospital has eClinicalWorks, it cannot be visualized on Rikers Island. This paper examines a way for solving the problem through coordinating Corizon Health and Bellevue Hospital to synchronize the system and necessary training.

The Current State

Corizon Health runs Rikers Island through the use of an electronic system known as eClinicalWorks, which has emerged as a leader in medical software solutions. The system enables healthcare providers the opportunity to deliver the highest quality care by placing the customers and employees first. The newest version of the system encompasses a cloud-based tool that can be utilized in varied areas including: social media, home monitoring, healthcare facilities and correctional facilities. As one of the leading providers in healthcare in correctional facilities, Corizon Health has adopted eCW in many of its facilities in order to enhance patient safety and awareness. Corizon Health's adoption of eClinicalWorks is attributable to the fact that it's very prison friendly and helps the organization to establish a culture of open communication and integrity, collaboration, and accountability. Moreover, the adoption of the system is fueled by the organization's attempts to enhance the quality of the healthcare it delivers, ever watchful of safety, efficiency and cost-effectiveness (Corizon Health, 2015).

This organization acquired a ten-year contract to provide healthcare on the Rikers Island jail complex in New York City in 2002. Rikers Island is composed of ten jail facilities located in the East River between Queens and the mainland Bronx. The complex houses inmates awaiting sentencing and those sentenced with jail time under one year. Rikers Island can house up to 14,000 inmates on any given day. All inmates are entitled to safe and unbiased care; this is inclusive of personal safety and medical care. Rikers Island is owned by the state of New York but contracts their medical care to outside agencies.

Based on the current structure, inmates requiring hospitalization or other invasive treatments are transferred to Bellevue Medical Hospital for further treatment as shown in Figure 1. While hospitalized the inmates are awarded the same medical care as civilians, they are provided with follow up appointments, discharge teaching and skill training. For example, many inmates are taught to safely administer insulin or perform simple wound care independently. The currently used eClinicalWorks computer system provides a safe communication link between the nurses, physicians, and other health departments. It helps facilitate the management of patient healthcare, therefore bringing about patient and user satisfaction.

The provision of medical care at Rikers Island Correctional Facility through eClinicalWorks computer system involves several users of this medical solution. First, the system is used by correction officers who utilize their own computer systems with an inmate's criminal history, current arrest, housing area, current location, religion, bail hearings, court dates and other official criminal proceeding. Secondly, the system is used by nurses for every aspect of care including medicine administration, inmate identification, wound care orders, verification of history, appointments, follow ups, diabetic care, immunizations, and documentation. The system provides nurses with the ability to update medical information of inmates that was missed on admission or from facility transfer. The third users are physicians who use the system to accurately record medical details about inmates to ensure the correct diagnosis is made and the right treatment is provided. Through the system, physicians share patient data, document orders, prescribe medications, and schedule follow up appointments with outside clinics.

Fourth, the system is used by dieticians or the dietary department to ensure that the correct diets are provided to incarcerated patients. eCW enables easier documentation of meal requirements, allergies, medical conditions, religious observances, and post/pre-operative dietary restrictions. Discharge planners also utilize the system since it comprises a discharge planning module that has the capacity to produce a discharge planning user interface for visualization by different users. The facilities' administrators also use eClinicalWorks for summarization of yearly proceedings in the form of programs, such as the expenditures for personnel, facilities and equipment obtained.

System Issues or Problems

While eClinicalWorks is a very prison friendly system, it is characterized by some issues or problems in medical care processes at Rikers Island. The main issue surrounding this system is that when inmates go to Bellevue Hospital for an emergency or follow appointment there's no place for the hospital staff to visualize findings, discharge instructions or recommendations. As a result, these processes are completed on paper and sent back in an envelope, which is sometimes lost because it needs to be manually scanned into the computer by a clerk. In addition, Bellevue Hospital does have ECW but it cannot be visualized on Rikers Island because in jail they use their jail ID number but in the hospital they are under a medical record number for billing purposes. In essence, while Bellevue Hospital and Rikers Island Correctional Facility utilize similar systems, their interfaces do not cross. There is lack of coordination between Bellevue Hospital and Corizon Health because the system is not synchronized.

The lack of coordination and synchronization of the system is a major issue since it acts as a source of confusion for providers. Even though eClinicalWorks is a comprehensive electronic health record, the continued use of paper and computer-based medical records is not only cumbersome but also generates confusion for providers because of the increased likelihood of loss of information (Stazesky, Hughes & Venters, 2012). Moreover, the lack of coordination is a problem that not only affects providers but also generates significant issues for correction officers, hospital staff, discharge planners, and correction administrators. This is primarily because the efficiency of these users would be enhanced through visualization of findings, discharge instructions, and recommendations.

Proposed Innovation

Given the current issues or problems with the utilization of eClinicalWorks at Rikers Island Correctional Facility, there is need to improve the system in order to enhance efficiency. Actually, there is need for a collaborative data-sharing system or application to enhance care coordination between Bellevue Hospital and Corizon Health so that interfaces of the eClinicalWorks systems would cross. Through an effective data-sharing system, hospital staff and correction officers and others will have access to shared clinical information is a seamless manner that promotes enhanced care coordination while lessening unnecessary, costly duplication as shown in Figure 2. A data-sharing system will help avoid the current production of parallel paper and electronic health information, which is characterized by numerous problems that make it difficult to synchronize systems at the hospital and the correction facility.

Proposed Web-based HIE Application

Therefore, the proposed innovation for this desired goal is a web-based health information exchange (HIE) system. A web-based technology for shared clinical information will provide relevant stakeholders secure, real-time access to important information regarding hospitalized inmates and improve efficiency of the existing eClinicalWorks computer system. Web-based health information exchange systems are developed in a way that they can be used by different organizations including healthcare facilities and correctional facilities. As a result, the adoption of such a system will fit Rikers Island Correctional Facility and Bellevue Hospital. However, the web-based system should be developed and utilized in a manner that only authorized personnel can access the information in order to address potential privacy and confidentiality issues.

Generally, health information exchange systems electronic share pre-determined patient information with healthcare providers and other organizations throughout the continuum of care (Vest et al., 2014). Information sharing through these systems enables various personnel in the care process to access patient data and utilize it in enhancing care. Vest et al. (2014), state that data in health information exchange systems eventually improve patient safety and quality of care. To this extent, a web-based health information exchange system would help synchronize existing systems and improve coordination between Bellevue Hospital and Corizon Health.

The web-based HIE system will be integrated with the existing eClinicalWorks computer system in a manner that hospitalized inmates' data is captured and electronically documented. The clerk at Rikers Island Correctional Facility will be mandated with the task of documenting findings, discharge instructions or recommendations relating to hospitalization of inmates at Bellevue Hospital. The clerk will then share the information with the hospital staff at Bellevue Hospital through an online platform. Notably, the system will not necessarily be a website that can be accessed by both institutions but a web-based application that is available at the correction facility and health care facility. Given its wide accessibility, the web-based application can be utilized by hospital staff and correction officers simultaneously. The hospital will not utilize paper to document findings, discharge instructions or recommendations but upload it on the web-based application where it can be easily accessible by relevant authorities or personnel at the correction facility.

The web-based application will be built into eClinicalWorks computer system to ensure visualization at the hospital and correction facility. By building the web-based HIE application into the eClinicalWorks, these institutions will protect it from unauthorized use, which is likely to generate concerns regarding privacy and confidentiality of data on hospitalized inmates. In essence, the application will promote electronic messaging that enhances completeness of documentation and enhances availability and timeliness of patient data. The application will also integrate billing information into patient data so that it can be easily used by hospital staff.

Functions and Tasks of the Proposed Innovation

The functions and tasks of this proposed innovation include provide integration of computerized systems at the hospital and correction facility, enhance sharing of patient data, limiting errors or mistakes associated with paper documentation, and ensure timely access of patient information. The system will also help generate electronic demographic data regarding inmates in need of care, progress notes or specialized reports (Miller, 2012, p.537). As a result, the system will deal with the identified problems in the existing eClinicalWorks computer system through interfacing these systems at the hospital and correction facility. The proposed innovation will ameliorate the issues through eliminating the need for paper documentation, ensuring visualization of important information at the facilities, and create a link through hospital and correction staff work collaboratively towards patient care and safety.

Timeline and Budget

The timeline for implementing the proposed innovation, which will take 6 months to fully develop and implement, will entail determination of desired objectives of the system. This is a crucial element in the process because the proposed innovation will be considered effective based on its ability to deal with issues or problems in the current system. Once the system is developed as explained in the next segment, the other component in the timeline is project testing and implementation. Project testing and implementation is important because the functionality of the application needs to be examined before it's fully launched in the correction and hospitality facility. Third, the use of the application will be subjected to evaluation in order to enhance its effectiveness through making necessary changes.

The proposed budget for development, implementation, and evaluation of this web-based HIE application is estimated to be $40,000 as shown in Figure 3. The seemingly high costs of the project are attributable to the high costs of technological innovations. Actually, the amount of development, implementation, and evaluation is relatively cheaper in comparison to purchasing an already developed application or outsourcing a company to do so is more costly. Therefore, it will be relatively cheaper for the organization to develop and implement the application rather than purchase one.

Proposed Implementation

As previously mentioned, the development of a web-based application for health information exchange is usually a complicated process. As a result, this process requires comprehensive steps based on the project management model. In this case, the development of this information system will be as follows

Establishing Project Management Team

The first step in the process is establishing a project management team that will handle all aspects of creating the web-based application. This team will comprise the members of the management teams of the correction and healthcare facility, individuals from the IT department, and other end users. They will be in charge of handling all tasks of developing, implementing and reviewing the application relative to desired objectives.

Definition of the Application

Once the project team is established, the next step is to define the application with regards to its purpose, goals, and direction. The two-week process of defining the web-based application will include determining functional specifications, design layout, interface design, visual guide, scope, and budget.

Project Design

This will be followed by designing the application based on the pre-determined technical specifications, technology, and web application structure. The design process will take three months given the complexity associated with creation of a web-based application including developing the database structure, designing web application architecture, and creating all functionalities.

Project Testing

The next process will be project testing, which will entail using the system for a one-month period to examine its functionality relative to desired goals and objectives. During this process, end users will provide important information on how the system functions with regards to promoting data-sharing between the hospital and correction facility.

Project Implementation and Evaluation

Once the application has been tested, necessary changes or modifications will be made for a period of one month. This will be followed by launching the application and monitoring and review its functionality to ensure it meets desired goals even with operational changes as shown in Figure 4.

However, the development, implementation, and evaluation of this proposed innovation is likely to experience some challenges or barriers that could hinder its effectiveness. Some of these potential barriers include diffused approach to the project, project ambiguity, poor communication, poor project staffing, and insufficient cross-functional cooperation. These potential barriers will be addressed through ensuring adequate representation in the project team, clearly defining project scope, ensuring accountability among project team members, defining project strategy, and establishing effective communication strategies.

Proposed Training Plan

One of the most important measures for enhancing the effectiveness of the proposed innovation is through project training. The training should incorporate strategies for enlisting End User, Super User, and Physician acceptance. Generally, the staff on Rikers Island and Bellevue Hospital would need to be trained on the new system to help ensure its effective in promoting coordination between the two institutions. The training of these professionals will involve creating a training team of several instructional designers from the project team and project developers (Pantaleoni et al., 2015, p.81). The training team will be mandated with the task of creating training content and educating physicians, super user, and end user. The training content will largely comprise the technical aspects and functionality of the proposed innovation.