eClinicalWorks EHR System at Rikers Island Correctional Health

Corizon Health is the founder and leading provider of correctional healthcare in the United States. It is a corporation built on more than thirty-five years of innovation and expertise in the healthcare industry, having grown into the largest and most prominent care provider in its field. The mission statement of Corizon Health clearly outlines that it is a company which, over the years, has established itself on modernism and capability (Corizon Health Website, 2015). Its personnel, practices, and commitment to achievement through evidence-based medicine empower it to consistently meet and surpass client expectations. The core mission of Corizon Health is centered on patient safety. Health management in correctional healthcare facilities and prisons brings about quality inmate patient care in tandem with public safety, which are at the core of the company's mission (Corizon Health Website, 2015).

The main goals and objectives of Corizon Health are to provide client partners with high-quality healthcare and support services that will improve the health and safety of patients, decrease recidivism, and better the communities where the company lives and operates. Corizon Health's organizational culture encompasses a focus on open communication, integrity, accountability, and collaboration. These same objectives and goals provide the basis for the company's organizational dedication to a culture of patient safety. The company acknowledges excellence in patient safety as a journey rather than a destination, and strives at all times to improve the quality of the healthcare it delivers, with constant attention to safety, efficiency, and cost-effectiveness (Corizon Health Website, 2015).

eClinicalWorks (eCW) has emerged as a leader in medical software solutions. Its newly designed electronic health records software is top rated in customer satisfaction and usability. It enables healthcare providers the opportunity to deliver the highest quality care by placing customers and employees first. The system is designed for locating and storing records within the facility. Prior to eCW, Rikers Island was documenting patient information on paper. Therefore, when inmates left facilities, it was difficult to locate their records. In addition, when they were re-arrested, their old records could sometimes not be found. This computer system helps with continuity of care. Furthermore, the system can be accessed for the Bellevue Hospital prison ward, so if prisoners are hospitalized, their medical records can be retrieved and reviewed.

One of the challenges and downsides of the system currently in use is that it cannot be accessed from outside the facility on personal computers, due to HIPAA regulations. The practical implication of this is that if a staff member forgets to document or record information, he or she is forced to return to Rikers Island to obtain it. This wastes time and resources. More significantly, it can cause serious consequences when a patient in critical condition must wait for treatment due to the lack of accessibility to patient information.

One aspect of the system that works well is the ease with which users can engage with data and their patients. The eClinicalWorks system provides a secure communication link between nurses, physicians, and patients, and facilitates the management of patient health. For instance, users are able to access personal health records (PHR), review lab results, request refills of approved prescriptions, request referrals, and note dietary changes or important patient information.

There are numerous users of the eClinicalWorks computer system in the provision of medical care at Rikers Island Correctional Facility. The following describes each user group and their specific needs.

There is a need to ensure that correct diets are administered to the right patients. For instance, if a certain drug is prescribed and certain foods are contraindicated, the system enables meal providers to ascertain the appropriate dietary procedures and confirm that the correct meal is administered. Similarly, if a patient is scheduled for surgery and must fast beforehand, the system ensures that no mix-up or error occurs. This also applies to post-operative diets and to inmates who are allergic to certain foods. The system facilitates awareness of which inmates must avoid certain meals.

Nurses are among the primary users of the computer system. They use the system for medication administration to different patients. For example, if a patient is to be administered medication three times a day, that information is entered into the system for nurses' reference. Nurses also use the system to update the medical records and information of inmates, which is essential for future treatment needs. Additionally, the eCW system provides nurses with valid access through a single tap of a secure card, eliminating the need to enter usernames and passwords repeatedly. This allows nurses to spend less time on the computer and more time providing direct nursing care — an approach consistent with Corizon Health's mission to promote both patient and employee satisfaction, thereby contributing to patient safety and improved healthcare outcomes.

Medical doctors must administer care to numerous inmates at Rikers Island Correctional Facility. The system supports several needs. Doctors are able to accurately record medical details of inmates to ensure correct diagnoses and appropriate treatment. The system also enables doctors to share patient data with nurses and the broader facility. Physicians can search and retrieve patient records efficiently. Given that the hospital is at some distance from the facility, a doctor can provide a medication note without needing to write paper orders each time. The use of the eCW system and standardized order sets helps eliminate handwriting inaccuracies that could otherwise lead to adverse patient events.

Correctional officers are primarily consumers of data from the system, though they may also be involved in monitoring data entry. The system is used to maintain summaries of disciplinary proceedings and their outcomes — for instance, transfers to alternative custody, hearings, and releases to parole.

The eCW system provides discharge planners with the ability to manage patient discharge processes. This includes a patient data repository capable of storing patient information, as well as a discharge planning module that can generate a planning interface for different users. Discharge planners use the system to facilitate the transfer or discharge of prisoners hospitalized at the Bellevue Hospital prison ward. They can also use the system to identify necessary post-discharge medical care options, match patients with appropriate care providers, and automatically send discharge requests to designated medical providers (Gerdin et al., 1997).

The computer system is employed for administrative functions by the institution's administration. It supports the summarization of annual activities in the form of program reports, including expenditures for personnel, facilities, and equipment. The system is also used to maintain up-to-date personnel records, including appointments, departures, assignments, and relieving of assignments. Day-to-day activities undertaken at the facility require the ongoing use of the computer system (Josi and Sechrest, 1998).

Gap analysis outlines the variances between the actual and required states of a system. Applied to the computer system in use, it identifies the differences between what the system currently does and what it is intended to do. A functional gap analysis examines different types of functions and determines whether identified gaps are critical or whether users can accommodate them. For gaps that are not critical, the analysis offers solutions that may encompass changes to system design or to user practices (Balm, 1996).

Presently, there is difficulty in accessing information for inmates who are patients. If a staff member forgets to document or record information, he or she is forced to return to Rikers Island to retrieve it. This adversely impacts resources in terms of time and cost, and can have devastating consequences when urgent information is required for a patient in intensive care. In addition, the system currently assists primarily with medical care — specifically, replacing paper for reporting and obtaining inmate medical information. This functionality operates in a single dimension, whereas the present need is for a compound or multi-use system.

The desired situation is a more comprehensive system overall. The implemented system is designed to automate clinical transactions; however, the goal is to attain a system that is more transactional in nature and supports multiple applications. This would improve client satisfaction and increase the operational performance of the facility as a whole. Another priority is increased mobility. Improved mobility solutions would allow the facility to increase patient satisfaction while adding agility to its business operations model. This would also promote superior employee productivity across the board (Herrick et al., 2010). However, it is important to note that increased mobility implies increased security risk for computing systems, making it necessary for the organization to enhance its security framework to ensure safe remote access to information. A further desired improvement is a system that limits the number of times nurses, doctors, and other users must enter login credentials. This would reduce time spent on administrative computer tasks and increase time available for direct patient care, thereby enhancing patient safety.

The following priorities for change have been identified:

1. Multiple transaction use of the system — not only for medical transactions, but also for financial and operational transactions. This is intended to increase client satisfaction through improved operational performance and cost-effectiveness.

2. Increased mobility — ensuring the availability and accessibility of data regardless of the location of the patient or the clinician.

3. Reduction in login and password requirements — decreasing the frequency with which system users must authenticate their credentials.

One growth opportunity is data warehousing, which integrates data stores and combines logical, physical, and conceptual models to address business goals and end-user information needs. This approach can provide support for reliable operational systems and offer extensive accessibility to required information through agile data warehousing and analytics (Berndt, 2001). Another possible solution is incorporating multiple functions within the system to facilitate not only medical transactions but also financial and operational ones. The login burden may be reduced by limiting system access rights to the fewest necessary users.