eClinicalWorks at Rikers Island: HIE Innovation Plan
This paper examines the use of eClinicalWorks (eCW) electronic health records software at Rikers Island Correctional Facility, operated by Corizon Health. It identifies a critical workflow gap: when inmates are transferred to Bellevue Hospital, staff cannot visualize findings, discharge instructions, or recommendations across the two systems, resulting in reliance on paper documentation prone to loss. The paper proposes integrating a web-based health information exchange (HIE) application into the existing eClinicalWorks platform to synchronize records across both institutions. It outlines a project management approach covering team formation, application design, testing, implementation, training, go-live strategy, and ongoing maintenance to support successful adoption of the innovation.
- Introduction: Overview of eClinicalWorks use and problem statement
- The Current State of eClinicalWorks at Rikers Island: Roles, users, and operations of eCW at Rikers
- System Issues and Workflow Problems: Paper-based workaround and coordination failure identified
- Proposed Web-Based HIE Innovation: HIE application design, functions, timeline, and budget
- Implementation Plan, Training, and Go-Live Strategy: Project phases, training approach, and launch strategy
- Conclusion: Summary of problem and proposed HIE solution
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- Clearly identifies a concrete, real-world workflow problem — the inability to visualize inmate health records across two institutions using the same software — and builds a focused solution around it.
- Uses a logical project management framework (team formation → design → testing → implementation → training → maintenance) that gives the proposal credibility and practical structure.
- Grounds abstract technology recommendations in specific operational context, naming the relevant institutions, user roles, and estimated budget figures, which adds realism and specificity.
Key academic technique demonstrated
The paper demonstrates applied problem-solution argumentation in a healthcare informatics context. The author diagnoses a system-level coordination failure, supports it with reference to published literature on EHR implementation and HIE systems, and designs a staged intervention. This is a strong model for health informatics policy and systems analysis papers at the undergraduate or early graduate level.
Structure breakdown
The paper opens with an introduction establishing the technology and setting, then describes the current operational state in detail — including all user roles. A dedicated problem section isolates the core workflow failure. The solution section introduces the HIE concept, explains its integration rationale, and outlines functions and budget. The implementation section follows project management phases sequentially before addressing training, go-live, and maintenance. A concise conclusion ties the argument back to the opening problem.
Introduction
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 contributing factor to eCW's top rating is its newly designed electronic health records (EHR) software, which is highly rated in customer satisfaction and usability. This medical software solution is currently used at Rikers Island, which is operated by Corizon Health. The healthcare organization — one of the leading providers of healthcare in correctional facilities — has adopted eCW in many of its facilities because it is well suited for prison environments.
However, when inmates are transferred to Bellevue Hospital for an emergency visit or follow-up appointment, hospital staff have no way to visualize findings, discharge instructions, or recommendations from the correctional facility's system. While Bellevue Hospital also uses eClinicalWorks, the records cannot be visualized at Rikers Island. This paper examines a solution to this problem through coordinating Corizon Health and Bellevue Hospital to synchronize the system, alongside the necessary training to support that coordination.
The Current State of eClinicalWorks at Rikers Island
Corizon Health operates Rikers Island using eClinicalWorks, a system that enables healthcare providers to deliver high-quality care by placing patients and employees first. The newest version of the system includes a cloud-based tool that can be utilized across varied settings, including social media, home monitoring, healthcare facilities, and correctional facilities. As one of the leading providers of healthcare in correctional facilities, Corizon Health has adopted eCW across many of its facilities to enhance patient safety and awareness. This adoption reflects the organization's commitment to open communication, integrity, collaboration, and accountability. The system also supports the organization's efforts to enhance healthcare quality while remaining watchful of safety, efficiency, and cost-effectiveness (Corizon Health, 2015).
Corizon Health acquired a ten-year contract to provide healthcare at the Rikers Island jail complex in New York City in 2002. Rikers Island comprises ten jail facilities located in the East River between Queens and the Bronx. The complex houses inmates awaiting sentencing and those serving sentences of under one year, and can accommodate up to 14,000 inmates on any given day. All inmates are entitled to safe and unbiased care, including personal safety and medical care. Rikers Island is owned by the state of New York but contracts its medical care to outside agencies.
Inmates requiring hospitalization or other invasive treatments are transferred to Bellevue Medical Hospital for further treatment. While hospitalized, inmates receive the same medical care as civilian patients, including 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 eClinicalWorks system provides a secure communication link between nurses, physicians, and other health departments, facilitating the management of patient healthcare and promoting both patient and user satisfaction.
Several categories of users rely on eClinicalWorks at Rikers Island. Correction officers use their own computer systems to manage inmate records including criminal history, current arrest, housing area, current location, religion, bail hearings, court dates, and other official proceedings. Nurses use the system for every aspect of care, including medication administration, inmate identification, wound care orders, verification of history, appointments, follow-ups, diabetic care, immunizations, and documentation. The system allows nurses to update medical information that was missed during admission or facility transfer. Physicians use the system to accurately record medical details, ensuring correct diagnoses and appropriate treatments. They also share patient data, document orders, prescribe medications, and schedule follow-up appointments with outside clinics.
Dieticians and the dietary department use eCW to ensure correct diets are provided to incarcerated patients, including documentation of meal requirements, allergies, medical conditions, religious observances, and pre- or post-operative dietary restrictions. Discharge planners utilize the system's discharge planning module, which produces a user interface that can be visualized by different users. Facility administrators use eClinicalWorks to summarize yearly proceedings in the form of program reports, including expenditures for personnel, facilities, and equipment.
System Issues and Workflow Problems
While eClinicalWorks is a well-suited system for correctional environments, it is characterized by significant problems in the medical care processes at Rikers Island. The central issue is that when inmates go to Bellevue Hospital for an emergency visit or follow-up appointment, hospital staff have no way 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 must be manually scanned into the computer by a clerk.
Although Bellevue Hospital does use eClinicalWorks, its records cannot be visualized at Rikers Island because the correctional facility identifies patients by jail ID number, while the hospital uses a medical record number for billing purposes. As a result, the interfaces of the two systems do not cross. There is a fundamental lack of coordination and synchronization between Bellevue Hospital and Corizon Health.
This lack of coordination creates significant confusion for providers. Even though eClinicalWorks is a comprehensive electronic health record platform, the continued reliance on parallel paper and computer-based records is not only cumbersome but also increases the likelihood of lost information (Stazesky, Hughes & Venters, 2012). The problem affects not only clinical providers but also correction officers, hospital staff, discharge planners, and correction administrators — all of whom would benefit from seamless visualization of findings, discharge instructions, and recommendations.
Conclusion
Rikers Island currently uses the eClinicalWorks computer system, run by Corizon Health, for its daily operations. While the system is effective, it is characterized by several problems that hinder its maximum optimal performance. When inmates are transferred to Bellevue Hospital for an emergency visit or follow-up appointment, hospital staff have no way to visualize findings, discharge instructions, or recommendations. Documentation is completed on paper and sent back in an envelope, which is sometimes lost because it must be manually scanned into the computer by a clerk. Because Bellevue Hospital uses a medical record number for billing purposes while Rikers Island uses a jail ID number, the two interfaces do not cross and the system lacks coordination.
The most suitable innovation for addressing these problems is integrating a web-based health information exchange system into eClinicalWorks. The proposed innovation will eliminate the need for paper documentation, create a link between the two systems, and enable visualization of patient information across institutions. Implementing this system will require a comprehensive project management process to ensure that every stage — from design and testing through training and maintenance — is carried out effectively.
References
Corizon Health Website. (2015). About Corizon Health. Retrieved 26 November, 2015 from: http://www.corizonhealth.com/S=0/About-Corizon/Who-We-Are-History-and-Today
Miller, R. H. (2012, March). Satisfying patient-consumer principles for health information exchange: Evidence from California case studies. Health Affairs, 31(3), 537–547.
Pantaleoni, J. L., et al. (2015, February 11). Successful physician training program for large scale EMR implementation. Applied Clinical Informatics, 6, 80–95.
Stazesky, R., Hughes, J., & Venters, H. (2012, April). Implementation of an electronic health record in the New York City jail system. Retrieved April 18, 2016, from http://www.cochs.org/files/hieconf/implementation-ecw-new-york.pdf
Vest, J. R., et al. (2014, July 13). The potential for community-based health information exchange systems to reduce hospital readmissions. Journal of the American Medical Informatics Association, 2014(0), 1–6.
Yuan, C. T., Bradley, E. H., & Nembhard, I. M. (2015). A mixed methods study of how clinician "super users" influence others during the implementation of electronic health records. BMC Medical Informatics and Decision Making, 15(26), 1–10.
Create your account
Always verify citation format against your institution’s current style guide requirements.