How HIE can improve mental healthcare in prison
Update: HIMSS20 has been canceled due to the coronavirus. Read more here.
How an inmate in Colorado receives mental health treatment while in custody directly affects both the quality and the cost of their care once released. This is true in all states, but in Colorodo recent legislation has spurred a pilot connecting county hospitals and jails vie HIE.
These networks enable a more seamless transition of care between outside and correctional medical care, say Kate Horle, Chief Operations Officer at CORHIO, and Danielle Culp, Health IT Exchange Coordinator with the Office of Behavioral Health for the state of Colorado.
Seeing the longitudinal record
Should a patient with a mental health issue end up in Denver County Jail, “clinicians are able to see your longitudinal record, know your mental health history and replicate that treatment while you are in care,” says Culp. Because prison facilities are increasingly becoming front line intake facilities for people experiencing mental health crises, there is a tremendous advantage to fast and comprehensive access to patient data.
“You can’t turn around and open 6 mental health hospitals,” says Horle. The state “wanted to at least ensure those who were on clinical med health meds had access to them while they were incarcerated.”
There are a lot of reasons for connecting the dots between correctional facilities and healthcare providers. Depending on the jail, the facility may still use paper records. Staff must perform significant legwork “to call pharmacists, providers, to get the information they need,” says Culp. “If someone is in and out it’s hard to work within that capacity to get right healthcare information at the right time.”
Fast access to relevant mental health information benefits the patient and also those around them. Someone who could become violent and risk hurting themselves or staff if they don’t receive proper medication can remain on the necessary treatment, preventing the potential of injury.
The financial perspective
Almost everyone benefits from a financial perspective as well. For the facilities in Denver’s program, there is a major financial stake in managing a continuum of care for patients.
“Taking an inmate to a county hospital for care is incredibly expensive,” says Horle. Jails “have to do that if they don’t know what meds [a patient] is on” and they begin to exhibit a decline in health. Faced with either an expensive but necessary reactive solution, having access to an HIE enables them to pe proactive and either preserve the current wellbeing of a patient- or reverse an adverse episode they may be experiencing.
Further, many of the mental health patients a jail sees touch upon multiple state services, such as Medicaid. Culp notes that while stabilizing someone and finding an effective medication may be difficult, maintaining treatment is much easier. That can all go out the window if someone enters a jail and doesn’t receive proper medication.
“If care had been adequate or appropriate during incarceration, they’re going to be less expensive to medicate when they get out,” she says. This has translated into savings for Medicaid and private payers.
Institutional and IT challenges
Although there are many institutional and IT challenges to overcome, Culp says that the program has garnered interest. Jails have reached out asking to participate, she says, and the state is planning to expand soon. Horle says that the exchange partially sells itself, when providers realize what they’ve been missing.
“When new providers come on board they are almost always amazed at how much information is available to them,” she says.
Kate Horle and Danielle Culp will share some of the state’s findings in their pilot program at HIMSS20 in a session titled “Criminal Justice System Data Sharing to Improve Outcomes.” It's scheduled for Tuesday, March 12, from 10-11 a.m. in room W230A.
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