The story we want to tell involves a great community need, the commitment of local government, a willingness to partner, a couple of lucky breaks and good timing – that has all helped establish a system that is saving lives every day.
About 18,000 people move through the Chatham County jail annually through the Chatham County Detention Center (CCDC). With a daily jailhouse census of more than 1,600, Chatham County and its 290,000 residents has one of the highest incarceration rates in Georgia, a state ranked ninth among all states in incarceration rates.
It is estimated that 90 percent of the inmate population is uninsured (Georgia is a non-Medicaid expansion state) and does not have access to primary or behavioral health care; CCDC may be their only access to health services. An estimated 20 percent of inmates have behavioral health issues. A significant portion of middle-aged detainees often picked up on alcohol-related charges suffer from chronic conditions like chronic obstructive pulmonary disease, diabetes and congestive heart failure.
Until 2016, the CCDC’s medical records were stored in a “siloed” paper records system creating barriers and pervasive inefficiencies accessing critical health information and providing adequate care. This situation proved dangerous for both inmates and staff.
Chatham County elected officials and executive leadership had been highly motivated and fully committed to the development and long-term support of a local health information exchange (HIE). In 2015, the CCDC was quickly identified as a critical piece of the Chatham County healthcare safety net system, central to protecting the continuity of care for highly vulnerable populations like the homeless and jail detainees.
For local Chatham County officials, it became imperative that meaningful health information be accessed at the time of processing or “booking” for detainees at the jail in order to effectively support their continuity of care, reduce duplication of services and protect the safety and welfare of everyone in the CCDC system. Better management of the inmates with mental illnesses and chronic medical conditions would improve safety, reduce costs and better provide for the healthcare needs of this population.
“If we could provide continuity of care for this population, it could, in the long run, reduce homelessness and chronic health issues for our lower-income population,” said Lisa Hayes, project leader and executive director of the Chatham County Safety Net Planning Council, a partnership that represents the major hospitals and federally qualified health centers (FQHCs) in the area. She started by integrating the countywide HIE into the larger and better-funded Georgia Regional Academic Community Regional Health Information Exchange (GRAChIE), which now has more than 2.5 million people in its database.
When the sheriff’s department initiated a search, Hayes jumped in to insist that any new contract include installing an electronic medical record (EMR) system that was interoperable with the regional HIE. The medical staff can now access every detainee’s medical history in real time. She also pushed for accountability metrics that show the new jail health provider was using the system to conduct health screenings that queried the regional HIE. Now the health vendor staff query the database each time a person is jailed, even if only overnight.
Instead of purchasing its own EMR, the county jail obtained a low-cost license from a local FQHC for an EMR that included a jail module.
The system went live in late 2016, but not without overcoming some initial glitches unique to its patient population. “We had to deal with how we verified a person’s identity,” said Hayes. “What we found is that aliases are used both at the hospital and at the jail. We had to utilize fingerprints and the first name associated with the fingerprints as our identity. It needed to happen first before an HIE query and before we moved on to health screening.”
Now that it’s up and running, the jail-HIE connection is helping providers on both sides of the jailhouse door. “When inmates are released, if they have an emergency and arrive at the ER, we can see what medications they were taking while in jail,” said Tara Cramer, executive director of GRAChIE. “It gives the clinician insight into what may be going wrong with this person.”
The impact on continuity of care for former jail inmates is evident through patient crossover data – which shows how many patients are shared with other HIE members – with local safety net health providers. In April 2018, reports showed that 8,693 former detainees, or nearly half of the yearly jail census (48.3 percent), were queried at the point of care at the region’s indigent care hospital that has been connected to the HIE since 2015. HIE patient data is cumulative and crossover numbers increase over time. As more information becomes available in the HIE, doctors have a clearer picture of a patient’s medical history and are able to improve coordinated patient care, reduce duplicative treatments and avoid costly mistakes.
“If we could provide continuity of care for this population, it could, in the long run reduce homelessness and chronic health issues for our lower income population,” said Hayes.
The new system has “been a big help,” said Sheriff Wilcher. “You have people come into jail who have this ailment or that ailment, or saying I’m taking this or that.” Now, he said, “medical can take care of them accordingly.”
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