Ten years ago, California Correctional Health Care Services (CCHCS) was buried in paper. Tens of thousands of inches of health care records were spread out across the state at more than 30 institutions – as well as a more than 150,000 square foot warehouse archive. The patient population reached numbers of more than 125,000 individuals, with approximately 600 new arrivals every week and roughly 11,000 transfers monthly.
These paper records were unwieldy and sometimes lost during transfers. Many processes were person-dependent, and health care risks were not considered appropriately during placement. Placing vulnerable, clinically complex patients in inappropriate locations was identified as a frequent contributor to potentially avoidable adverse health outcomes. This was not acceptable for a health care organization.
With the appointment of Federal Receiver J. Clark Kelso, CCHCS introduced a new clinical classification system in 2009. This process established health care factors to consider when housing individuals and introduced the concept of a “basic” versus “intermediate” care institution. While this was a step in the right direction, the person-dependent, paper process left risk levels too broadly defined and was not often accurate or up-to-date. There were frequent discrepancies between reported risk and actual risk, whether due to missed relevant clinical information, incorrect interpretation of clinical risk rules, or a failure to update the clinical risk as new clinical information became available. Significant staff time was dedicated to identify, update, and communicate health care factors pertinent to the appropriate patient placement.
In order to address the challenges with a person-dependent paper process, CCHCS set out to leverage available data sources and information technologies to automate the clinical rules for a risk stratification system. This system would provide timely, actionable information for those involved in the process of housing patients and provide near real-time performance reports to track progress, with a goal of improving placement of clinically high-risk patients.
Improving Inmate Assignment to Appropriate Housing
While CCHCS began the multi-year journey to shift business practices from paper to electronic, the organization also looked to automate the clinical risk tracking system. To accomplish this upgrade, CCHCS leveraged multiple available data sources, developed a structured data warehouse and created daily automated jobs to update and communicate the clinical risk for all patients to their custodial colleagues who used this information, in part, to inform appropriate housing.
The organization utilized an effective change management strategy that included training of clinical and correctional staff and developed decision support tools to aid end users in the new process. CCHCS also reported performance for placement of high-risk patients to a subset of institutions identified as having access to an expanded set of health care services, including closer proximity to tertiary care centers.
As a result, CCHCS improved the appropriate placement of high-risk patients by nearly 20 percent, which led to improved accuracy of reported risk for individual patients, improved consistency in assigned risk between similar patients, and improved transparency of a patient’s risk factor determinants - all while eliminating paper forms and person-dependency.
The organization was able to achieve a reduction in potentially avoidable hospitalizations for high-risk patients from 70.9 per 1,000 patients in June, 2015 to 43.5 per 1,000 patients in December 2017. Administratively, the automated clinical risk classification system has saved more than two million dollars in the first three years of its implementation by eliminating the need for licensed clinicians to complete paper records.
HIMSS Davies Award of Excellence
The HIMSS Davies Award of Excellence recognizes outstanding achievement of organizations that have utilized health information technology to substantially improve patient outcomes and value. The HIMSS Davies Award of Excellence is the pinnacle of the HIMSS Value Recognition Program and highlights organizations promoting health information and technology-enabled improvements in patient and business outcomes through sharing evidence-driven best practices on implementation strategies, workflow design, change management and patient engagement.
“California Correctional Health Care Services (CCHCS) faced the unique challenge of delivering care to a challenging patient population in a difficult care setting. Getting patients to the appropriate level of care at the correct time is critical for success,” said Jonathan French, CPHIMS, senior director of quality and value-based care at HIMSS. “Using a variety of registry tools coupled with an electronic health record, CCHCS significantly improved outcomes for patients within their correctional population, particularly patients with end stage liver disease. HIMSS is proud to recognize California Correctional Health Care Services as a 2018 Davies Award of Excellence Community winner.”
“Quality patient care is the principal function of any health care organization, regardless of the patient population,” said J. Clark Kelso, receiver over medical care for the California prison system. “Incorporating information technology solutions to leverage health care data is imperative to make informed decisions and improve organizational performance. CCHCS is honored to be recognized by HIMSS as deserving of this prestigious Davies Program award.”
California Correctional Health Care Services will be recognized during the 2019 HIMSS Global Conference & Exhibition, February 11-15 in Orlando, Florida.
Learn more about how California Correctional Health Care Services has embraced the value of health information and technology: explore three award-winning use cases.