A study was published in the Health and Human Rights Journal about the implementation of electronic health records (EHR) across 12 jails in New York City between 2008 and 2011. This study highlights an interesting use of the EHR – that of using it as a tool to monitor human rights among the patients. In particular, they were interested in violent injuries and mental health stressors. The report highlighted the fear inmates have in revealing their healthcare needs. The report noted that “Patients in jail often avoid care because they fear their information will not be confidential.” Panelists did not find this to be true in the patient populations they have been involved with. The study talked about how aggregate data from the electronic health record system was used to look for vulnerability points such as patterns of injuries in various facilities. This isn’t something that would be readily available through a paper system. They are also using the system to track vulnerabilities such as traumatic brain injury and complex case management. One of the areas they found difficult was integrating mental health care into the EHR. Mental health documentation can sometimes defy categorization with large amounts of narrative notes and free-text assessments. However, expanding visit type options and structured data elements helped. As to human rights and vulnerabilities, they were able to track levels and locations of self-harming incidents and found that adolescence, serious mental illness, and solitary confinement were highly associated with self-harm in their jail system.
The Alabama prison system is reporting an outbreak of tuberculosis. Infection management in the confined spaces of our overcrowded prison system is a continuing issue. The Alabama Department of Public Health is reporting nine active cases of TB so far this year while they have only had 5 cases on average in past years. They are looking to contain their active cases to their designated healthcare facility at St. Clair, which is a fairly common practice. The article affirms what we already know as correctional practitioners – rates of TB are higher behind bars than in the general population. Panelists debate whether there may be increasing TB rates in other systems and how far reaching this concern could be.
Besides infectious diseases, mental illness is of high concern for our patient population, as we discussed with our first story on capturing mental health documentation and trending. This third story is an op-ed from the Salt Lake Tribune advocating community treatment rather than incarceration for the nonviolent mentally ill. The author suggests that a major constraint is the lack of treatment services for addiction and mental health issues. Panelists agree that we need more resources for both violent and nonviolent mentally ill inmates.
Ending on the upbeat, there is encouragement in news of the hospice program in the Illinois prison system. The article quotes Edgar Barens, whose documentary on a prison hospice program in Iowa was nominated for an Academy Award, as saying that working as an inmate volunteer in a prison hospice can be transformational but that only 20 of the 75 known prison hospice programs have inmate volunteers. This number seems low and panelists hope more prison hospice programs will include inmate workers.