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By Brian Robinson
Until recently, California’s record of health care for its prison inmates was abysmal. After lawsuits and a federal takeover, however, the state stands to have one of the best systems in the country in the next few years. It will be fueled by a massive investment in health information technology.
By the end of next year, if things go as planned, a high-speed fiber-optic network will link California’s 33 prisons, and each institution will have a fast local-area network connecting all its buildings. The goal is to have the entire system’s medical recordkeeping and other processes fully electronic by 2013.
Overall, state officials are tackling more than 20 projects, initiatives and programs as part of an ambitious plan to improve the prison health care system.
“The adoption of both basic IT and health IT is absolutely central to our ability to deliver quality health care,” said J. Clark Kelso, a former California chief information officer whom the court appointed to oversee the reform efforts.
U.S. District Judge Thelton Henderson appointed Kelso to the post in January. Kelso takes over from Robert Sillen, who had held the position since April 2006.
Henderson established the California Prison Health Care Receivership, which Kelso now leads, in 2005 after the state lost a class-action lawsuit in 2001. The suit claimed that the state violated prisoners’ constitutional rights by not providing them with adequate medical care, contrary to the Eighth Amendment’s protection against cruel and unusual punishment.
At the time he made his decision, Henderson said the California prison health care system “is broken beyond repair.”
The core of the reform program is the construction of a clinical data repository to hold all of the prison system’s health information. Jamie Mangrum, CIO of the state’s California Prison Health Care Services (CPHCS), called it the program’s Rosetta stone project.
That database would be the hub for all CPHCS health IT activity, Mangrum said. It would allow physicians to see basic information about a patient on a single screen, using standard medical protocols.
“We’ve already kicked that off and hope to be piloting it by March of 2009,” he said. Officials haven’t chosen the four institutions for the pilot test, he added, but they intend to deploy the database at most of the state’s prisons by the end of 2009.
Applications built on top of the database will offer timely access to lab reports and radiology images from outside providers, easier ways to capture prescription information, and access to a network of medical professionals so prison-based providers can communicate with specialists and hospitals.
Those applications will link to prisons’ systems for registering and discharging inmates. In theory, medical professionals will have easy access to inmates’ records no matter where the individuals are in the prison system and will also be able to access the records after inmates are released so they can follow up on needed treatments.
One of the first applications officials plan to focus on is telemedicine. Several California prisons already have basic telemedicine capabilities, but the goal is to enhance them and extend them to all prisons.
“It’s so costly and time-consuming to get clinicians to go to prisons or to transport prisoners to an outside facility for appointments,” Mangrum said.
“Telemedicine is such a good fit for that, so [improving those capabilities] is a big requirement,” he added.
Providing an electronic medical record system is also a necessity, but it probably won’t happen right away.
“One of the reasons why our prison health system is so deficient is because of the lack of [an electronic] medical health record,” Kelso said. “But it’s at the end o f our list of requirements right now because of its complexity.”
There are much more basic needs for officials to tackle. For example, fixing the scheduling system is a top priority because one of the biggest problems is getting inmates to show up for appointments, Kelso said.
“We have an enormous number of missed appointments,” he added.
Some observers say they believe the California program could become the model for other state prison systems, many of which are struggling with the same concerns.
Overall, the U.S. health care system is about 20 years behind the commercial sector in its level of IT use, and prison systems are another 10 years behind that, said Howard Salmon, chief operating officer at Phase 2 Consulting, a health care management and consulting company.
“Almost every jail and prison we have been asked to consult for [has] significant problems just with the use of basic IT systems,” he said. “Rarely do they have any expertise with side-by-side systems that also deal with health care.”
Salmon agrees that California’s efforts could light the way for other states. “After all, what happens in California usually rolls across the rest of the country after a time,” he said.
However, Kelso and his organization must first overcome some significant hurdles. One is the disorganized state of the paper-based system. Mangrum said there is no universal process for handling inmate records, and it would be pointless to try to deploy IT until such a foundation has been established.
Then there’s the inevitable problem of funding, made worse by California’s budget woes. Kelso has asked for $7 billion to finance the program — $70 million of which is needed in the current fiscal year, about $3.5 billion in fiscal 2008-2009 and lesser amounts in the following two years.
The California State Senate failed to pass a bill in May that would have authorized the sale of bonds to cover the requested funds, something Kelso attributed to political maneuvering. He filed suit in U.S. District Court to compel the state to provide the funds. The court agreed to the motion Aug. 13.
Kelso said he isn’t concerned because the state legislature has approved all the projects he is pursuing, and there is broad bipartisan support for his efforts. He added that he expects to eventually receive all the money he has requested.
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