Case for Electronic Health Records in Corrections:

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Case for Electronic Health Records in Corrections

• Reasons to Transition Now

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The kentucky model
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Pre EHR Kentucky

• 13 state-operated facilities
• 3 privates
• 16 different ways to conduct and document
  encounters
• Missing and duplicate lab orders and results
• Print and fax formulary management
• Decentralized consults

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EHR Drivers

• State and National goals
• Increasing health care expenditures
• Cost advantages
• Immediate
• Long-term
• Leadership by Commissioners and Secretaries of
  DOCs

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The business and non-business cases for EhRs

• Making the decision to go or not to go electronic

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Business Case

• Is the electronic record a real improvement?
• Will the system decrease expenditures?
• How do I budget for the system cost?
• What is will the transition cost be?
• What infrastructure will I need?
• What level of access will I have to data?
• From whom do I need buy-in and commitment?

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How the business case impacted selection

• The decision to go

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Which option supports my case?

• Build system myself

• Buy off-shelf system

• Can customize to infinity
• Do I have the expertise
• What is my core responsibility
• Responsible for upgrades, maintenance
• What resources do I have
• Duplicating work of others

• There may be limitations to specificity
• Rely on the experts
• EHRs is core business
• May be a fee for upgrades and maintenance
• Resources dedicated to EHRs

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Leasing a system

• THE THIRD OPTION

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• Expertise in field
• EHRs are core business
• Upgrades and maintenance are included
• Customization may be enhanced
• Assumes EHRs are not static technology
• Less costly than building and purchasing
• Development, maintenance, and storage

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A leasing cost structure

• Minimize or avoid startup costs
• Pay for what you use (per offender or encounter)
• Identify what lease includes
• Training, support (hard/soft), enhancements
• Full service or a la carte
• Should be able to calculate true cost

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What is true cost?

• Cost of creating a record (materials supplies)
  per year
• Cost of EHR (buy or lease) per year
• EHR Paper True cost
• For example
• Annual cost of EHR 600K1
• 15/paper record 10K offenders/year 150K
  (supplies only)
• True cost is 450K (1.02 out of a 44 million
  budget)
• The EHR just on this data is pennies per day per
  offender

1 Configurations and needs will impact your
annual cost.
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significant savings from the non-business case

• Some health care savings are immediate

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Non-Business Case

• Continuity of care
• Grievances
• Frequency
• Committee
• Outside consults
• Labs, tests, and procedures
• Pharmacy management
• Formulary control
• ePrescribing

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Outside consults

• eContacts
• Manage and control outside consults
• Manage care remotely and asynchronously
• Minimize unnecessary trips
• Decrease cost of office visits
• Avoids expense of officers
• Eliminates transportation

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Labs, tests, procedures

• eLabs
• KY saw a 10 reduction in lab events
• Provided access to data
• Corrections orders about 10 more labs, tests,
  and procedures than standards require
• Savings
• Pre-EHR Annual lab costs Current costs
• Savings from duplication/over ordering

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Pharmacy management

• ePrescribing (from start to receipt of med)
• Formulary management and control
• Improved discontinue/elimination of duplicates
• Access to data

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How do we duplicate this success?

• EHRs will be part of the standard of care (not
  if, but when)
• Maintain control, but use experts
• Start with what you know cost to create record
• Target business aspect of the non-business
  factors
• Identify immediate ROI
• Look to other states, departments, and
  institutions
• Be bold and dont expect perfection
• Leadership from the top and diligence

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Questions, Comments,

• THANK YOU

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Contact

• John Rees
• Former Commission KyDOC
• jdreescon_at_aol.com

• Madison Gates
• University of Kentucky
• mgates_at_email.uky.edu
• Anthony Baxter, PhD
• University of Kentucky
• tony_at_uky.edu