The switch from an antiquated paper-based records system — where medical files could take days or even months to find while patients were left without care — represents a major milestone for a troubled state correctional system under federal court supervision.
And it’s one the court-appointed receiver in charge says will lead to better care of some 136,000 inmates.
“We’re able to see what’s happening all the way down to the patient level,” J. Clark Kelso, the federal receiver, told Techwire in an interview Thursday. “I’ve never seen something in state government this current.”
The completion of the rollout — which wrapped up this month at three state institutions in Lancaster, Corcoran and Ione — capped 14 months of continuous, successful Go-Live launches after a year delay and a budget that more than doubled in the last five years.
Bringing the prisons online and into electronic medical record keeping was an enormous undertaking — 1,141 wireless access points installed in 72 buildings, 14,000 new desktop computers and 7,000 laptops deployed. Another 5,000 devices such as tablets, printers and Dragon mics were added and roughly 13,000 users were trained.
“This is not like going to the grocery store or to Best Buy and buying something off the shelf,” Kelso said.
The challenge for prison officials was the hundreds of thousands of documents — medical records that had been scanned into PDFs — that were difficult and cumbersome to access. The sheer volume of files slowed down the system and doctors struggled to find a complete picture of an inmate’s medical history. Maintaining such a system, Kelso says, was “a disaster.”
In 2012, it became clear to prison monitors that the prison health-care system needed a different approach. The private sector had mobilized behind electronic health-care records, as had federal lawmakers when they provided incentives under the Affordable Care Act for electronic health-care systems.
“We were still in the paper world entirely and we were doing poorly with paper,” Kelso said. “It created serious problems for us.”
Kelso, charged with bringing up the standard of medical at the prisons, wanted to digitalize medical records and the scheduling system — a last systemwide push to get the prisons to a place where they could be turned back over to state control.
A former state chief information officer, Kelso pursued an off-the-shelf medical record-keeping system — an option he knew would save the state money over a customized one. He said he made clear that prisons would not ask for exceptions or so-called off-ramps to tailor the system to their processes. That could lead to the loss of many of the advantages the system offered, he explained. Instead, the state would change its work flows to fit the system.
The project stayed within what Kelso described as standard configurations — nothing was customized outside of a configuration, with the exception of some scheduling enhancements that will be implemented in the future.
The cost of the project, however, more than doubled, from nearly $182 million to $386 million. The initial contract, signed in 2012, didn’t include everything the state required because, Kelso says, the state didn’t know what it would need several years down the line when the project began testing.
Among the issues that led to schedule delays was a pharmaceutical records system piloted at Folsom State Prison. Pharmacists struggled to get pills out to patients, and the lack of employee training became evident. The private sector, for example, would have spent two months training staff whereas the state had set aside just two weeks with a skeleton staff.
And project planners learned they must define tasks at a detailed level so that rollouts would be smoother. That step for additional planning also pushed the project timeline back, but it is one Kelso says led to a successful deployment.
“Sometimes, there’s an attempt to hit your project schedule even if you’re not ready,” Kelso said.
What has emerged is a system that today handles 8.5 million transactions a day and provides doctors and nurses with a more comprehensive view of an inmate’s medical history. With one click on a computer, doctors can bring up a patient’s lab results going back 18 months, and easily see the trends of that lab history that might alert them to a potential problem. The system contains prompts for vitals checks and flags any drug interaction issues.
And if an inmate moves to another yard or prison, their medical record won’t get lost as it did in the days of paper records — which critics had complained led to gaps in treatment and care.
“It has made it a lot easier for me to monitor care and evaluate care,” Kelso said. “We’re going to see a quantum improvement in the quality of care.”
Here's a by-the-numbers look:
The Scope of the Electronic Medical Records Project
- Contract signed in 2012
- $386 million budget through fiscal year 2020-21
- Cerner system deployed at 35 state institutions
- Trained 13,000 new users
- Deployed 14,000 desktop computers, 7,000 laptop computers
- Installed 1,141 Wireless Access Points
- Configured more than 10,000 devices
- Moved 450,000 prescriptions from the old system
- 14 months of continuous Go-Live launches at one to four institutions at a time
- Cleared more than 100 training coaches to support the project
- Tallied 760 hours for a headquarters operations center during Go-Live weeks
- IT Solutions Center processed 14,000 tickets to answer questions
- 120,000 new inmate ID cards printed with new medical record numbers
- 9,552 users a day
- 8.5 million transactions
