EClinicaWorks at Rikers Island Rikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use of this electronic health records software at this correctional facility in relation to hospitalized inmates. The author includes an overview of how this software is run by Corizon Health and how the correctional facility works with Bellevue Hospital, which also has eClinicalWorks. The discussion includes an evaluation of how this software has been characterized by a workflow challenge that hinders effective workflows. The use of paper documentation by hospital staff because of inability of this software to visualize findings, discharge instructions or recommendations is discussed. This is followed by discussion of a proposed innovation and how it can be implemented using a project management approach. The final sections discuss strategies for going live and ongoing maintenance of the proposed innovation.

eClinicalWorks at Rikers Island

The modern healthcare environment is characterized by several innovations and technology solutions including eClinicalWorks (eCW), which has emerged as a leader in medical software solutions. One of the contributing factors to eCW's top rating is its newly designed electronic health records software that is top rated in customer satisfaction and usability. This medical software solution is currently used in Rikers Island, which is run by Corizon Health. The healthcare organization, which is one of the leading providers in healthcare in correctional facilities, has adopted eCW in many of its facilities because it's very prison friendly. However, when inmates go to Bellevue Hospital for an emergency or follow appointment there's no place for the hospital staff to visualize findings, discharge instructions or recommendations. While Bellevue Hospital has eClinicalWorks, it cannot be visualized on Rikers Island. This paper examines a way for solving the problem through coordinating Corizon Health and Bellevue Hospital to synchronize the system and necessary training.

The Current State

Corizon Health runs Rikers Island through the use of an electronic system known as eClinicalWorks, which has emerged as a leader in medical software solutions. The system enables healthcare providers the opportunity to deliver the highest quality care by placing the customers and employees first. The newest version of the system encompasses a cloud-based tool that can be utilized in varied areas including: social media, home monitoring, healthcare facilities and correctional facilities. As one of the leading providers in healthcare in correctional facilities, Corizon Health has adopted eCW in many of its facilities in order to enhance patient safety and awareness. Corizon Health's adoption of eClinicalWorks is attributable to the fact that it's very prison friendly and helps the organization to establish a culture of open communication and integrity, collaboration, and accountability. Moreover, the adoption of the system is fueled by the organization's attempts to enhance the quality of the healthcare it delivers, ever watchful of safety, efficiency and cost-effectiveness (Corizon Health, 2015).

This organization acquired a ten-year contract to provide healthcare on the Rikers Island jail complex in New York City in 2002. Rikers Island is composed of ten jail facilities located in the East River between Queens and the mainland Bronx. The complex houses inmates awaiting sentencing and those sentenced with jail time under one year. Rikers Island can house up to 14,000 inmates on any given day. All inmates are entitled to safe and unbiased care; this is inclusive of personal safety and medical care. Rikers Island is owned by the state of New York but contracts their medical care to outside agencies.

Based on the current structure, inmates requiring hospitalization or other invasive treatments are transferred to Bellevue Medical Hospital for further treatment as shown in Figure 1. While hospitalized the inmates are awarded the same medical care as civilians, they are provided with follow up appointments, discharge teaching and skill training. For example, many inmates are taught to safely administer insulin or perform simple wound care independently. The currently used eClinicalWorks computer system provides a safe communication link between the nurses, physicians, and other health departments. It helps facilitate the management of patient healthcare, therefore bringing about patient and user satisfaction.

The provision of medical care at Rikers Island Correctional Facility through eClinicalWorks computer system involves several users of this medical solution. First, the system is used by correction officers who utilize their own computer systems with an inmate's criminal history, current arrest, housing area, current location, religion, bail hearings, court dates and other official criminal proceeding. Secondly, the system is used by nurses for every aspect of care including medicine administration, inmate identification, wound care orders, verification of history, appointments, follow ups, diabetic care, immunizations, and documentation....

The system provides nurses with the ability to update medical information of inmates that was missed on admission or from facility transfer. The third users are physicians who use the system to accurately record medical details about inmates to ensure the correct diagnosis is made and the right treatment is provided. Through the system, physicians share patient data, document orders, prescribe medications, and schedule follow up appointments with outside clinics.
Fourth, the system is used by dieticians or the dietary department to ensure that the correct diets are provided to incarcerated patients. eCW enables easier documentation of meal requirements, allergies, medical conditions, religious observances, and post/pre-operative dietary restrictions. Discharge planners also utilize the system since it comprises a discharge planning module that has the capacity to produce a discharge planning user interface for visualization by different users. The facilities' administrators also use eClinicalWorks for summarization of yearly proceedings in the form of programs, such as the expenditures for personnel, facilities and equipment obtained.

System Issues or Problems

While eClinicalWorks is a very prison friendly system, it is characterized by some issues or problems in medical care processes at Rikers Island. The main issue surrounding this system is that when inmates go to Bellevue Hospital for an emergency or follow appointment there's no place for the hospital staff to visualize findings, discharge instructions or recommendations. As a result, these processes are completed on paper and sent back in an envelope, which is sometimes lost because it needs to be manually scanned into the computer by a clerk. In addition, Bellevue Hospital does have ECW but it cannot be visualized on Rikers Island because in jail they use their jail ID number but in the hospital they are under a medical record number for billing purposes. In essence, while Bellevue Hospital and Rikers Island Correctional Facility utilize similar systems, their interfaces do not cross. There is lack of coordination between Bellevue Hospital and Corizon Health because the system is not synchronized.

The lack of coordination and synchronization of the system is a major issue since it acts as a source of confusion for providers. Even though eClinicalWorks is a comprehensive electronic health record, the continued use of paper and computer-based medical records is not only cumbersome but also generates confusion for providers because of the increased likelihood of loss of information (Stazesky, Hughes & Venters, 2012). Moreover, the lack of coordination is a problem that not only affects providers but also generates significant issues for correction officers, hospital staff, discharge planners, and correction administrators. This is primarily because the efficiency of these users would be enhanced through visualization of findings, discharge instructions, and recommendations.

Proposed Innovation

Given the current issues or problems with the utilization of eClinicalWorks at Rikers Island Correctional Facility, there is need to improve the system in order to enhance efficiency. Actually, there is need for a collaborative data-sharing system or application to enhance care coordination between Bellevue Hospital and Corizon Health so that interfaces of the eClinicalWorks systems would cross. Through an effective data-sharing system, hospital staff and correction officers and others will have access to shared clinical information is a seamless manner that promotes enhanced care coordination while lessening unnecessary, costly duplication as shown in Figure 2. A data-sharing system will help avoid the current production of parallel paper and electronic health information, which is characterized by numerous problems that make it difficult to synchronize systems at the hospital and the correction facility.

Proposed Web-based HIE Application

Therefore, the proposed innovation for this desired goal is a web-based health information exchange (HIE) system. A web-based technology for shared clinical information will provide relevant stakeholders secure, real-time access to important information regarding hospitalized inmates and improve efficiency of the existing eClinicalWorks computer system. Web-based health information exchange systems are developed in a way that they can be used by different organizations including healthcare facilities and correctional facilities. As a result, the adoption of such a system will fit Rikers Island Correctional Facility and Bellevue Hospital. However, the web-based system should be developed and utilized in a manner that only authorized personnel can access the information in order to address potential privacy and confidentiality issues.

Generally, health information exchange systems electronic share pre-determined patient information with healthcare providers and other organizations throughout the continuum of care (Vest et al., 2014). Information sharing through these systems enables various personnel in the care process to access patient data and utilize it in enhancing care. Vest et al. (2014), state that data in…