Transitioning to Electronic Health Records in Corrections: A Kentucky Model

1. Case for Electronic Health Records in Corrections: Reasons to Transition Now

2. The kentucky model

3. 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

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

5. Making the decision to go or not to go electronic The business and non-business cases for EhR’s

6. 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?

7. The decision to go How the business case impacted selection

8. Which option supports my case? Build system myself Buy “off-shelf” system 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 • 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

9. THE THIRD OPTION Leasing a system

10. 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

11. 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

12. 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.

13. Some health care savings are immediate significant savings from the non-business case

14. Non-Business Case • Continuity of care • Grievances • Frequency • Committee • Outside consults • Labs, tests, and procedures • Pharmacy management • Formulary control • ePrescribing

15. 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

16. 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

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

18. 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 don’t expect perfection • Leadership from the top and diligence

19. THANK YOU Questions, Comments, …

20. Contact John Rees Former Commission KyDOC jdreescon@aol.com Madison Gates University of Kentucky mgates@email.uky.edu Anthony Baxter, PhD University of Kentucky tony@uky.edu