C. Identify your technology options
This section describes a range of technical tools that jurisdictions are using to share information across agency boundaries, with case studies and examples of how these technologies are being used to increase access to essential healthcare services.
1. Paper-based sharing
Agencies should strive to move away from paper-based data systems to manage health records. However, when the goal of an information sharing is relatively simple and technology is not affordable or necessary, then sharing information via sheet of paper, telephone, and a fax machine can still be an effective way to deliver important information.
Connecticut’s Correctional Managed Healthcare Pharmacy Voucher Program
In 2011, the Connecticut Correctional Managed Health Care (CCMHC) implemented a pharmacy voucher program as a way of increasing access to essential medication for people leaving corrections custody. Prior to the program being created, some people leaving jail or prison were given two weeks of medication with no refills while those released directly from court typically received no medication. Even when released with a prescription, most people were unable to register with a doctor and arrange an appointment within two weeks of reentry, and, as result, they were running out of essential medication. This scenario is particularly perilous for people with serious mental health and other chronic conditions that require uninterrupted access to medication in order to stay healthy and stable.
The pharmacy voucher program uses faxes and paper vouchers to increase access to medication and reduce the cost of packaging and delivering prescription drugs to correctional facilities, where they are often not retrieved. People leaving correctional facilities receive a paper voucher that can be presented to any pharmacist in Connecticut. The voucher informs the pharmacist that the individual received medical care while incarcerated, and lists a phone number that they can call to verify details of the prescription. Upon calling the correctional health provider, the pharmacist is authorized to issue one month’s supply of medication.
2. Secure e-mail
Advanced information technology is not always necessary for agencies to effectively share data. For example, relatively inexpensive technology that allows clinicians to share patient data via e-mail can enhance continuity in care, protect patient privacy, and illustrate the value of improving communication without a significant investment of resources.
The Direct Project
The Direct Project is an open-government initiative developed by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology. The direct framework can be used to transmit patient treatment information from correctional health settings to primary care providers in the community when a person leaves jail or prison.
The Direct Project:
- uses encryption technology to transmit health information directly to trusted recipients over the Internet;
- provides a straightforward, affordable, secure, scalable, standards-based method for transmitting information;
- can replace traditional methods of exchange (such as paper, fax, or phone calls), increasing efficiency and providing a future path to advanced interoperability; and
- offers a viable option for organizations without advanced technological capacity.
3. Web-Based Information Sharing
Web-based technologies allow multiple agencies to access the same online data system to coordinate services and inform decision making. Secure logins, passwords, and account settings are assigned to each user to limit the types of information they can access in accordance with their professional responsibilities. For example, a reentry service provider working in a jail may be able to access information on health service contacts in the community to help them make appropriate referrals for people leaving custody. A clinician working in the same setting may have greater access, allowing them to see clinical notes, diagnoses, and information on drug regimens.
Illinois: Jail-Data Link System
The Jail Data Link system in Illinois is an example of an internet-based technology that allows staff in county jails and community mental health settings to share data securely. Launched by the Corporation for Supportive Housing, this web-based system links the county jail, Department of Mental Health (DMH) in-patient facilities, and community mental health centers. Service providers working in these settings can access the Data Link system to identify and treat people with serious mental health conditions as they transition between the jail and community. The system is equipped with two user portals individually tailored to the needs of jail and community treatment staff. Each system user receives a unique user-identification and password which determines which agency portal they can access and what information is displayed.
Click here to read a detailed process evaluation of the Jail Data Link program that explains how the technology works, how it was set up, and how much it costs to sustain.
The Behavioral Health Integrated Provider System (BHIPS)
BHIPS is a web-based clinical information system for substance use and mental health service providers that supports information sharing and coordination of services. The system automatically creates an electronic health record (EHR) for each person and centralizes demographic and treatment service information in a single location. Five states and one large urban county currently use BHIPS, including the Texas Department of Criminal Justice-Community Justice Assistance Division, which uses the system to coordinate behavioral health services for clients in its diversion programs.
4. Health Information Exchanges (HIEs)
Health information exchanges act as information hubs that connect health providers across a range of settings. Members of the HIE are able to access information from other providers in the same network. HIEs and web-based approaches to data sharing are often used together. The exchange defines the purpose of information sharing, members of the networks, and information to be shared, while the web technologies provide the means to communicate data through a secure web portal. A core component of HIEs is the use of security protocols to restrict access to records based on patient consent.
New Jersey: HIEs and the Camden County Jail
Watch The Unseen Provider: This short documentary, produced by Community Oriented Correctional Health Services (COCHS), highlights the importance of linking jail systems to HIEs as a way of building connectivity between corrections and the community. Since the production of this video, the county jail has joined the local HIE, and, as a result, staff at the jail are now able to log in to an online system and access important clinical information for people in the jail.
5. Accountable Care Organizations
Accountable care organizations (ACOs) are an essential component of the Affordable Care Act. An ACO is a group of healthcare providers who offer coordinated care and chronic disease management to improve the quality of care patients receive, commonly referred to as medical homes or health homes. To receive federal incentive payments, ACOs are required to use health information technology (HIT) to facilitate care coordination between providers. Your jail may be able to join a local ACO, such as a patient-centered, behavioral health home, providing access to healthcare information from a network of healthcare providers working in the community. Click here to read more about the role of health information technology in an ACO, the Mental Health Home of Maimonides Medical Center, in which the local corrections system is a partner.
6. Cloud-Based Technologies
Cloud-based technology allows software to be located and information to be stored on remote servers. It offers an affordable option for service provider organizations working in jurisdictions that do not have access to the computer system or technical expertise required to design and operate a customized technological infrastructure. Because cloud-based technologies use remote servers, the maintenance and upkeep of these systems does not require technicians to be physically present, making them particularly suited to agencies based in more remote areas.
Cloud Technology in Health and Justice
- Addressing Health Disparities with Cloud-Computing: Click here to read how public health leaders in Illinois are using cloud-computing to foster information sharing and address health disparities.
- Promoting Public Safety with Cloud Computing: Click here to read the “Guiding Principles on Cloud Computing in Law Enforcement” from the International Association of Chiefs of Police, which gives guidance on issues such as confidentiality, proper use, and data security when using cloud-based computing.
7. Standards-Based Architecture
To promote communication within and between organizations working in different sectors that use different types of technology and record keeping systems, the federal government has developed Standards Based Architecture (SBA) for sharing information. SBA provides a method for disparate systems to exchange data in a secure way, using a standardized language and method of transmission. Some of the most commonly used SBAs include the National Information Exchange Model (NIEM) and HL7.
You can access further details of SBA and support to design and implement one of the national models, using the following links:
For an overview of justice systems information sharing, including technological solutions visit the Department of Justice Global Justice Information Sharing Initiative site.
For information on a set of data standards used across government departments and service sectors visit the National Information Exchange Model (NIEM) site.
To learn more about interoperability standards for health information sharing, see HL7.