Introducing the Justice & Health Connect Toolkit

The Justice and Health Connect Toolkit provides a framework for planning, implementing and sustaining interagency collaboration between justice and health systems.  The toolkit is organized into four modules, describing the steps to setting up information sharing initiatives. While the toolkit is presented in a linear format, we encourage you to explore the different sections as your information sharing initiative evolves and progresses based on your interests and needs.

Wherever possible, the toolkit references real-world examples of jurisdictions that have adopted effective approaches to address information sharing challenges, accessible summaries of the research literature, and examples of best practices. In this way, the toolkit provides a different way of accessing information included in the resource library. If you still cannot find what you are looking for or have feedback on the toolkit, contact the Justice and Health Connect Team.

 

Module 4: Technology

Overview

Community health and criminal justice agencies vary widely in their adoption of electronic data systems and the resources that they have at their disposal to implement new technologies. Generally, correctional and behavioral health providers lag behind the rest of the health sector when it comes to health information technology implementation. While there are clear benefits to advancing information technology, it is not required to achieve effective data sharing and it is often helpful to adopt technology gradually, paving the way for a fully integrated system by taking incremental steps. Before making any decision about adopting new technology, you should first find out how other justice and health agencies in your jurisdiction are communicating and determine if they have developed information sharing networks that you can become part of by joining an existing Health Information Exchange, for example.

This module: (1) discusses the importance of clarifying your information sharing goals; (2) describes the main information sources that are typically included in justice and health data exchanges; (3) outlines a range of technology options for sharing information; and (4) provides links to resources that will help you develop and maintain information sharing technology.

Click here for an overview of health information technology and how it is improving connectivity between health and justice systems.

A. Clarify your goals

While technology provides a powerful tool for putting your information sharing plans into practice, a fully integrated health and justice information system will not help you answer questions about what information should be shared, when, about whom and for what purpose. Mapping out your technology needs involves first stepping back and determining:

  1. What data needs to be shared and with whom?
  2. Where is that data currently stored?
  3. How can data flow between the appropriate parties?

Salt Lake City, Utah:

Click here to learn how public health and criminal justice officials in Salt Lake County, Utah reached consensus on data sharing needs, mapped data systems, and then developed technical solutions to connect the county jail system with the county’s Division of Behavioral Health Services and 35 behavioral health treatment entities.

 

B. Identify information sources

Most justice/health information exchanges draw information from a combination of three basic data sources: correctional health systems, community health systems, and criminal justice systems. Once you have identified the data that exists in each of these systems and how the information is stored, you can explore solutions for transferring information from one system to another, and build connectivity. The following figure provides further information on these three core information sources.

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Click here for a definition of the information sources in the graphic above.

Featured Resource 

Opportunities for Information Sharing to Enhance Health and Public Safety Outcomes

This report by the IJIS Institute and Urban Institute presents more than 30 user-case scenarios for information sharing between justice and health systems. It includes detailed “Information Exchange Synopses” where enhancing information sharing can improve public health and foster inter-agency collaboration. Each synopsis explains: (1) what will be achieved through information sharing; (2) the type of information needed; (3) the data source, or where the data are captured; (4) the parties that need to be involved; (5) how information will flow between parties; and (6) associated legal and technical challenges.

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.

Click here to read an interview with Dr. Robert Trestman, who helped develop the voucher program.

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.

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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.

D. Find Support

The following organizations provide a range of resources describing best practices to consider when developing information sharing technology solutions:

Health Information Technology

Financial Resources for EHRs in Jails and Prisons: the Medicaid EHR Incentive Program: Under the HI-TECH Act, healthcare providers working in jails and prisons are now eligible for financial incentives to support adopting, implementing, and updating EHRs if: at least 30 percent of the patients they serve are enrolled in Medicaid and the EHR vendor selected is certified by the Office of the National Coordinator for Health Information Technology (ONC).

 Justice Information Sharing

  • The Bureau of Justice Assistance (BJA), the U.S. Department of Justice BJA is a federal agency supporting the advancement of information sharing between justice and health systems. BJA’s National Training and Technical Assistance Center (NTTAC) is a federal resource state and local government agencies can contact for a range of technical assistance services, including mapping out and implementing information sharing strategies and technical solutions.
  •  Integrated Justice Information Systems Institute (IJIS) is a prominent membership organization with extensive expertise in advising and developing technology solutions to facilitate information sharing between government agencies as well as the private sector. Through technical assistance, IJIS has hands-on experience helping jurisdictions apply the National Information Exchange Model (NIEM) to facilitate justice-health data sharing.