michael vasquenza, bs kirsten shea, mba correctional managed health care
TRANSCRIPT
Michael Vasquenza, BSKirsten Shea, MBA
Correctional Managed Health Care
NO CONFLICTS OF INTEREST
Participants will understand the current challenges, specifically those in CT, of disseminating health information across departments, across facilities, and across agencies in the absence of an EMR.
Participants will understand cost effective alternatives to an EMR as demonstrated by CMHC’s Information Technology solutions.
Participants will understand the importance of developing data systems which are interoperable and easily transferable to ancillary programs and applications.
CT is 1 of 6 states with an integrated jail and prison system. 20% of admissions require prompt medical or mental health intervention Hartford Correctional Center (jail) averages > 45 intakes daily
26,143 annual admissions, each with screening requirements
Medical and psychiatric disease prevalence rates far greater than community
19% active Mental Health treatment 24% active Medical treatment 60% on medications
Cost of global healthcare per inmate per year (both genders) was $4,735 (FY 2012)
60% of inmates on medications
Specialty Care (on-site/off-site appointments)
Discharge Planning
Facility InmatePopulation 1 2 3 4 5 1 2 3 4 5
Bridgeport 938 511 286 126 0 5 358 420 144 6 0Brooklyn 506 295 211 0 0 0 277 229 0 0 0Cheshire 1393 710 580 103 0 0 680 551 161 1 0Corrigan 945 389 369 180 1 4 348 366 186 40 3Enfield 809 519 290 0 0 0 450 358 1 0 0Garner 628 190 151 41 237 9 272 250 87 19 0
Half Way House 792 398 301 89 4 0 326 349 112 5 0Hartford 1143 656 217 255 5 0 657 228 162 86 0
Hospital Care 12 3 3 4 2 0 2 1 5 1 1Manson 334 150 85 85 5 1 209 75 20 22 0
MacDougall 1546 572 637 336 0 1 508 492 453 73 20New Haven 854 473 225 135 1 0 324 233 274 2 0
Niantic Annex 655 445 210 0 0 0 392 262 1 0 0Northern 228 50 82 93 3 0 86 79 56 7 0Osborn 2011 675 792 457 84 3 470 572 736 199 33
Radgowski 716 440 276 0 0 0 372 344 0 0 0Robinson 1492 817 575 100 0 0 622 628 242 0 0Walker 407 231 126 50 0 0 205 126 76 0 0
Willard/Cy 1051 532 352 168 0 0 322 419 310 0 0York 1060 101 222 617 45 12 147 492 275 65 5
Totals: 17520 8157 5990 2839 387 35 7027 6474 3301 526 62
Mental Health Medical
Census (2/1/2013)
• Challenges
• Population Needs in the context of budget reductions• Pharmacy services• Aging population• Legal obligations
• Logistics specific to Correctional Institutions / Building Infrastructure• Space and accompanying environment
• Organizational Structure / Ownership
Foundation outlined in 2009 – RFP
Funding challenges
DOC RFP - Offender Management Information System (OMIS)
Health care module
No Money – No EMR
Develop Alternative Strategy
◦ Establish Organizational Focus Areas
◦ Identify customers
◦ Consolidate/centralize data
◦ Statistics/Trends/Research
Managerial / Operational applications
Disseminating Clinical Information
Optimizing Resources
Discover Trends / Research
DemographicsNameNumberAgeDate of BirthLast AddressSexSSNReligionFacilityHousing CodeVeteran StatusSentencing BondStatusRelease DateHWH Hold DateHWH EligibleDetainerDR TicketsClassification Medical ClassificationMH ClassificationMedical sub codesMH sub codesSex Treatment codesDisciplinary history (tickets and classification of tickets)
Infectious DiseasesTB StatusS/S screeningsTST plantedTST readTST resultCXR History – TB IndicatedCXR Result – TB IndicatedExposure HistoryIsolation HistorySputumCulturesClaims positive historyAdverse Reaction to Medications- - - - - - - - - - - - - - - - - - - -Communicable Disease – DiagnosisDate of DxComment on disease- - - - - - - - - - - - - - - - - - - -HIV Risk FactorsHIV Confirmation - ByHIV Confirmation - DateLiving WillTest History (both community and CMHC records) – ex: CD4, HCV, HIV-RNA, etc..Exam History – ex: CXR, PEVaccination historyProblem list details – various categories- - - - - - - - - - - - - - - - - - - -Hep C Treatment dates2 vs 3 Dug Regime DistinctionsMental Status EvaluationsSigns/Symptom trackingMedication adjustmentsTreatment outcome
Interoperability
Meaningful Use
Health Information Exchanges
Continuity of Care Document (CCDs)
Dashboards
Medical Census
Mental Health Census
Employee Overtime
UR Appt Completion Stats
Psychiatric Diagnoses
Current JDH Inpatient Census
340b Patients to be Seen
Monthly Statistics: Episodes Self-Injury Suicide Attempts Number Sick Call visits
Scheduling Application
W10 Application (discharge planning)
Infectious Diseases
340b Federal Program
◦ Implement process by which doctors see patients
◦ Develop simple InfoPath form to retrieve data
◦ Provide reports to assure accountability, follow-up
Simple example: Medication costs
◦ Provide data!
◦ Data available via pharmacies/vendors…share it!
◦ Educate physicians
Example: START NOW
Objective variables:
Disciplinary tickets
Inpatient admissions
Security score modifications
Recidivism
