Report: DOC health record system needs overhaul

Commissioner Claire DeMatteis, left, discusses a review of the Delaware Department of Correction healthcare system Thursday morning, joined by Deputy Commissioner Monroe Hudson Jr. (Delaware State New/Craig Anderson)

DOVER — Implementing an upgraded electronic health record system is critical to providing health care services to approximately 5,100 inmates, Delaware Department of Correction Commissioner Claire DeMatteis said Thursday morning.

The agency’s leader spoke with the media at headquarters following the release of an independent review of medical and behavioral health care services within state prisons.

An 18-page analysis included recommendations to improve operations. Beginning in September, ChristianaCare utilized 15 staff members to conduct the analysis at no charge to the state.

A previous cost estimate for implementing new technology was between $3 million to $5 million, officials said. The General Assembly would need to approve funding.

According to the report “It is questionable whether the current technology system used, iCHRT, even can be considered a viable electronic health record system. …

“There was widespread evidence that the use of iCHRT as part of the delivery process creates substantial waste, including rework, for staff and providers, with questionable benefit. …”

Speed and reliable connectivity with the facility’s network through iCHRT are problematic, according to the report. Also troubling is losing data that can’t be recovered, or after-hour documentation due to system limitations.

Additionally, the report found, “iCHRT creates tremendous waste of workforce productivity that impacts all staff.”

According to the study, existing stakeholders within the DOC are “siloed” and have “inconsistent communication” that “limits opportunities for coordination, shared goal-setting and mutual accountability.”

High turnover, vacancies

High staff turnover and vacancy rates have plagued the DOC’s health care system, Commissioner DeMatteis said, exacerbated by an inmate uprising that led to a correctional officer’s death at James T. Vaughn Correctional Center in Smyrna in early February 2017.

For the current DOC personnel “It was evident in numerous facilities that staff were second victims, experiencing psychological trauma from adverse events, and that support for them was inadequate or non-existent.”

While an ongoing backlog of chronic care visits continues “there was no evidence that the fundamental backlogs are reported on, measured, or analyzed …”

Commissioner DeMatteis described the task of responding to the recommendations as “manageable,” and said “the improvements will benefit offenders, our medical and behavioral health teams, counselors and correctional officers alike.”

The commissioner pointed to the 41 recommendations in a 169-page report addressed within a year following the Vaughn riot as a successful track record of implementing meaningful changes within the prison system.

Visiting the facilities

Earlier this year, state lawmakers unanimously approved a bill reforming a committee charged with monitoring prison health care in Delaware, the Associated Press reported.

According to the AP, the bill was introduced after the attorney general’s office confirmed that it was investigating allegations that DOC’s medical contractor, Connections Community Support Programs, had ordered staffers to forge documents to falsely state inmates were getting mental health treatment they never received.

From Sept. 17 to Oct. 3, the Christiana review team visited Delaware’s four maximum security prisons — Vaughn, Howard R. Young Correctional Institution in Wilmington, Delores J. Baylor Women’s Correctional Institution in New Castle and Sussex Correctional Institution in Georgetown.

Also visited during the same period of time were corrections centers in Dover (Morris), Wilmington (Plummer) and Georgetown (Sussex).

“In our ongoing commitment to positively impact health in all the communities we serve, we are glad to provide our expertise in health care quality and safety to the Department of Correction through this report,” said ChristianaCare Executive Vice President and Chief Clinical Officer Dr. Ken Silverstein in a news release.

“We applaud the DOC leadership and staff for taking this important step to improve the delivery of care in its facilities.”

The DOC has had seven medical vendors in the past 34 years, with no assessments of how to improve delivery of healthcare and clinical quality during transitions, Commissioner DeMatteis said.

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