HIMSS has honored California Correctional Health Care Services with its 2018 Davies Community Award of Excellence, recognizing the provider organization's efforts in using health IT to reduce hospitalizations for high-risk patients.

Ten years ago, California Correctional Health Care Services was buried in paper. Tens of thousands of inches of healthcare records were spread out across the state at more than 30 institutions – as well as a more than 150,000 square foot warehouse archive. The patient population reached numbers of more than 125,000 individuals, with approximately 600 new arrivals every week and roughly 11,000 transfers monthly.

Inappropriate patient placement

These paper records were unwieldy and sometimes lost during transfers. Many processes were person-dependent, and healthcare risks were not considered appropriately during placement. Placing vulnerable, clinically complex patients in inappropriate locations was identified as a frequent contributor to potentially avoidable adverse health outcomes.

With the appointment of Federal Receiver J. Clark Kelso, California Correctional introduced a new clinical classification system in 2009. This process established healthcare factors to consider when housing individuals and introduced the concept of a "basic" versus "intermediate" care institution.

While this was a step in the right direction, the person-dependent, paper process left risk levels too broadly defined and was not often accurate or up to date. There were frequent discrepancies between reported risk and actual risk, whether due to missed relevant clinical information, incorrect interpretation of clinical risk rules, or a failure to update the clinical risk as new clinical information became available.

Significant staff time was dedicated to identify, update and communicate healthcare factors pertinent to the appropriate patient placement.

In order to address the challenges with a person-dependent paper process, California Correctional set out to leverage available data sources and information technologies to automate the clinical rules for a risk stratification system.

This system would provide timely, actionable information for those involved in the process of housing patients and provide near real-time performance reports to track progress, with a goal of improving placement of clinically high-risk patients.

From paper to electronic

While California Correctional began the multi-year journey to shift business practices from paper to electronic, the organization also looked to automate the clinical risk tracking system.

To accomplish this upgrade, California Correctional leveraged multiple available data sources, developed a structured data warehouse, and created daily automated jobs to update and communicate the clinical risk for all patients to their custodial colleagues who used this information, in part, to inform appropriate housing.

The organization used a change management strategy that included training of clinical and correctional staff and developed decision support tools to aid end users in the new process. California Correctional also reported performance for placement of high-risk patients to a subset of institutions identified as having access to an expanded set of healthcare services, including closer proximity to tertiary care centers.

As a result, California Correctional improved the appropriate placement of high-risk patients by nearly 20 percent, which led to improved accuracy of reported risk for individual patients, improved consistency in assigned risk between similar patients, and improved transparency of a patient's risk factor determinants – all while eliminating paper forms and person-dependency.

The organization was able to achieve a reduction in potentially avoidable hospitalizations for high-risk patients from 70.9 per 1,000 patients in June 2015 to 43.5 per 1,000 patients in December 2017.

Administratively, the automated clinical risk classification system has saved more than $2 million in the first three years of its implementation by eliminating the need for licensed clinicians to complete paper records.

"Quality patient care is the principal function of any healthcare organization, regardless of the patient population," said J. Clark Kelso, receiver over medical care for the California prison system. "Incorporating information technology solutions to leverage healthcare data is imperative to make informed decisions and improve organizational performance."

California Correctional Health Care Services will be recognized during HIMSS19, February 11-15 in Orlando, Florida.

Also at HIMSS19, California Department of Corrections and Rehabilitation Chief of Quality Management and Informatics John Rekart will show how analytics can help boost the success of EHR go-lives in an educational session entitled “Analytics-Based EHRs Implementation: Improved Outcomes,” scheduled for Thursday, February 14, from 11:30 a.m. to 12:30 p.m. in room W308A.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com