Strengthening the medication practices of jail staff is a key priority for Colorado, and as proof the Colorado State General Assembly recently passed legislation aimed to positively impact the quality of care provided within the state's jail system.
In 2017, the Assembly passed Senate Bill 17-019 calling for enhanced medication-consistency solutions in county and municipal jails, as well as a partnership with a health information exchange.
The Office of Behavioral Health and state HIEs are collaborating to achieve these efforts by providing jails with access to clinical data. Colorado hopes these collaborative efforts from state agencies, HIE and community providers will ensure that people with behavioral health disorders have access to a broad spectrum of effective medications as they transition between settings and service providers.
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The goal is to create positive health outcomes for this vulnerable population, reduce recidivism and create healthier communities.
In a HIMSS20 digital presentation, Kate Horle, chief operating officer of the Colorado Regional Health Information Organization (CORHIO), said about 92% of the U.S. population is served by HIEs, which exchange patient information through secure networks under strict medical privacy and confidentiality procedures. Most states have one or more HIEs exchanging data between providers.
"We simply wanted access to community-based care data on these patients," said Horle. "Providers didn't know which medications they were taking or what conditions they were presenting with. (They) didn't know the proper medications or the dosage. There was a lack of standardized screening, and no standard way to share information."
Thanks in part to the 2017 legislation, Colorado received $65 million to be an innovation model state, which meant an expansion of the state's mental health program to include jails, crisis intervention systems and medication assisted treatment. Jails in particular have limited resources, especially in the state's rural and frontier counties.
The state's two HIEs also benefited from more than $500,000 from the state's marijuana tax cash fund, a $400,000 federal match for HIE planning and assessment and $40,000 in mental health expansion funding that went toward the jail pilot.
"We're finding not only do users want access to this meaningful data, but they want to be able to use it and provide the HIE with data for future use by other entities," said Danielle Culp, criminal justice HIE coordinator for Colorado's Office of Behavioral Health.
The pilot entailed contracting with 10 jails initially, with six more expected to be added this month. Goals and considerations include the timely access to clinical and medical information, information security, user flexibility and improved care coordination for inmates with mental illness through medication consistency.
Those goals didn't come without challenges. The HIE had to build interfaces for data exchange in a limited amount of time, train jail staffs across a broad geographic area and deal with varying bureaucracy that differed by county, meaning implementation looked different depending on the location.
"This was a difficult undertaking, but we lined up schedules and we made it happen," said Culp.
Mental health expansion dollars have been earmarked to provide current pilot sites with additional HIE user access based on higher utilization rates, clinical demand and the capacity of the jails.
Ongoing evaluation of the pilot will determine what the long-term strategies are, but in the short term, positive results have already been achieved, including quicker access to meaningful data and a reduction in the time it takes staff to chase down information. Better care coordination has resulted in improved health outcomes, and inmates are transitioning to the community in better health, with more comprehensive care plans. Outcome and performance measures have led to enhanced transparency, and costs for psychotropic medications have been reduced.
"This was an outcome we didn't anticipate, and we're finding it's the most important outcome on our county jails," said Culp. "They can reduce costs by bulk purchasing. They can have better outcomes and reduced costs for medications and other services if they can look at their performance metrics to see what they're doing well and what they could improve.
"We keep navigating, climbing this mountain, but we know when we reach the summit it's going to be just such a beautiful view."
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