By Bryan Denson
The Oregonian
PORTLAND, Ore. — The health care records of Oregon’s 14,600 inmates choke prison infirmaries across the state, and the files of at least 40,000 former prisoners crowd nearly a mile of shelf space in a Salem warehouse.
It’s a paper colossus that potentially obstructs delivery of care, poses greater risks of medical errors and sometimes leaves the whereabouts of medical charts unknown for as long as a day. With files spread across 14 prisons, it’s also impossible for officials to search for trends that might improve inmate health.
Medical files choke Oregon prison system Wendy Smith, a spokeswoman for the Oregon Department of Corrections’ Health Services Administration, gives The Oregonian a guided tour of the massive repository for inmate medical files.
Prison officials plan to pitch a $3 million plan to the governor’s office this summer to move the recordkeeping out of the days of Doc Holliday into an electronic future, potentially feeding millions of pieces of paper into a digital storehouse.
Corrections officials have handled the paper files so long they’ve gotten good at it, says Steve Robbins, the prison system’s top health administrator.
“But it is inefficient,” he says. “It’s not the wave of the future.”
A key problem confronting the paper filing system is that inmates’ medical, dental, mental health and pharmaceutical records – all kept by hand – reside in one chart. This means that if a prisoner goes to see a doctor, his file might be found with the dentist. Finding those files can take hours.
“In a rare case, it might take us a day to locate it,” Robbins says.
Prison health care officials, in answer to a questionnaire by The Oregonian, described the recordkeeping as antiquated, with heavy, cumbersome, hard-to-decipher files that occasionally shed pages. Patients are sometimes turned away because their charts are missing in action. Copying the files can be difficult, making them hard to share with medical professionals outside the razor wire.
“There have been issues when an inmate has the same name and the wrong chart is transferred,” wrote Carrie Coffey, the medical services manager for the Oregon State Penitentiary. “In these cases we have to fax the most pertinent information to each other until the chart can be shipped. ... It can be very time consuming searching for the charts, and absorbs staff resources.”
Many prison systems, including those in Utah and Washington, also maintain paper health care records – with the Evergreen State keeping and retaining files almost identically to the way they are kept in Oregon’s prisons.
Idaho prisons entered a contract in January to convert their medical recordkeeping to an electronic system, according to Jeff Ray, a spokesman for the state’s Department of Correction.
Oregon Department of Corrections officials have tried to put an electronic health records system in place for several years. In 2011, they pulled the plug after a company they planned to hire for the project fell under criminal investigation. In 2013, they put in a budget request for $2.6 million, but the governor’s office trimmed the request before it could come to a vote in the Legislature.
Robbins remains optimistic. A committee created by the Legislature in 2013 to find ways to reduce inmate health costs recommended that the state install an electronic health care system for its prisons. A consultant was hired to assess the system.
For inmates, there’s much to be gained from an electronic repository of their charts.
Many will leave prison and sign up for health care under the Affordable Care Act. The government program has pushed private health care providers to switch to electronic recordkeeping, and Robbins doesn’t want the prison system to be the weak link in that system.
“Right now,” he says, “we’re a bit of a black hole.”
Doctors inside and outside the prison system, accustomed to years of writing in charts by hand, are not universally happy about making the switch from paper charts to electronic repositories.
Prison doctors have another reason to be chilly to the notion: Prisoners often sue them. Keeping a digital record of every contact between inmates and the prison medical system creates a record – exposing corrections officials to liability when inmates sue.
For that reason, prison systems are likely to establish limits on how long they store electronic records, according to officials with the National Commission on Correctional Health Care, in Chicago.
Oregon keeps paper health care records for seven years after a prisoner leaves the system. The records are destroyed after that time or when a prisoner dies. But it’s not yet clear how long the Department of Corrections might keep electronic records.
Converting to an electronic recordkeeping system would give the prison system’s 550 medical staffers a chance to query medical records and identify trends.
“If someone were to ask me how many broken arms that we’ve had in the Department of Corrections in the last two years, I couldn’t tell you,” Robbins says. “With an electronic health record ... we can begin to learn why people are breaking their arms so we can begin to address those things operationally.”
The big question for Oregon prison officials is how to make the transition from millions of pieces of paper to electronic records. Putting all of the files into a secure database would be an immense challenge.
One way to launch a system, Robbins says, is to pick a date to begin storing new records electronically, keeping the old files on paper. Another way, he says, is to begin the electronic storage system and then work backward to scan the paper files into the new system.
Corrections officials recently allowed The Oregonian to tour infirmaries at three eastern Oregon prisons, where file rooms and rolling carts brimmed with health care charts. But those files are dwarfed by a storage facility in Salem, which keeps the charts of 40,000 to 50,000 former inmates.
Wendy Smith, the chief spokeswoman for the prison health system, guided a tour of the warehouse last week. She walked past pallets piled with heavy boxes full of files to crank open heavy walls of shelving, which move on wheels.
The shelves hold 5,100 linear feet of paper charts, which begin with a pale blue folder and grow into overflow folders. A file documenting the complete medical history of a high-needs inmate can take up to 4 feet of shelf space.
The prison system moved those files from a prison complex in Wilsonville to the Salem warehouse a year ago, and already corrections officials are noticing a problem.
“We’re nearing capacity,” Robbins says.