Why use an EHR or EMR in your correctional facility?
An Electronic Health Records (EHR) system, or as it is sometimes known, an Electronic Medical Records (EMR) system, is a computer-based system used to store patient medical records as opposed to using paper charts to track patient medical history. The healthcare industry has been one of the last industries in the U.S. to move to computerized-based record keeping systems. Led by the federal government’s push for “meaningful use” and ONC-certification of EHR systems, hospitals and doctor’s offices and are almost all now using EHR systems. Employing a series of incentives and penalties, government and health insurance companies (third party payors) have forced the adoption of EHR by tying reimbursement to the use of an EHR system. Unlike hospitals and doctor’s offices however, healthcare in the correctional industry is not typically paid via third-party payors such as Medicare, Medicaid, and/or commercial insurance. Therefore, to this point, no formal push has been made to force the jail or prison to use an EHR system. As of today, there are still many correctional healthcare facilities using paper charts to store patient medical information. So, absent any formal push by government or payors, why should your correctional organization replace paper charts with an EHR? There are several good reasons to move to EHR that are typical of moving any organization to a computer-based system, such as improved efficiency, accountability, and compliance, as well as redundancy (meaning multiple copies or backups of your records in multiple locations), access to the records from multiple locations simultaneously, and of course the ability to easily assimilate and report on the content of the information being tracked. In addition to the above advantages, healthcare organizations that computerize can strive for a higher level of patient care, improved medical outcomes, and the computerization of specific medical processes such as nursing protocols, chronic care management, detox assessments, and so on. Perhaps one of the biggest reasons for a correctional healthcare facility to move to an EHR system is the potential decreased liability exposure that the proper use of a well-designed, correctional-specific EHR can offer. Through the proper use of a well-designed, correctional-specific EHR, the correctional organization can demonstrate that correct protocols are being followed, medications are being ordered and administered on time, sick call requests are being properly triaged and acted-upon within an appropriate time frame, patients with specific conditions (e.g. substance abuse, chronic disease, or behavioral health concerns) are appropriately assessed and treated within acceptable time frames, and so on. The proper use of a well-designed correctional-specific EHR will allow the organization to demonstrate (prove) the date/time that any health concern was discovered, and the dates/times that appropriate care was delivered. Furthermore, computerized protocols can be tied to the discovery of specific medical concerns (such that noting in the EHR the discovery of a new diabetic patient, can then suggest to the clinician, the organization-approved options for treating the diabetic patient). In addition to the above, a well-designed, correctional-specific EHR will contain a log of all changes made in the event that an audit of a specific patient chart is needed. The patient chart itself can be easily printed or saved in an industry standard file format (such as pdf) to allow the correctional organization to supply a copy of the patient’s health records. In summary, the proper use of a well-designed, correctional-specific EHR, gives the correctional organization a tremendous “toolbox” for improving the overall efficiency and compliance of the healthcare services within the organization as well as the ability to demonstrate that efficiency and compliance for any one patient, a group of patients, or all patients.
Questions to ask yourself…
If you are still using paper charts:
- Does your staff spend time looking for paper charts?
- Do you have staff dedicated just to managing the paper charts?
- How much time does your staff spend documenting paper MARs (Medication Administration Records)?
- Does your staff spend time assimilating reports such as the number of diabetic or hypertensive patients?
- Do you know how many chronic care patients are in your facility?
- Do you know how many medication doses were refused yesterday, last week, last year?
- Do you have any breakdowns in communication between departments or clinicians?
- Can you “prove” the date/time a medication was actually administered?
- Can you “prove” that all sick calls were documented and triaged?
- Can you “prove” the dates/times medical concerns were discovered and the dates/times appropriate care was given?
If you are having difficulties with your current EMR/EHR:
- Can you report on basic statistics such as intakes, diabetic patients, chronic disease clinic patients, etc.?
- Are you able to report on any information in the system?
- Can you track the number of patients on specific drugs?
- Can you track the cost of specific drugs?
- Is the system easy to learn and easy to use?
- Do you ever have to type (as opposed to simply clicking on an answer)?
- Is the system workflow-driven with workflows tied to the processes of your organization?
- Can multiple people access the same chart at the same time?
- Can the system be easily modified (configured) to introduce new forms, processes, and workflows?
- Are there things you think the system should do but it cannot?
Why the CorrecTek EHR versus the Competition?
Assuming your correctional organization has made the decision to acquire an EHR, why should you consider the CorrecTek EHR over the competitors’ EHR’s on the market?
Reason # 1 to consider CorrecTek over the competition:
The CorrecTek EHR is a correctional-specific EHR. It is not a system for a physician’s office or hospital. Correctional healthcare organizations have unique needs not found in physician offices or hospitals.
For example, the physician office is an ambulatory setting and most workflow is driven by the presence of a patient showing up for an appointment. If no patients show up, very little clinical work can be done. A correctional healthcare setting is an institutional setting not an ambulatory setting like the physician office. In an institutional setting, work is driven by physician/provider orders such as requests for vital signs, suicide watch, medication administration, dental examinations, blood sugar checks, chronic disease maintenance and so on.
A hospital setting, like a correctional setting, is an institutional setting, but hospital needs are markedly different from those of a correctional facility. Operating rooms, intensive care units, heart caths, emergency rooms, chemotherapy, MRI scans, etc. all happen in a hospital but are rarely if ever seen in a correctional setting. Dental exams, substance abuse programs, sick call requests, long term care protocols are all common in correctional settings but may not be so common in a hospital setting.
Hospital and physician systems documentation is also driven by, and highly sensitive to, the demands of entities that reimburse for the services provided. Therefore, procedure codes, fee schedules, insurance contracts, revenue codes, Medicare, Medicaid, etc. are all part of the fee for service model that is healthcare outside of the correctional setting.
There is no reason for the correctional healthcare organization to compromise and settle for a physician or hospital system when a strong, correctional-specific EHR, like the CorrecTek EHR, is proven and available.
Reason # 2 to consider CorrecTek over the competition:
The CorrecTek EHR is a complete, fully integrated EHR. The CorrecTek EHR is not a modular system. Everything required of an EHR to allow the medical, behavioral health, and dental departments of the correctional organization to realize their full mission is available for use in the CorrecTek EHR.
The CorrecTek EHR contains a fully integrated Electronic Medication Administration Record (eMAR) or just sometimes called “the MAR.” Some competing EHR systems do not include an eMAR or MAR, and those vendors will supply an EHR module and an eMAR module that can perhaps share some information, but are still two separate systems. Separate systems can present licensing issues, technical issues, and even support issues if the two vendors that supply each module are not always in sync. Full integration of the eMAR within the EHR allows the clinician to view the medical records of a patient while administering drugs. The benefit of this is that some medication administration is contingent upon lab values or vital signs being within a certain range. Full integration of the eMAR allows for medication compliance reports to include considerations such as disease condition, the agency served, housing locations, etc., that is, information that is stored in the patient medical record is accessible to the eMAR and the overall reporting system. Full integration of the eMAR allows medication orders to be directly and easily issued from within the documentation process of the EHR. The benefits of the complete integration of the eMAR and the EHR far outweigh the drawbacks of a modular system where each module is its own self-contained application. With CorrecTek, there is only the one application, the CorrecTek EHR, and it includes all functionality required in a correctional healthcare setting.
The CorrecTek EHR contains a fully integrated Reporting System (sometimes called a Report Writer). The ability to assimilate information via reports is critical to the organization’s ability to drive workflow, monitor compliance, gather statistics, track outcomes, productivity, and even costs. With the CorrecTek EHR, patient-specific reports can be automatically inserted into provider documentation for such things as clinical trends (HgbA1c, Lipids, Blood Pressure, BMI, etc.). The tight level of integration between the workflow, documentation, and reporting functions of the CorrecTek EHR is simply not possible if the EHR vendor does not contain a reporting system and instead relies on a third-party report writer (such as Crystal Reports). Furthermore, with the CorrecTek EHR, it is a simple matter to incorporate new reports for workflow, compliance, statistical, clinical, productivity, etc., needs at any time.
In addition to medical services documentation, the CorrecTek EHR is fully developed for behavioral health. Protocols are available for initial and follow-up mental health exams, initial and follow-up psychiatric evaluations, psychiatric progress notes, individualized treatment plans, mental health rounds, suicide risk assessments, neurological assessments, detox/withdrawal protocols, AIMs, Glasgow Coma scales, etc., as well as any consent and refusal forms that may be needed. Any and all behavioral health protocols can be modified to fit the specific documentation needs of your behavioral health staff. Furthermore, all protocols can be driven using the same intuitive workflow processes employed by the medical staff within the CorrecTek EHR. Reports for workflow, compliance, productivity, statistics, etc. are all available as well and can be configured as needed to answer the requirements of the behavioral health staff.
In addition to medical and behavioral health, the CorrecTek EHR is fully developed for the dental staff in your organization. Dental exams, dental extractions, and dental sick call protocols/processes, and the consent/refusal forms needed for all dental services are available and can be modified to fit the specific documentation needs of your correctional organization. Furthermore, all protocols can be driven using the same intuitive workflow processes employed by the medical and behavioral health staff within the CorrecTek EHR. Reports for workflow, compliance, productivity, statistics, etc. are all available as well and can be configured as needed to answer the requirements of the dental staff.
In addition to the standard dental processes available within the CorrecTek EHR, CorrecTek also offers a professional dental suite that allows for visual documentation of professional dental services such as crowns, bridges, implants, fillings, past treatments, future planned treatments, etc. Both adult and juvenile images are available. Dental hygienists can visually document via a periodontal chart the pocket depth, bleeding points, etc., of the patient.
This professional dental package is not an add on module; it was fully developed by the development team at CorrecTek, and it is fully integrated within the CorrecTek EHR system. However, most correctional organizations do not perform professional dental services, and some training is required in the use of the professional dental package, so the professional dental functionality is not “turned on” within the CorrecTek EHR unless specifically contracted to do so by the customer.
The CorrecTek EHR is a complete, correctional-specific EHR. It contains the functionality typically required by the medical, behavioral health, and dental staff of the correctional organization. Do not settle for anything less than a complete, correctional-specific EHR for your correctional organization.
Reason # 3 to consider CorrecTek over the competition:
The CorrecTek EHR is easy to use, and just as important, easy to learn how to use.
The first attribute of an easy to use EHR is the ease in which a user can start a task.
The CorrecTek EHR user interface mimics the button layout of an iPhone or Android smartphone (except the CorrecTek EHR runs on a desktop, tablet, or laptop PC, not a phone). The smartphone button-based user interface is ubiquitous, and nearly every user of a smartphone knows how to operate the phone without attending a class or reading a user manual.
Like the smartphone, it is very easy to start using the CorrecTek EHR. The user just presses a button to start a task. On a smartphone, one can press a button to send a text message place a phone call, check email, or start an app. With the CorrecTek EHR, one can press a button to begin the documentation of an intake, review the list of patients to be seen by a provider, start a med pass, review a compliance report, begin a detox assessment, and so on.
With the CorrecTek EHR it is easy to find and start a task, just press the appropriate button.
The second attribute of an easy to use EHR is the ease in which a task can be performed after it has been started.
With the CorrecTek EHR, all tasks are question and answer based, with one question appearing at a time to the user. When a question appears, the user will be given a list of possible answers to select from. This simple approach of one question at a time with a list of possible answers allows for a very fast, accurate, and easily understood documentation process. The user simply clicks on answers as fast as he/she can, to easily complete the documentation process. For example, during the intake documentation process, the nurse may see the questions and answers similar to the following (each question will appear one-at-a-time):
|Able to complete the intake screening?||Yes||No||
|See any physician(s) regularly?||Yes||No||
|Is this the inmate's first arrest?||Yes||No||
|Select an physical aids:||Cane||CPAP||Crutches||Dentures
Also, based on answers selected, the CorrecTek EHR can lead the user to new questions that are ramifications of answers to the earlier question. For example, if the user answers “Yes” to the question “Is the patient diabetic,” the user will then be guided to questions about diabetes as well as be allowed to document a finger stick blood glucose value.
Typing is typically not required, apart from short number sequences such as blood pressure, weight, or other vital signs. No typing means no misspelled words and faster data input.
With the CorrecTek EHR, it is easy to perform the task once it is started.
The third attribute of an easy to use EHR is a consistent method for documenting all tasks so that if the user understands how to document any one task, the user will be able to document any other task.
With the CorrecTek EHR, all tasks start by pressing a button on the EHR home screen, and then all tasks are completed by answering the questions one at a time as they appear. This consistency is the same for all clinicians – nurses, providers, dentists, behavioral health staff, etc.
Tasks that are easy to start, easy to complete, and consistent in the method of documenting are all attributes of the CorrecTek EHR.
Reason # 4 to consider CorrecTek over the competition:
The CorrecTek EHR is quite adaptable and can be configured around not only the documentation needs of the correctional organization (e.g. specific forms with specific questions and information to be gathered), but it can also be configured around the specific workflows of the organization. For example, the intake process may drive admission to chronic care clinics, sick call, behavioral health assessments, suicide risk protocols, etc. The CorrecTek EHR can be configured to capture those workflows. There may be an approval process for utilization that requires multiple levels of sign-offs before medication or therapy can be administered; the CorrecTek EHR can be configured to capture utilization review workflows.
Agencies (e.g. ICE, US Marshals, BOP) served by the correctional organization may require specific printed forms; the CorrecTek EHR can be configured to closely mimic and print those specific forms.
During the documentation process by a clinician, referrals may be required as problems are uncovered, such as suicide or abuse concerns, past medical history events, unsafe lab values or high-risk vital signs, etc. For these conditions and others, the documentation process can automatically, or with approval by the documenting clinician, create the referrals and/or orders required to address the concern.
At the lead and direction of the medical, behavioral health, and/or dental authority/director within the correctional organization, CorrecTek can configure the CorrecTek EHR to properly capture the documentation, workflow, and referral needs of the entire organization. This is a standard part of all CorrecTek implementations and your implementation coordinator will work closely with the proper authority in your organization to direct the CorrecTek configuration team as they configure the CorrecTek EHR to your authority(s)’s specifications.
Reason # 5 to consider CorrecTek over the competition:
Free, online courses on how to use the CorrecTek EHR - All educational courses required to learn how to use the CorrecTek EHR are available online at www.correctek.com/elearning. There is no fee to access this library and you do not have to be a customer to access the library. It is available right now to any interested party.
The courses available online in the CorrecTek eLearning library are the same courses taught by CorrecTek trainers during the implementation of a new CorrecTek customer. All course material offered onsite or online is available in this library.
Reason # 6 to consider CorrecTek over the competition:
The CorrecTek EHR can be acquired as either a license purchase or an ongoing subscription. In either model the CorrecTek EHR can be hosted in the cloud, or installed onsite on the customer’s facility. There are pros and cons to either approach, and it is suggested that you talk to a CorrecTek representative to further explore these options.
Reason # 7 to consider CorrecTek over the competition:
Virtually every field stored in the CorrecTek database is a reportable field. As mentioned earlier, the integrated reporting system within the CorrecTek application allows for seamless integration of reporting information to both drive workflow and be included in clinical documentation. Reports are of course also available for compliance, statistics, productivity, clinical trends, cost analysis and so on.
Reason # 8 to consider CorrecTek over the competition:
CorrecTek offers a full-service, face-to-face, implementation model. A CorrecTek implementation coordinator will oversee all aspects of the implementation, including but not limited to coordination of I.T. services with your I.T. vendor, database configuration (per your medical director’s specifications), interfaces with your third-party vendors such as the Offender Management System (OMS), pharmacy, labs, commissary, radiology, dental images, sick call feed, and health information exchange, and the coordination of any testing requirements you may have, the end-user training schedules, and finally, coordination of the actual go-live.
For end-user training, we will bring our trainers (and a computer training lab) to your correctional facility and conduct classes face-to-face in a classroom setting. After classroom training our training team will be on-site (typically the day after training ends) to assist in the “go-live” (production) use of the CorrecTek EHR. Our trainers will assist your staff at intake, during the med-pass, at sick call, chronic care clinic, provider assessments, etc. Our team will be present anywhere that your staff may need assistance.
We also offer an “express” or customer-driven implementation model. With this model, the customer drives the implementation process and we respond as the customer makes a request. This is a lower cost alternative that may make sense for a smaller correctional facility.
Reason # 9 to consider CorrecTek over the competition:
CorrecTek offers a full-service support model, 24/7. You can contact us via the electronic support request button available at all times within the CorrecTek EHR application. Using this button allows the CorrecTek EHR to provide information specific to the current task in use at the time of the problem and can assist the CorrecTek support representative in the diagnosis of the problem.
As part of the full-service support model, you can also directly call CorrecTek at any time if you prefer to speak with a CorrecTek support specialist.
For smaller, budget-conscious jails, we also offer support models that are limited in scope (for example business hours only, or electronic support only) that may work for a correctional organization that does not foresee a need for full service 24/7 support.
Reason # 10 to consider CorrecTek over the competition:
The CorrecTek “Advantage” program - CorrecTek also offers an “Advantage” program that sits on top of the standard support and upgrade services provided by CorrecTek. With the “Advantage” program, the customer receives unlimited configuration and training services. Without the “Advantage” program, each request for a change in configuration (e.g. a new form, workflow process, report, etc.) will incur an hourly charge to make the change. Without the “Advantage” program each request for training will require an hourly fee to perform the training.
With the “Advantage” program, the CorrecTek customer can enjoy the benefits of a “bumper-to-bumper” warranty. Under the “Advantage” program, the customer no longer has to “ask” the powers-that-be in their correctional organization for approval to pay for a needed change in the CorrecTek system; just call CorrecTek.
The CorrecTek “Advantage” program has been quite successful. Nearly a third of our customers have moved to the “Advantage” program in the short time that it has been offered.
Reason # 11 to consider CorrecTek over the competition:
CorrecTek is an independent EHR company. We are not affiliated with any other provider of goods or services in the correctional industry. We are not a pharmacy, healthcare vendor, or even a supplier of custody staff software. We have no entanglements with other products or services, and we have no conflicts of interest. Our sole focus is to a provide a complete, correctional-specific, EHR that meets the needs of our customer – the jail or prison looking for a better way to document and manage their medical, behavioral health, and dental services.
Accountability vs. Accessibility
Every organization strives for accountability and compliance.
The organization’s goal is for each member of the organization to be held accountable so that the organization can be compliant with all requirements imposed on the organization.
A correctional healthcare organization is no different. It expects to be fully compliant and that all clinicians, staff members, etc. working on behalf of the organization will be fully accountable to the organization’s requirements for compliance.
For example, to be fully compliant, a correctional healthcare organization may require that medication doses are administered on time, sick call requests will be triaged and acted upon within a given time frame, diseases or medical conditions discovered at intake (or any other time) will be addressed and treated appropriately and within the prescribed time frames laid down by the medical authority of the organization.
But one could also view accountability as one side of a two-sided coin. The other side of that coin is accessibility. To expect a member of an organization to be accountable to the organization's requirements means that the organization also has to provide a path for the member to realize that accountability. If a member does not have a reasonable (accessible) way to achieve compliance, the requirements of the organization will not be met, and the organization will be “out of compliance."
In other words, the organization can demand accountability, but if members are not given accessibility to achieve accountability, organizational compliance will not be realized, and this is not the fault of the member, but rather of the organization itself.
It should be apparent that the use of paper charts in the correctional healthcare organization can put the organization in the untenable position of demanding accountability/compliance, but not giving an accessible path of accountability to the members of the organization. Lost paper charts, illegible notes within the chart, the inability to easily track who needs what and when (and even where) are all impediments to accessibility for the staff and therefore unrealized compliance for the organization.
Surprisingly (or perhaps not), a poorly designed and/or implemented computer system can also lead to the untenable position of demanding accountability, but not offering access to the information needed. The business world is full of horror stories of failed computer implementations both in the world of EHR and elsewhere.
One can easily attempt to computerize the organization and introduce a tool that makes things worse rather than better, and again, EHR’s are no exception.
So, the relevant question then is, what should the correctional organization expect from an EHR (and the EHR’s vendor) to help ensure that the introduction of that EHR to the organization will offer both sides of the coin, accountability and accessibility?
There are several attributes of an EHR system that allow for accessibility and accountability:
- The system is easy to use. Or in other words, it is obvious to the user to see how to start a process/task, actually begin the task, and then finish the task. For example, if the nurse wishes to document an intake, he/she can easily see the method employed within the EHR to start the intake documentation process. The nurse can then actually and quickly begin the intake process. Once started, it is easy and intuitive to for the nurse to perform and finish the intake process. It should be easy from start to finish.
- The EHR system is organized in such a way that the user can easily know what work needs to be done, and can see all of the work that needs to be done at any point in time. For example, the nurse can easily see who needs a medication, who needs a blood sugar check, who needs to be seen at sick call, etc. This ability to easily see everything, and therefore know what to do next, allows the user the ability to achieve accountability because the big picture is readily available at any time to the user.
- The system is task/workflow driven and those tasks/workflows are configured to the organization's specific requirements. For example, specific nursing protocols can be developed by the medical director of the jail/prison and then configured for use within the EHR. These computerized nursing protocols can be driven by sick call requests/workflows, referrals from other departments/clinicians within the organization, or even ad hoc at the nurse’s discretion.
- The system is point and click, with little to no typing required. Typing is slow and prone to error. If information can be entered via multiple-choice selections, the documentation can be entered quicker, and will always be spelled correctly and fully reportable.
- The system is consistent in its user interface. All tasks are documented in the same manner such that once a user knows how to document one task, the user will be capable of documenting any task as all tasks flow using “style” of data input.
- Work to be done (accessibility), and work that has been done (accountability), are both reportable and based off of the same information. For example, a workflow report can give the nurse a list of all patients that need a blood sugar check. The workflow report will allow the nurse to easily see the list of patients, and drive the documentation of a blood sugar check for each patient. The associated compliance report can provide a list of all of the patient that were to receive a blood sugar check and state whether or not the patient did receive a blood sugar check. Workflow reports and compliance reports are the two sides of the same accountability/accessibility coin.
In summary, accountability and accessibility are two sides of the same coin, and you must have both to successfully meet the compliance requirements of a correctional healthcare organization. The proper use of a well-designed, correctional-specific EHR offers “accessibility” to achieve “accountability” for the members of the correctional organization in their pursuit of compliance on behalf of the organization.
A lot of people like to shop at a Wal-Mart Supercenter. With one trip you can pick up bananas, cat food, motor oil, a pair of needle nose pliers, a case of Diet Coke, tube socks, mayonnaise, and a large jar of dill pickles. This is one-stop-shopping at its finest, and nearly everyone loves one-stop shopping.
Unfortunately, one-stop shopping may work for consumer goods, but for professional products and services, it is not always a smart decision.
It may seem to the correctional organization, if one can acquire multiple products/services from the same vendor, there is an inherent advantage – fewer vendors to deal with and fewer vendors to call when a problem arises. In theory, so far so good, but what happens when one of the product/service lines the vendor carries is failing you and the vendor threatens to pull all product/services lines if you fire any one of them?
To be more specific what happens if your healthcare vendor supplies their own EHR system, and then you decide to change healthcare vendors? Will the EHR stay, or will the healthcare vendor take that “ball” too, and go home?
CorrecTek has no entanglements. The CorrecTek EHR is the only product offered by CorrecTek.
Make no mistake, once implemented, an EHR is a challenging product to replace. First, your organization will be highly dependent on the EHR to drive the work of the organization, and second, all of your patient medical records are tied up in the EHR (and data migrations can be costly when moving from one EHR to another EHR).
Because of the difficulty and high cost of replacing an EHR, there are companies with a primary focus in other lines of business now offering an EHR that can potentially assist in their retainage of your business in their primary focus area. For example, if a pharmaceutical company also provides an EHR, it may make it more difficult for you to change pharmacies. First, the pharmacy company may not let you keep their proprietary EHR if you replace their pharmacy services, and second, no other pharmacy will want to interface to that pharmacy’s proprietary EHR as that gives their competitor information about them. So, you’re stuck with the original pharmacy’s EHR and the original pharmacy, and hopefully, your medication pricing will remain competitive over time.
Another entanglement – some providers of custody products/services such as offender management systems, phone systems, etc. may also offer an EHR that can be “budget neutral” if paid for by inmate funds received from, for example, phone system services. Again, an entanglement that may give you grief down the road if either the EHR or the custody product/service fails to meet your needs.
Another entanglement – healthcare vendors that offer to bring in their own proprietary EHR. This approach is common to several healthcare vendors. If the healthcare vendor is fired and replaced with another healthcare vendor, there is no way the first healthcare vendor will allow the second healthcare vendor the use of their proprietary EHR. Just like with the pharmacy company example, you virtually eliminate your ability to change vendors due to the proprietary nature of healthcare vendors that also have their own EHR.
There is another potential conflict when a healthcare vendor "owns" the EHR. Do you trust the healthcare vendor to report negative information to you out of their EHR accurately? They control the information; it is their EHR. Can you use their tool (EHR) to hold them accountable? To be fair, at CorrecTek, we have never heard of an instance of a healthcare vendor altering or withholding data in their proprietary EHR to cover up an alleged mistake on their part. Whether this is a conflict of interest or not, and whether or not the healthcare vendor can be held accountable with their own tool is something you will have to decide.
Conversely, at CorrecTek we have worked with virtually every major correctional healthcare vendor, including those vendors that have their own proprietary, or preferred, EHR. Our number one concern is that the information in the CorrecTek EHR is accurate, reportable, and available to you, our customer, the correctional organization. The use of the CorrecTek EHR does not preclude the services of any healthcare vendor, or any other vendor for that matter.
The best business model, by far, is for you, the correctional organization, to contract directly with CorrecTek, and hold us accountable to you and no one else. You can then use the CorrecTek EHR as a tool to hold your clinical staff accountable whether they are your direct employees or the staff members of an organization you contract to for healthcare services.
Contracting directly with CorrecTek allows you to pick the best pharmacy, the best healthcare vendor, the best Offender Management System, the best phone system provider, etc.
By avoiding entanglements, you can ensure the best product/services are in use for your correctional organization, and if any one of them fails to perform, you can replace them with a competitor without affecting other areas of your organization.
On a different, but somewhat related twist to entanglements, some governments have expressed a desire that multiple organizations within the government should use the same product. For example, one county administrator suggested that both the county health department and the county jail should use the same EHR. While both the health department and the jail have healthcare responsibilities, the specifics of those responsibilities are different. Health departments deal with patient health issues of course, but also perform restaurant inspections, deal with environmental health issues, emergency preparedness, government assistance programs such as WIC, and a whole host of other programs/responsibilities that are not part of a correctional healthcare mission. Likewise, correctional healthcare settings deal with behavioral health, dental, substance abuse, chronic care, infirmary, drug administration, long term care issues (in prison settings), and other institutional care type responsibilities that are not typically present in an ambulatory health department setting. Asking the health department and the jail to use the same EHR is a lot like asking the police department and the fire department to use the same vehicle (after all they both need a vehicle that goes fast with flashing lights and loud sirens). Obviously, different missions require different tools.
Related to the above twist is one more angle – in some jails the local hospital provides healthcare services to the facility. Again, to those unfamiliar with correctional healthcare it might appear that a hospital system could serve a jail's need for an EHR, but that is just as untenable as using a health department or a physician's office EHR in a correctional setting. Hospitals have emergency rooms, intensive care units, insurance billing departments, heart centers, operating rooms, etc., and most jails and prisons do not. The bottom line is that a correctional healthcare setting is unique, and is best served, by far, by employing the proper use of a well-designed, correctional-specific EHR.
Does a small jail have the same need for an EHR that a larger jail would have?
The answer is not only, yes, but perhaps, yes and then some.
Certainly, a large jail/prison can realize substantial gains in efficiency, compliance, and liability protection through the proper use of a well-designed correctional-specific EHR just due to size alone, but a small jail can benefit as well. Even a correctional facility with less than 100 inmates can realize significant improvements.
A smaller correctional facility may only have a handful of nurses (or even just one). The healthcare compliance of that small facility can then rest on just a few or even just one nurse. There may be substantially fewer checks and balances in the small jail as opposed to the larger jail. Furthermore, assuming the nurse is not just competent, but extremely competent, he/she still has the burden of proof in everything he/she does. Documenting on paper is always subject to question because paper can be lost, altered, destroyed, and there is no way to “prove” when information was put to paper. A well-intended nurse may still be put on the defensive if relying on paper charts alone.
Providing the competent nurse/clinician in a small jail with a well-designed, correctional-specific EHR gives that nurse, and that jail, the added protection of being able to follow proper protocols and “prove” those protocols were adhered to such that all medications/treatments were administered appropriately and on-time. The competent small jail nurse will typically welcome the use of an EHR because it adds the ability for the nurse to document his/her competency (as well as all of the benefits it brings to the correctional organization).
In the unwanted event that an adverse outcome happens to a patient in a small jail, that one bad outcome could be just as painful, if not more painful to the small jail than to the larger jail, as the larger jail will probably have significantly more resources available to its defense. The proper use of a well-developed, correctional-specific EHR can potentially help defend the small facility if accused of responsibility for a bad outcome.
Other points to consider:
For the small jail, in the event of nursing staff turnover, the EHR can help ensure consistency when new staff comes on board, as the same protocols will be in place and driven from within the EHR.
For the small jail that struggles to find nursing staff, a well-designed, correctional-specific EHR may enhance the ability of the jail to find and retain good nurses.
If authorized by the organization, the EHR can also be accessed remotely, so that nurses, providers, and other staff may be able to access patient medical records without the need to travel to the jail. For certain situations, if authorized, this can be a significant benefit to the facility and the healthcare staff that serve there.
In summary, the apparent benefits of efficiency and compliance that an EHR can bring to a large jail are also available to a smaller jail, but in some ways, these benefits can have an even greater value to the small jail.
CorrecTek Spark Configuration Management and Compliance
With the CorrecTek EHR, the correctional organization has the ability to review, test, and authorize-for-use, all configurable items. Configurable items include but are not limited to Departments, Users, Workflows, Documentation Protocols/Processes, Forms, Order Definitions, Report Definitions, and Referral Types.
For example, the medical director can review and test the nursing protocols to be used by the nurse department. Upon review and test of the various nursing protocols, the medical director can then "approve" for production use, each protocol as configured. If, however, the medical director determines that a deficiency exists in a specific nursing protocol (perhaps a different treatment option, or medication choice needs to be added/removed to/from the "plan" section of a protocol), the medical director can immediately send an electronic ticket request to the CorrecTek Client Services Department directly from the protocol review process requesting a configuration change to that specific nursing protocol.
Workflows on the CorrecTek EHR Dashboard will be available to the appropriate medical authority (e.g., medical director, behavioral health director, dental director) to see all configurable items that have not yet been approved for production use. As the CorrecTek Client Services Departments answer requests, the medical authority can then re-review and approve/reject the reconfigured item.
This same methodology is used to review all workflows, processes, forms, department responsibilities/duties, etc. for the medical, mental/behavioral health, and dental departments in the organization.
Furthermore, each configurable item can be assigned (by the customer) a version number and serial number, as well as effective start and stop dates for production use. If configurable items are based on pre-existing customer forms, those forms can be scanned into the CorrecTek EHR system and linked to the configurable item. This allows the customer to review the basis for, and the history of, each configurable item. All electronic tickets submitted by the customer to request modifications to the configurable item will also be available for review by the customer directly from the workflows used to review the configurable item.
This approach gives the customer complete awareness and control of the content of all configurable items and the confidence to know that each item has been reviewed and approved for production use.
The customer can now ensure that all workflows, department responsibilities, forms, documentation protocols, orders, reports, etc. are compliant with standards as set by the appropriate medical authority.
CorrecTek Spark Multi-Agency Support
The CorrecTek EHR has the ability to track the “agency” associated with a particular patient stored in the CorrecTek database. For example, if the patient is an ICE detainee, the CorrecTek EHR can track that association as well as all medical records created during the existence of that association.
If a patient associated with one agency is discharged from the facility and then re-enters the facility under an association with a different "agency," (e.g., U.S. Marshals, State DOC, etc.) that association can be tracked as well. Any medical records created for this patient while associated with the second “agency” can also be tracked as pertinent to that second “agency."
There is no limit as to the number of agencies that can be represented for one facility. There is no limit as to the number of times one patient may be associated with one or more various agencies.
This ability to track the agency associated with a patient offers the following functionality within the CorrecTek EHR application:
- Reports can be filtered based on “agency” so that only the patients and/or medical records pertinent to a specific agency will be seen.
- If the Offender Management System (OMS) is capable of sending the patient’s agency association via the OMS interface between the CorrecTek EHR and the OMS, the patient’s current agency can be auto-assigned at intake (or any other time).
- Users can be limited to only seeing patients associated with one agency. This is useful to allow auditors representing a specific agency to be given a temporary user account that is limited to the patients under their purview.
- Statistical and compliance reports can be created and run for specific agencies.
- Unique workflows that are agency-specific can be configured to ensure that proper agency-specific policies are followed.
- Medicine formularies can be agency-specific.
- Any printed (or pdf-based) forms can be agency specific. Using the CorrecTek EHR’s ability to “merge” information into a Microsoft Word or an HTML file allows for the configuration of printed/pdf forms that closely mimic the actual agency form.
- Consent/Refusal type forms can be configured that are agency specific, multi-lingual, and able to electronically capture both a patient signature (using a Topaz signature pad) as well as additional witness/clinician signatures as required by the agency.
In summary, if your correctional organization serves multiple agencies in the same, or multiple facilities, the CorrecTek EHR offers functionality to help ensure compliance on behalf of those agencies.
The Request for Proposal (RFP) Process
– Respectful Suggestions from CorrecTek
At CorrecTek, we have participated in the Request for Proposal (RFP) selection process for an EHR hundreds of times. The following advice is based on our experience. We have seen good RFP's and bad RFP's. A poor RFP, and/or RFP process, has the potential to deny the correctional organization the ability to make an informed decision based on the complete picture. We share this experience to offer our perspective on what can make for a good or poor RFP process. Of course, you may view it differently.
So, after much internal discussion, you've been given the go-ahead to explore the possibility of bringing an EHR into your correctional facility, and the powers-that-be have informed you that you must use a Request for Proposal (RFP) process to acquire an EHR.
Given the above, the last thing you should do is issue an RFP. Don't misunderstand, you will most likely release an RFP, but again, that should be the final step in the process.
The first thing you should do is… do your due diligence. Call several EHR vendors. You can find them on the internet or get references from other correctional facilities that have EHR’s.
When you call us, we will be happy to receive your call. The best phone-call any EHR vendor can receive starts with the statement, "I'm so-and-so from the such-and-such jail/prison, and we are interested in moving to an EHR system.” We’ll be more than willing to answer any questions you may have.
Given the above state of our mind, rest assured, we know full well that you cannot buy today, or tomorrow, or even until after you’ve gone through the RFP process and awarded the contract. We know that even then, you may not ever buy, due to budgetary concerns, or some other bump in the road. We also know that if you’re calling us, you’re calling our competitors as well. We know the game; we play it every day.
We do want you to be fully informed throughout the entire RFP process, and of course, we want an honest shot to make our case and earn your business, fair and square.
When you call, in addition to answering any questions you may have, we are going to ask that you view a presentation (demonstration) of our EHR offering. We typically do this presentation online with a representative at your site (with your permission) to answer any further questions.
We encourage you to see presentations by the EHR vendors you are considering BEFORE you write your RFP. For these pre-RFP presentations, let the EHR vendor do their standard, canned, presentation. By allowing the EHR vendors to give their standard presentation, you allow the EHR vendor to put their best foot forward, so-to-speak, and you can then gain an understanding of "what is out there" before writing your RFP. EHR presentations may take an hour, two hours, or even more, depending on the number of questions, the size of the audience, and the expertise in the audience. Don’t short change the time for this presentation. You will turn your organization upside down and inside out with the introduction of an EHR, so take your time at every step to make sure you get the right EHR for your organization.
After you (and the stakeholders in your organization) have seen the standard presentation by the EHR vendor, there is another due diligence step that some correctional organization may take, contacting references provided by the vendor. Again, do this before you write your RFP. Due diligence information gained here may aid in the writing of your RFP.
The most important thing you can ask a reference check is “Does the EHR vendor support you and stand by you?” Nearly every correctional organization will struggle with the change that an EHR brings. Some will adapt better than others, and the critical point to consider is if the EHR vendor stayed engaged, or if the EHR vendor was unresponsive and/or unsupportive. Every correctional organization has different processes, personnel dynamics, budgets, compliance standards, and so on. Therefore, every correctional organization will use an EHR in a different way. But, the one consistent theme across all organizations as it relates to an EHR is… does the EHR vendor offer quality support? This is the best and most important question you can ask of a reference check.
Some correctional organizations may consider an on-site visit to see the proposed EHR already in use at another correctional facility. This is usually not a good idea for the following reasons: As mentioned above, every jail/prison is unique and each organization will use their EHR system in different ways. What you see at another correctional facility may be more confusing than enlightening. Furthermore, some organizations may have a lower or higher bar of compliance/standards due to the societal and budgetary standards of that city, county, state, etc. The standard of quality of care varies significantly from region to region across the United States. You may be shocked at the level of care you see at another jail. Sometimes we’ve been blamed for that, but in reality, that EHR can only perform at the standard that the healthcare organization chooses to implement. If the jail does not perform an intake, does not perform H&P’s, does not offer dental care or mental health care, does not have chronic disease management protocols in place, allows the nurses to withhold medications in retribution to a personal offense, and so on, that is not the fault of the EHR.
Because of the above reasons, and others, onsite visits can be disappointing. This is again a reason to do customer reference checks and onsite visits before writing the RFP. First, due diligence gained here can aid in writing the RFP. Second, if you have concerns from an onsite visit and/or a reference check, you have the opportunity, and you owe it to the EHR vendor, to hear the EHR vendor’s side of the story. If you have not yet issued the RFP, then you are not breaking any rules in contacting the EHR vendor. If you perform reference checks after issuing the RFP, and have concerns, but must maintain the “RFP Zone of Silence," you do a disservice both to yourself and the RFP vendor because you only hear one side of the story.
After you’ve done as much due diligence as possible, potentially talked to references, and formed a good opinion of what can and cannot be done with an EHR, it is finally time to write the RFP.
Every governmental organization will have boilerplate language and questions that go in the RFP, and of course, we expect such language and will respond to it.
Our advice on the RFP content is to keep it simple and focus on the primary goals at hand. Many RFP's are feature set driven and try to cover every single possible issue that has ever been experienced or might be experienced in the correctional organization. Sometimes one can miss the forest for the trees.
Feature set or functionality questions are of course needed, but questions concerning training, support, interfaces, and the implementation process are also helpful. Questions about the ease-of-use or ease-of-learning the EHR may benefit your decision-making as well. Some RFP's will mention budget limitations and some will not. Giving the EHR vendor budget guidelines allows the EHR vendor to tailor the response appropriately. Hopefully, during your due diligence phase prior to issuing of the RFP you've asked the EHR vendors under consideration for price quotes so that you know the general cost of the deliverables you are seeking.
Larger correctional organizations sometimes propose a train-the-trainer model to save costs. With this approach, the EHR vendor is asked to train a few "super-users," and those super-users are then expected to train everyone else. This is rarely a good idea. Unless the super-users are dedicated trainers within the organization and have been involved with EHR implementations in the past, this approach will likely fail or prove more expensive in the long run. Super-users are typically already busy enough with their currently assigned duties, and we've seen other individuals react spitefully if they've NOT been selected to be a super-user. Furthermore, a great nurse does not necessarily make a great trainer. Allow the EHR vendor's supplied training specialists to do all of the training; in the long run, it is the best value for the correctional organization and offers the highest chance of a successful implementation.
Attempting to save money on the front-end by reducing initial training costs, can cost more in the long run if staff are not trained or poorly trained. Those staff may leave, or may require additional training down the road. CorrecTek recommends full-service training of all your staff by CorrecTek trainers.
Some organizations will hire outside consultants to craft the RFP. This often leads to an RFP that is geared more towards hospital systems rather than a correctional setting if the consultant has little to no correctional experience, but has worked in a hospital environment. If a consultant is brought in to write the RFP and even guide the organization through the EHR acquisition process, please make sure the consultant has correctional experience and a good understanding of your organization’s goals and concerns.
Some RFP’s, typically crafted by the larger jails/prisons, may outline a specific implementation process or project management methodology that must be followed to implement the EHR. While we respect the expertise in the organization suggesting a particular project management approach, we know how to implement our EHR; we have done it successfully over a hundred times. If you demand that a specific project management model be followed at least allow the EHR vendor the possibility of offering a competing model for consideration.
Larger organizations may also demand milestone checkpoints, multiple layers of testing, sandbox environments to test configuration and/or interfaces, etc. Please understand that adding these additional layers of implementation steps will increase the implementation effort and therefore, the price. We are happy to accommodate any and all milestones, and for larger organizations, we welcome the opportunity for sign-offs by the organization for milestones completed, but this will increase the price and lengthen the time to implement.
Your organization may decide to ask for another EHR presentation during the formal RFP process. Specific requirements of the organization may drive this demonstration and require those particular scenarios to be demonstrated by the EHR vendor. For example, the scenario-driven demonstration may expect that the EHR vendor demonstrates an intake that includes key points such as a suicide risk assessment, chronic care clinic assignment, and the appropriate follow-up orders/referrals. We have no problem participating in such a presentation and look at this as an opportunity to further "show off" our EHR. However, there are two important caveats that we would ask the organization to consider:
- Give as much lead time as possible for the EHR vendor to prepare for a scenario demonstration. Two or three weeks at a minimum is needed to properly configure and create a scenario demonstration database. Just like you, we are busy and actively serving existing customers, just like you’ll want us to serve you if we earn your business. It takes a significant amount of time and effort to put together a demonstration database with specific scenarios outlined. We have to configure and test the scenarios as well as all supporting processes such as compliance, statistical, and workflow reports around each situation. Supporting medical records such as lab results, blood sugar values, vital signs, etc. may have to be pre-entered to support the proposed scenario. It is a lot of work to set up a demonstration database that looks like an actual jail with all of the ramifications that a specific scenario entails. It is nearly as much work as creating a new database for a new customer because it will typically involve a significant percentage of the functionality and workflows that will go into a new customer database.
- A significant amount of time will be required to demonstrate one scenario. A good rule of thumb is anywhere from 30 minutes to an hour for one scenario, such as a specific patient with specific medical conditions presenting at intake. It will certainly not take a nurse that long to document the actual scenario in a production setting, but to demonstrate and explain the scenario, discuss all the ramifications of each step in the scenario, and answer all of the questions that will inevitably be asked, will eat up a tremendous amount of time. We have been in multiple presentations where a large number of legitimate questions have prevented us from completing all scenarios in the prescribed demonstration time limit. If you ask the vendor to present 4 or 5 scenarios in a two-hour time frame, you are doing a disservice to yourself, and to the vendor. Be aware that immediately before the first scenario demonstration, the EHR vendor will probably want to start with a brief overview demonstration to bring the audience up to speed on the basic use and philosophy of the EHR.
Again, the above is our advice on how to use the RFP process to everyone’s benefit based on our experience over the years. This advice may or may not be relevant to your needs.
If after going through the RFP process, a decision is made to not move forward with a contract award, please let the EHR vendors know. If a decision to award is made, please give the reasons for your choice to the losing vendors. Sure, we'll be disappointed that we lost, but we're big boys and girls, and we know your decision is final. We want to hear about our shortcomings so we know what we can do better the next time. We also want to stay on good terms with you so that in the event it does not work with your first choice, we may have an opportunity down the road to again attempt to earn your business.
But, if we do earn your business, thank you for your trust, and we’ll work hard to keep it.
One follow-up consideration, if we reach out to you to ask about the status of your EHR acquisition process (outside of the “RFP Zone of Silence”), please give us a response good or bad. If a decision has been made to go with a competitor, let us know. If the budgeted money has been spent elsewhere, let us know. If nothing has changed, or there is uncertainty on your part, or we’re too expensive, or you can’t get an answer from your boss, or you’ve got more important things on your plate right now, let us know. We can handle the news, good, bad, or indifferent. We know that it can take months, and for some customers, even years before an EHR acquisition is feasible. When we reach out for a status update, it is not to push for a contract and a check today, but rather to make sure there are no concerns or assumptions that have not been addressed.
If there is an objection to our price, our product, our proposal, or any other concern, allow us to address it. You won't offend us. We want to earn your business and part of earning your business is to resolve any concern you may have. When a potential customer "goes dark," it is frustrating for us as we spend a significant amount of time and resources attempting to earn your business.
On more than one occasion we’ve had a potential customer “go dark” because of an assumption they made about us only for them to finally learn later that the assumption was false. Don’t penalize yourself by holding a negative concern about the EHR vendor without given the EHR vendor an opportunity to know and address the problem.
We have many satisfied customers that have implemented and use the CorrecTek EHR year after year. We want to add you to that list of satisfied customers, and all that we ask is that you give us a fair shot to earn your business.
Hidden Costs – You Get What You Pay For (and sometimes even less)
In your process of considering various competing EHR vendors, you have, of course, reached out for quotes from those vendors. Naturally, every vendor’s price is different, and you may be unclear as to the deliverables being proposed by each vendor and if there are in fact, any hidden costs in the vendor proposals.
Some EHR vendors will offer a license purchase, others may only offer a subscription (or software as a service model), and some vendors (CorrecTek included) may offer both models.
In terms of the services around the acquisition of the EHR, some vendors may offer onsite training, and others may provide online training. There may be a significant amount of initial configuration and setup involved.
You’ll probably need a few interfaces so that your shiny new EHR can share information back-and-forth with your offender management system, your pharmacy, lab, radiology, and commissary vendors, and other systems already present in your facility.
There should also be pricing on the quote for ongoing support after the implementation, as well as pricing for version upgrades to the EHR.
Some vendors may allow you to install their EHR on your existing computer network, others may only offer an internet (cloud) hosting solution (CorrecTek offers both), but in the event of an internet/cloud solution, there may be a price for those services.
Some vendors (not CorrecTek) may have a modular approach, and the prices around each module may be separated out. Some examples of add-on modules may include the electronic medication administration record (MAR, or eMAR), reporting engine, dental package, behavioral health package, etc.
The deliverables that you should look for are the following:
- Initial setup and configuration
- Initial training & go-live services
- Interface fees
- Technical support services after the initial training & go live.
- EHR software version upgrades
- Additional training & configuration services
- If add-on modules are present any or all of the above seven deliverables may be repeated for the add-on module(s).
Given the above, so far, so good, but are there hidden or misleading costs in an EHR vendor’s quote for any of the above? Let’s take each deliverable one-at-a-time and try to uncover where hidden costs might be found.
Number 1, License/Subscription – This line item is typically pretty hard to have any hidden costs apart from the question, can the subscription price increase over time?
If the licensing/subscription is based on the number of users or providers, then you will pay more to the EHR vendor if you increase your staff. This can be a hidden cost if you have planned to have more staff than allowed for on the quote. In contrast to a per user or per provider license model, CorrecTek’s licensing model is based on a snapshot of your ADP (average daily population of inmates/residents/detainees) at the time of the quote, and so there is no limit on the number of users, staff, clinicians, nurses, providers, etc. you may employ.
There are two caveats with CorrecTek’s pricing model:
1) If you significantly increase the size of your correctional facility, for example adding a new wing or pod that doubles your capacity, CorrecTek will expect a consideration for that increase in your ADP. However, the month-to-month fluctuations in ADP you will typically experience are not a concern.
2) The use of Microsoft software (such as Windows, various operating systems, SQL Server, Terminal Server, etc.) is all licensed from Microsoft based on the number of users. This is not a cost payable to CorrecTek directly, but it is a cost to you, and it will fluctuate based on the number of users you need to access the CorrecTek system. Per-user licensing fees to Microsoft can apply whether the CorrecTek EHR is hosted via the internet/cloud or the CorrecTek EHR is installed on your facility’s network.
Number 2, Initial setup and configuration – The cost of this deliverable can vary greatly, and it is hard to give an accurate estimate as it depends on whether or not you are comfortable using the standard forms/processes supplied by the EHR vendor, or you prefer to have your specific forms configured into the EHR. At CorrecTek, our smaller customers are typically comfortable just starting with our standard library and then going from there. Our larger customers usually prefer (and can afford) to have us incorporate their forms into the CorrecTek EHR from the start. The typical medium to large jail will have a hundred or more forms and for CorrecTek, the time to configure all of those workflows, processes, reports, orders, etc. can range from 200 to 300 hours. If your EHR vendor does not quote a fair price for the forms you have, you may incur a hidden cost that can “surprise” you AFTER the contract is signed.
To help address the possibility of a “surprise” after the contract is signed, CorrecTek offers the “Advantage” program that for a low monthly fee allows the customer to make unlimited configuration requests (new forms, processes, workflows, reports, etc.) at no additional charge. The “Advantage” program serves as an insurance program / bumper-to-bumper warranty to help ensure that you don’t have to go back to the powers-that-be and ask for more money to implement your EHR or keep your EHR current with newly needed forms, processes, workflows, etc. This is especially relevant if you house detainees for federal agencies as those agencies change their documentation/reporting requirements fairly frequently.
Number 3, Initial training & go-live services – The cost of this deliverable is typically spelled out in the quote, but like the initial setup and configuration services above, this cost can be deceiving if it does not accurately reflect the effort required to implement the vendor's EHR successfully.
You should consider the following when evaluating the training and go-live services:
Is the amount of training quoted sufficient? Ask the EHR vendor to justify the services provided and the likelihood of a successful implementation based on the quoted training services. If the quote is for one person onsite for one day and you have 25 users (i.e., nurses, doctors, mental health, etc.) to train, do you honestly believe one person can do that in one day?
Is a train-the-trainer model being proposed? That is, one person from the EHR vendor trains a few of your super-users and then the super-users train everyone else. This approach can work, but it has been our experience that it can be a very frustrating user experience. The individuals selected to be the super-users already have too much work to do; they are "super" after all. The individuals not chosen to be super-users may even be jealous of those selected.
Furthermore, a great nurse does not necessarily make a great trainer. The best approach is to allow the EHR vendor’s specialists to train all of your staff. Introducing an EHR is a disruptive change to the organization, and CorrecTek's trainers are experienced in dealing with the issues and frustrations that come up when healthcare staff move to a new EHR, either from paper or a competing EHR.
Is the training on-site or online? Many people believe that online training is sufficient, but it has been our experience that healthcare professionals learn much better from actual face-to-face training. CorrecTek offers an online model, but we only suggest it for smaller, well-run, facilities that understand and are willing to accept the compromises.
As a companion to our training (online or onsite), CorrecTek offers a complete, free, online, eLearning library. The use of this eLearning library can supplement online and onsite training and give your staff a jump on getting up to speed with the CorrecTek EHR. You can access this eLearning library on our website at www.correctek.com/eLearning. The eLearning library is free to the general public and includes all course material taught online or onsite by CorrecTek trainers.
Nevertheless, CorrecTek still encourages the correctional facility to invest in face-to-face, onsite, training. It is the best approach with the highest chance of success. The hidden costs of online training may come back to bite you if a failed online approach means you have to come back later and pay more for onsite training.
There is another hidden cost that can occur with initial training and go-live. If the transition to an EHR is frustrating to the users, there may be staff turnover during the implementation. This is somewhat rare but can occur especially if at the same time, other changes are happening, for example, if process changes, management changes, compliance changes, etc. are being introduced in conjunction with the new EHR. Staff turnover is also likely to occur if a healthcare vendor transition is happening at the same time an EHR implementation or transition is in progress. High staff turnover can mean additional training costs if new staff are brought on after the initial training and go-live phase.
CorrecTek typically includes as part of its initial training effort, on-site "go-live" support. With this deliverable, CorrecTek trainers will be with your staff as they begin using the CorrecTek EHR to do their daily tasks. This "go-live" assistance is crucial to full acceptance and acclimation of your staff to using the EHR productively going forward as our team is adept at helping prevent little things that show up on day one from quickly becoming big things on days two, three, and beyond. Getting started on the right foot is one of the most significant steps to continued acceptance and usage of the EHR.
Number 4, Interface fees – This area has the possibility of several hidden costs. Let’s explore each of them in detail.
First of all, the EHR vendor will have a specific price to provide an interface, say to your offender management system. Be aware that your offender management system will probably have a cost as well for an interface to an EHR. Each side of the interface (e.g., CorrecTek and the OMS vendor) will have a development, setup, test, and support cost to maintaining that interface on your behalf. Be sure you understand the initial charge from both parties as well as any ongoing support costs.
Second, for a specific interface, it can be unidirectional or bidirectional, A unidirectional interface is a one-way only interface that only allows for information to be sent one way, from say the OMS to the EHR, but not the other way, from the EHR to the OMS. A bidirectional interface allows for either system to send or receive information with the other system; information flows in both directions. Please ensure that you are being quoted for exactly the interface you need and that both the EHR vendor and the other vendor can accommodate the quoted interface. For example, some offender management systems cannot accommodate a bidirectional interface; they can send information (e.g., inmate admissions moves, and discharges), but they cannot receive information from the EHR (e.g., orders for such things as lower level, lower bunk, contagious disease alerts, etc.). CorrecTek can accommodate a bidirectional interface for any system that can support it. Some vendors may charge more for a bidirectional interface than a unidirectional interface. Make sure you have not been quoted a unidirectional price but require a bidirectional deliverable.
Another concern with interfaces is scope creep. To give a specific example of scope creep, some jails allow their custody staff to perform a limited medical intake. This limited medical intake is recorded in the offender management system. However, the standard CorrecTek OMS interface does not include support for the transfer of a limited medical intake. CorrecTek can accommodate an intake feed, but the standard CorrecTek OMS interface only includes support for inmate demographics, photographs, admissions, discharges, and intra-facility location moves. Just because the information is stored in the OMS, does not mean that an interface with the OMS has been developed to receive the information.
In this limited medical intake example, a separate interface scope-of-work can be explored to accommodate a receipt of the limited medical intake, but, again, it is not part of the standard OMS interface specifications. It is a separate interface that requires its own development, setup, testing, and on-going support. There are actually two interfaces; one interface is for patient demographics and moves, the other interface is for a limited medical intake. Even though both feeds originate from the same system (OMS), each feed is a different deliverable and requires a different level of effort to implement and support.
The hidden cost of interface scope creep occurs when after the contract is signed, the correctional facility determines that more (or new types of) information should be shared between two systems than the original interface was currently “scoped” to support.
The last hidden cost associated with interfaces occurs when the correctional organization decides to change vendors. For example, if a jail changes pharmacy vendors, then a new interface will have to be implemented to accommodate the sharing of information between the EHR and the new pharmacy system. Be sure you understand the costs of interfaces if there are vendor changes as this will require additional fees on both sides of the new interface.
Number 5, Technical support services after the initial training & go live – There are several areas of potential hidden costs around technical support having to do primarily with the availability and quality of support provided by the EHR vendor. For example, are technical support services offered 24/7 or business hours only? Is support provided via phone or online? Be sure you are clear on exactly the level of service and response time you can expect to receive for the price you are asked to pay.
If possible, ask the EHR vendor for references of other customers that use their EHR. A legitimate, and perhaps the most legitimate, question to ask those references is, “Does the EHR vendor support you and stand by you when you have problems?” Over time, the support services of the EHR vendor can become almost as important as the functionality of the EHR application itself.
Another consideration of technical support, is the pricing too good to be true? If the EHR vendor is offering full-service support for $200 to $300 a month, do you genuinely believe the EHR vendor can give you the attention you need at that pricing? Just a couple of phone calls at a typical hourly rate of $125/hour can eat right through that monthly fee. If it seems too good to be true, it probably is. The EHR will be a mission-critical 24/7 system that your medical department will be completely dependent on to manage all aspects of patient care. Make sure you have a strong support organization/relationship with your EHR vendor so that when problems arise, you can get good, timely, assistance. Technology can be a tremendous benefit when it works, but all technology products and services have the potential to “take a day off” (for lack of a better phrase). When you have problems with email, accounting software, spreadsheets, etc., it can be a serious inconvenience, but when you have a problem with the EHR, it can go beyond a serious inconvenience as patient safety issues may arise. Don’t skimp on the cost of full-service for your EHR, or you may encounter a hidden cost much higher than the EHR vendor’s price for full-service support.
Number 6, EHR software version upgrades – If you acquire the EHR with a software-as-a-service subscription model, version upgrades are typically included, and you should not be faced with any upgrade fees. You may be forced to upgrade when you don't want to (as sometimes software-as-a-service models force all of the vendors' customers to be running on the same version), but there should not be any costs to the upgrades. If you acquire the EHR via a license purchase (not a subscription), then you may be forced to pay one-time upgrade fees each time you want to upgrade to a new version.
Be sure you understand any costs associated with software version upgrades to the EHR.
With CorrecTek, both models (license purchase and subscription) include version upgrades in the pricing models. With the license purchase model as long as you continue to pay the monthly (or annual) support and upgrade fees, you can anytime at your discretion, upgrade to the latest version for no additional charge. With the subscription model, you can also upgrade to the latest version at any time for no additional charge. CorrecTek does not force any one customer to be on the same version as any other customer; each customer can upgrade at a time best suited to their needs.
Number 7, Additional training & configuration services – The number of services you may need after the sale can be hard to determine prior to signing a contract. At a minimum, you should understand the cost of those deliverables such as a per hour cost or a per service cost. Hidden costs can arise if you need new services from the EHR vendor and then you have to pay for those services outside of the agreed to budget allocated for the EHR.
CorrecTek offers two models for services after the implementation, 1) a per hour price or 2) the “Advantage” program.
With the per hour price model, a request of CorrecTek for most services (excluding interfaces which are flat fee services) allows CorrecTek to offer an estimated cost based on the number of hours required to complete the service. You, the customer, can then decide to move forward or not move forward based on your ability to afford those services. While this works in theory, in practice it forces you to request money from the powers-that-be each time you need a service from CorrecTek to keep your staff and/or your configuration up-to-date. Most governmental organization have to operate within a budget, and one-time expenses, even if reasonable, are still unexpected and likely outside of the budgeted costs.
Given these types of budget concerns that many correctional organizations face, CorrecTek offers a second model for additional services after the implementation, the CorrecTek “Advantage” program. With the Advantage program, the customer is afforded the ability to receive unlimited configuration services (and sometimes unlimited training services as well) at a flat monthly (or annual) rate. This model is an insurance policy (sort of a bumper-to-bumper warranty) against any unexpected, hidden costs associated with services needed down the road. The CorrecTek Advantage program has proven to be very popular with our customers, and we encourage you to consider it as you evaluate the CorrecTek EHR for your organization.
Number 8, add-on modules – CorrecTek does not include any add-on modules with its EHR offering, as the CorrecTek EHR is complete in and of itself. However, some EHR vendors do not offer a complete EHR for the correctional market and may include modules developed by other companies as part of their offerings. If add-on modules are included, there may be hidden costs associated with any of the deliverables associated with the add-on module(s). Due diligence on the part of the buyer is required.
In summary, there are many areas in the acquisition process of an EHR that can be prone to the latent, unwanted, appearance of hidden costs. You as the customer owe it to yourself to attempt to discover any hidden costs that may be present. Remember if the price seems to good to be true, it probably is.
At CorrecTek, we do everything we can to provide a quote with a price that captures all of the costs to CorrecTek associated with implementing the CorrecTek EHR at your facility. Feel free to ask us any question about any aspect of a CorrecTek quote. Just like you, we don’t want any surprises to arise after the contract is signed.
Full disclosure on the front-end is the best policy for all concerned, and we'll do our best to provide a full disclosure quote to you. We may not always offer the cheapest solution, but we believe we offer the best solution at the best price to meet the EHR needs of nearly any correctional organization.