An Advocate for Modern, Accessible Correctional Health Information Systems

In July, Pauline Marcussen, DHA, RHIA, CCHP, administrator of healthcare services at the Rhode Island Department of Corrections (RIDOC) and a part of the policy and research committee for the National Commission on Correctional Health Care (NCCHC), wrote about HIPAA in an online article announcing a new NCCHC position statement aimed at improving healthcare for individuals re-entering the community after time in jail or prison, Sharing of Patient Health Records Upon Release From Incarceration.

“HIPAA was put in place to provide patients access to their own personal health information. Health care provided in the correctional environment is part of the health care delivery system,” she says.

Marcussen has a way of calling situations likes she sees them.

The first time she came across the job posting for a health information (HI) professional at RIDOC, “I blew it off,” she says.

She hadn’t yet imagined a path leading to a correctional healthcare career. Her interest in health records management had started when she was a teen, helping out with files in the convalescent home her family owned. Now she was in her first healthcare job, as the operations manager overseeing HI and administration at Lawrence and Memorial Hospital located in the coastal city of New London, CT.

Three months later, the RIDOC job was reposted. That time, “I thought, ‘You know what, why not? Let’s give it a shot.’”

Credentialed By and Representing AHIMA

Marcussen is now coming up on her 25th year of work on the RIDOC multi-facility campus in Cranston, RI, south of Providence.

In that time, in addition to AHIMA’s RHIA credential after her name, Marcussen has added a doctorate in health administration and a CCHP credential—Certified Correctional Health Professional—from the NCCHC, whose mission is improving the quality of healthcare in jails, prisons, and juvenile confinement facilities through standards-setting, accreditation, certification, published resources, and educational conferences.

For 2021, she serves as the NCCHC Board chair-elect, having served for multiple years as the AHIMA liaison representing HI on the board’s multidisciplinary-by-design roster.

A Paper System in Need of Updating

“I started there when it was paper,” Marcussen says of the records system when she arrived at RIDOC in 1997.

In the hospital where she had worked previously, the records were partially on paper and had partially moved to electronic—“not completely electronic, but enough,” she says. But a digital system did not exist at RIDOC yet. The healthcare staff was responsible for tracking a paper trail that spanned six building.

When a person was transferred, “we would put all the records in a bag, and we’d bring them over to the next building. Everything was paper,” Marcussen says.

Forget the bag, and the clinician was left scrambling for information.

Or a record might be misplaced. “Everybody had to help look for it,” she says, temporarily grinding work to a halt.

She knew that technology would improve processes, costs, and care and was relentless in advocating for that change. “I’d say, ‘We’re almost in the year 2000!’ Every year, when it was a budget year, I would say, we need to get rid of paper. We need to get rid of paper.”

One of the First Correctional EHRs

In 2009, all that advocacy finally bore fruit when RIDOC got funding for an electronic health record (EHR). AHIMA recommended a consultant to help the team with early planning. By the end of the year, the campus had its first digital system implemented up and running.

RIDOC was one of the first correctional facilities in the country to make the switch from paper to fully electronic records, streamlining everything from individual assessments and treatments to vaccinations and prescription reorders.

“It’s been extremely beneficial to our patient population and their community providers,” Marcussen says.

The usual, what she calls, “culture shock,” was involved. Some clinical staff members flat-out called in sick on the go-live day. “It didn’t stop me,” she says. “After a good six months, they didn’t want to touch paper,” ever again, as they saw the impact of the EHR. “Now there’s no delay in meds. There’s no duplication of effort when it comes to diagnostic testing.”

Today, the digital wish includes the latest advancements. “A little bit of artificial intelligence,” Marcussen says, “would be great. If the equipment we use could interface with the actual EHR so you don’t have to go through and scan in a document or document blood pressure and vital signs by hand.”

Extending Access Outside the Prison Walls

One key feature of RIDOC’s EHR is that it links up with Rhode Island’s state health information exchange (HIE), which allows providers in the community to access health records for patients who have been recently released from the facility.

During their first two weeks after leaving prison, a study published by the New England Journal of Medicine suggests, a formerly incarcerated person is 12 times more likely to die compared to others in their community. One underlying cause is patients’ and their providers’ difficulty in accessing health information and continuing care for health issues that can quickly escalate such as heart disease, mental health difficulties, and HIV.

When individuals leave RIDOC and its health system, the discharge team includes a medical discharge planner who provides information on how to access their health records from outside, in the community.

The NCCHC guidelines that Marcussen worked on were also designed with the goal of ensuring formerly incarcerated individuals’ health information is easily accessible and facilitates continuity of care.

The recommendations cover seven actions for correctional facilities. One is having electronic health records in place at the facility. Another is working with state HIEs to ensure individuals or their community healthcare providers have access to their records at the time, or shortly after, the individual walks out the gates.

‘I Saw a Doctor This Week’

As Marcussen goes about her daily life, she finds herself not infrequently running into individuals outside of work who she helped provide care for during their incarceration.

“It’s rewarding when somebody says to me, ‘Hey, I saw a doctor this week,’” or simply, “‘My meds are current.’”

Those encounters underscore that correctional healthcare is also public health, delivering care to once and likely future members of a community. Productive, contributing members, if all goes well.

“I’m here to provide healthcare. They’re going to be my neighbors,” Marcussen says. “And they will run into me at the mall.”