HIM at the Cook County Jail
Full-body pat downs and metal detector screenings don’t phase Linda Kampe, MPH, RHIA. As the director of correctional health information at Cermak Health Services, the healthcare clinic for detainees at Cook County Jail in Chicago, IL, they’re a mandatory part of her daily routine. Asked if the grim setting can take a psychological toll, Kampe explains, “If I stop and think about it, yes, but I try to just focus on my tasks at hand and not think about the circumstances under which many of our patients are here.”
Kampe acted as the tour guide for a small group of AHIMA members during the AHIMA19: Health Data and Information Conference held last September, giving attendees a rare glimpse into her workplace—a healthcare setting seldom seen by the public. The group walked through unoccupied sections of the jail’s living quarters, reminiscent of the housing featured in the television series Oz, and explored the underground tunnels that connect the buildings of the sprawling 99-acre jail complex. As the tour continued, it was easy to appreciate the tenacity Kampe’s position requires. “You can almost feel the despair,” Kampe noted as the group walked through the abandoned cell block, punctuated with dead roaches and concrete bunks.
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Affinity for Nontraditional HIM Jobs
Kampe received her bachelor’s degree in health information management (HIM) in 1987 from the University of Illinois at Chicago (UIC), where she discovered an early interest in public health and research.“When I graduated from the UIC program, I didn’t really know what direction I was going to go. I just knew that I didn’t really want to work in a hospital setting. One of my professors told me, ‘Hey, there’s someone over at the school of public health doing some research. He needs somebody to abstract some [emergency room] charts. Do you think you could help him?’” Kampe recalls. And she thought, “Why not? I’ll call him.”
“That project led to another, to another, to another, and that’s how my career took off,” Kampe says.
When a colleague approached her about applying to UIC’s first online master of public health (MPH) program, Kampe hesitated, arguing that having three small children and a full-time HIM job left her with little time for a new degree. Yet, her colleague persisted.
“You’re doing all the work of a person with an MPH, but you don’t have the credentials,” he told Kampe.
“So I did the online program and, yes, it took me a little bit longer because of my personal situation with raising my family, and all the mom duties and household duties,” says Kampe. “But I did it. I got the MPH 20 years after I graduated from my bachelor’s program.”
In 2008, Kampe was working at John H. Stroger, Jr. Hospital, formerly known as Cook County Hospital, when a coworker told her about the HIM director role at Cermak Health Services, which is part of the Cook County system. The facility needed someone who could help convert the jail’s paper records to an electronic health record (EHR) system. She didn’t think twice about applying and was undaunted by the prospect of working in what many might consider to be an unsettling environment.
HIM Behind Bars
When Kampe started her EHR conversion project at Cermak, there was an adjustment period; Cermak employees aren’t allowed cell phones without special permission and she had to invest in a see-through bag for personal belongings that she brings into the building. She acknowledges that periodic lockdowns made her nervous when she started there. Not much phases her now, although the question she gets most often from other HIM professionals is: “Is working at the jail scary?”It’s not hard to understand this line of questioning. When the jail is in the news, it’s usually reports on riots and prisoner escapes. The facility was put under a consent decree, or federal oversight, in 2007 when a Department of Justice investigation looked into “allegations of abuse and unconstitutional confinement, issuing a report a year later that found glaring deficiencies across the board, including in medical care, detainee safety and excessive force,” the Chicago Tribune reported. The jail was released from the federal oversight in 2017. Significant reforms were enacted by the consent decree and the facility is now touted as a federal model for addressing mental health and addiction issues. In the last five years, the population of the jail has dropped from 10,000 detainees to about half that. However, the acuity of the health of that population has gotten worse.
The first day a new patient arrives for processing—healthcare staff only refer to inmates/detainees as “patients”—they receive physical and psychiatric screenings, including a chest X-ray as a tuberculosis screening. They can also request dental services and a visit with an optometrist if eyeglasses need to be made. The clinics include an obstetrics department, a women’s contraception program, dialysis care, radiology, a laboratory, and an urgent care clinic.
Because detainees often enter the jail with substance abuse issues, Cermak has detox housing and works with patients on methadone taper plans. The facility is also certified as a Medication Assisted Treatment (MAT) program. The onsite pharmacy dispenses up to 500,000 doses of medications per month.
As AHIMA members noted during the site visit, the Cermak clinic looks like any other healthcare facility, aside from the razor wire that runs the perimeter of the facility and the bars that cover every window. Now that the massive EHR conversion project is complete, Kampe’s HIM responsibilities are comparable with those of an HIM director in any hospital—albeit with a twist. Patient matching is a challenge for any kind of provider, but for Kampe it can mean untangling the records for patients for whom revealing their legal name is not advantageous. She’s seen cases where siblings have been processed through the jail but use each other’s names to avoid lengthening their criminal record. She’s also been sent on labyrinthine quests to track down the medical records of patients whose records are in long-term storage, but are suddenly relevant due to post-conviction appeals.
Care coordination and release of information, critical tasks for any HIM department, carry additional weight in correctional health and attempts to address recidivism.
“I think it makes a big difference if we provide the information to the other organizations, such as halfway houses, which are helping the people on the outside indirectly. What we do, keeping accurate records, keeping them safe, making sure everything’s released and where it’s supposed to be, I think it makes a big difference,” Kampe says.
Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.