By Mary Butler
Many health information management (HIM) professionals lament the fact that their departments are often in the basements of hospitals. Linda Kampe, MPH, RHIA, is grateful her ground-level office has windows—even though there are bars over them. As the director of correctional health information for Cermak Health Services at the Cook County Jail, Kampe’s responsibilities are not radically different from those of a typical HIM director, even though the care setting in which she’s carrying them out might make others in the industry nervous.
On Monday, a group of nine AHIMA19 Conference attendees had the rare opportunity to tour Kampe’s workplace, which just happens to have housed some of Chicago’s most notorious individuals, including Richard Speck and John Wayne Gacy. All visitors must be cleared by the Cook County Department of Corrections. Security procedures for staff and visitors are tight—even staff aren’t allowed to bring in cell phones without special permission—and they undergo pat-downs every day before they can be allowed in the building. Kampe uses a clear briefcase for her personal belongings.
Despite the restrictive procedures, Kampe says it’s a common misconception that her work environment is unsafe. She has never personally felt that her physical safety is threatened, even though there are periodic lockdowns.
“I absolutely love what I do,” says Kampe, who has worked at Cermak for 11 years. “Our providers are phenomenal. People don’t realize—we have great healthcare and people who are truly dedicated to this area of underserved people.”
Healthcare Behind Bars
Cermak Health Services provides care exclusively for detainees at Cook County Jail, one of the largest single-site county jails in the country, occupying almost 100 acres.
“Five years ago, the jail population was over 10,000 people, but now our average population, I think, is 6,000. However, even though the population has decreased, the acuity has gone up. So even though we are getting fewer patients, people are sicker for some reason,” Kampe says.
Cermak provides extensive healthcare services for detainees, always referred to as “patients” by medical staff. The first day a new patient arrives for processing, they receive physical and psychiatric screenings, including a chest X-ray and a tuberculosis screening. They can also request dental services and a visit with an optometrist if eyeglasses need to be made. The clinic has 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. Staff pharmacists also provide training on the opioid overdose drug Narcan.
Records and Regulations
Kampe was hired at Cermak to help implement an electronic health record (EHR) to document the care delivered to patients while they’re at the Cook County Jail, as well as those that are transferred to other Illinois prisons.
“When I walked in it was totally paper and it was totally paper chaos,” Kampe says. “The jail is divided into divisions that can hold up to 2,000 people, and so they had different satellite medical records offices and every single one has little divisions. The sheriff moves inmates around constantly and notifications weren’t being sent when this happens, so new records were being created for the same patient.”
The on-site pharmacy, which dispenses up to 500,000 doses per month, also had a paper-based system that generated documentation every time a patient was given a medication. Needless to say, the facility was drowning in paper when Kampe arrived. On top of that, policy required that medical records for every patient be kept forever. However, in recent years record retention rules have changed, and are now aligned with private hospitals that require they be kept for 10 years.
Kampe is passionate about following HIPAA privacy regulations for her patients as well as the Illinois Mental Health and Developmental Disabilities Confidentiality Act. Because it’s more common for Cermak patients to receive mental health and/or substance abuse treatments in this setting, their records are subject to extra protections compared to typical hospital and physician office records. While patients can request their records, there are regulations around what they can see.
“For instance, we cannot deny someone from requesting their records; we will give them a request form. But we can deny them release of their information while they’re still detained for the safety, security, and operations of the facility,” Kampe says.
Giving a patient their full record would give them access to the full names of every nurse, physician, or provider they’ve seen, and this could put the provider’s safety at risk. Patients are encouraged to ask providers to go over their records in person instead.