Butler Ben
Community Oriented Correctional Health Services in Oakland, CA.
Perspect Health Inf Manag. 2014 Jan 1;11(Winter):1b. eCollection 2014.
Jails have often been compared to islands because they are thought to be cut off from the community both physically and perceptually. Few people understand that besides being places of confinement, jails function as health care providers. The separation of jails from community results in disjointed health care services and treatment for individuals cycling in and out of jail. Healthcare providers in the community have little knowledge of the care their patients have received in jail; the same can be said of jail health providers about care provided in the community. With the passage of the Affordable Care Act (ACA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), the federal government took the lead respectively in expanding health insurance coverage and in spurring the adoption of electronic health records (EHRs) and the development of health information exchanges (HIEs). Taken together, these initiatives place a strong emphasis on promoting continuity of care. With the expansion of Medicaid under the ACA, many of the individuals leaving jail will have access to health insurance for the first time. Community-based providers to the newly insured will want to know about the care that was provided in the jail. The developing technological infrastructure would seem to offer the best way to access this information. However linking the community and jail information systems is not just a technological issue, but requires the cooperation of all stakeholders.
one in which a single champion made the decision to link the jail health care system to the local HIE and the other where all stakeholders were included in the process. In the first case study, the jail healthcare system reverted to its "island" status when the HIE was abandoned without protest from community stakeholders. In the second case study, the multiple stakeholder approach, while not necessarily a complete guarantee of long-term success, ensured that the jail healthcare system could not so easily go back to being an island cut off from the rest of the community.
监狱常被比作岛屿，因为人们认为它们在物理和认知上都与社区隔绝。很少有人明白，监狱除了是监禁场所外，还充当医疗服务提供者。监狱与社区的分离导致医疗服务脱节，对进出监狱的人员的治疗也出现脱节。社区的医疗服务提供者对其患者在监狱中接受的治疗知之甚少；监狱的医疗服务提供者对社区提供的治疗情况也同样了解甚少。随着《平价医疗法案》（ACA）和《经济和临床健康信息技术法案》（HITECH）的通过，联邦政府分别在扩大医疗保险覆盖范围以及推动电子健康记录（EHR）的采用和健康信息交换（HIE）的发展方面发挥了带头作用。综合来看，这些举措大力强调促进医疗服务的连续性。随着ACA下医疗补助的扩大，许多出狱人员将首次获得医疗保险。为这些新参保人员提供服务的社区医疗服务提供者会想了解他们在监狱中接受的治疗情况。不断发展的技术基础设施似乎提供了获取这些信息的最佳途径。然而，将社区和监狱信息系统连接起来不仅仅是一个技术问题，而是需要所有利益相关者的合作。
一个案例中，一位倡导者独自决定将监狱医疗系统与当地的HIE连接起来；另一个案例中，所有利益相关者都参与了这一过程。在第一个案例研究中，当HIE被放弃且未遭到社区利益相关者抗议时，监狱医疗系统又恢复到了其“孤岛”状态。在第二个案例研究中，多方利益相关者参与的方法虽然不一定能完全保证长期成功，但确保了监狱医疗系统不会轻易再次变回与社区其他部分隔绝的孤岛。
