Federal inmates to get more advanced electronic health records

The Bureau of Prisons is starting to shop around for a new electronic health record system for federal inmates.

The federal prison system already has a basic EHR -- the Bureau Electronic Medical Record, which has been in place in 2006, handles inmate data, prescription drug information, and supports some more advanced functions, including telemedicine for X-rays.

The BOP now appears to be scoping out a more advanced system that includes clinical decision-making capabilities, mobility, infectious disease outbreak management, and compliance with meaningful use guidelines promulgated by government and industry. Like any RFI, it does not put the agency on the hook to actually make a formal solicitation.

The EHR would serve a population of 219,000 federal offenders, about 80 percent of whom reside in federal facilities, with the rest scattered in privately-managed or local institutions. The BOP maintains a staff of 245 primary care physicians at its prisons, with an additional 165 physicians and 460 beds at seven advanced care facilities. While the effort is small compared with plans for a behemoth $11 billion EHR system at the Department of Defense, a request for information released by the BOP on May 30 spotlights some of the unique challenges of health care IT behind prison walls.

The BOP is looking to hear from individual EHR software firms and integrators. The RFI specifies that "vendors should ... take care to recognize the secure environment in which the solution will be deployed, e.g., inmates may be housed in open general population units or may be confined in a special housing unit where they are primarily confined to their cell for most of the day. Thus, any proposed solution should also include discussion of any mobile capabilities or limitations to ensure that the system can be accessed throughout various locations within the facility." The contracting document also advises that "vendors should also be cognizant that construction materials (such as concrete and rebar) may limit deployment options."

Security is also an important factor. The bureau is seeking information on whether a system supports 128-bit encryption, if it can build an audit trail of use, and supply tiered privileges that offer practitioners, administrators and IT personnel the appropriate level of access based on their needs.

The RFI makes no mention of whether an inmate's health record should be portable and can follow an inmate into the private or government health care system upon his or her release from custody. But the bureau is interested in learning from vendors whether their commercial EHR systems are interoperable with existing third-party systems.