Paving the Way For EHR Implementation Within the Juvenile Justice System

Evidence has shown that adolescents within the Juvenile Justice System (JJS) experience greater health disparities and have more unique health care needs than their non-delinquent counterparts. These health issues are often undiagnosed and complex, necessitating the need for good continuity of care between correctional facilities and the community. Providing continuity of care for these at risk adolescents is complicated by a lack of integrated charting templates and an Electronic Health Record (EHR), as the ten juvenile justice medical clinics contracted with a large university along the Wasatch Front are currently utilizing paper based charting. Due to the lack of an electronic medical system and integrated adolescent health charting templates, the providers that deliver care within the medical clinics are unable to provide continuity of care for the adolescent patients they serve between their various facilities and other university based health care providers. The purpose of this scholarly project was to prepare for the implementation of an EHR system into the JJS clinics through the development and integration of applicable nursing and provider templates. Review of the literature confirms the complexity of JJS, with the adolescents in the system often experiencing a lower socioeconomic status (SES) and having many unmet medical needs. The literature revealed four barriers to providing continuity of care for adolescents within the JJS: time, lack of technology for information sharing, inability to contact family or a family interest, and a lack of health care access. Research shows the positive impact that EHR charting systems that are usable/customizable have on improving continuity of care. The three objectives of this project were to: 1) leverage knowledge of EHR features and template design capabilities for project development; 2) disseminate developed templates to providers and stakeholders for project evaluation; 3) disseminate information regarding the EHR implementation process to a wider audience. Implementation and evaluation of the project included: 1) receiving IRB exemption from the University of Utah; 2) administering a pre-survey questionnaire to the JJS medical staff to assess charting and documentation preferences; 3) developing applicable templates based on pre-survey results; 4) obtaining approval of developed templates 5) disseminating developed templates to medical staff at the monthly meeting; 6) giving a post-implementation survey questionnaire; and 7) disseminating the study results to a wider audience. The project resulted in the creation of four applicable and user-friendly templates specific to the JJS medical clinics that complied with both National Commission of Correctional Health Care (NCCHC) and American Academy of Pediatrics (AAP) standards. The post-survey results showed that the templates satisfied the charting preferences identified by the pre-survey, providing proof of successful project completion. The survey results also indicated that the templates will meet the perceived charting needs within the EHR system and will improve efficiency, information sharing capabilities, and continuity of care for the adolescents within JJS. In summary, this project aimed to prepare for the implementation of an EHR system into the JJS clinics by developing applicable and user-friendly charting templates to improve continuity of care within JJS. This project is part of a wider and ongoing effort to implement the complete EHR system into the JJS clinics.