E-Prescribing and The NYC Jail System. Ross MacDonald, MD Medical Director, Correctional Health Services NYC Department of Health and Mental Hygiene
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1 E-Prescribing and The NYC Jail System Ross MacDonald, MD Medical Director, Correctional Health Services NYC Department of Health and Mental Hygiene
2 None Disclosures
3 NYC Jail System
4 New York City Jail System 12 NYCDOC Jail Facilities 60,000 new admissions in 2013 Average daily census: ~12,000 Average length of stay: 37 days (median closer to 7 days) System wide Electronic Health Record Phased in
5 Many cooks in the kitchen * NYC Charter
6 Discharge Planning Workflow Upon admission to the jail all patients receive a medical evaluation. Those who need Mental Health services are referred. 1A Mental Health Assessment Psychosocial CTP Psychiatric Assessment DP Recommendation Treatment Plan Review (TPR) 1B Client Encounter Discharge Planning Initiation Caseworker begins Pre-Screening Medicaid Assistance & Application Consent To Release Brad H. Information General Consent To Release Information SW/CW Discharge Planning Session Public Assistance/Food Stamps Medicaid Assistance Medicaid Reactivation New Application 2 SW Discharge Planning Session Community Referral Care Coordination Link Referral VA Assistance SSA Assistance 5 Supportive Housing Assistance Consent To Release 3 Pre-Release Conference: Preparation of Deliverables MGP Medication Support (Walking Meds) Transportation DHS (Referral) 4 Day of Release: After Care Letter Walking Meds Prescriptions MGP Card Bus Pick-up 5 Post-Release Follow-up: Mental Health Appointments Mental Health Referrals Housing Clinical Assessments Housing Offerings
7 Discharge Planning Brad H. Stats FY13 FY13: 16, 399 CTP: 11,986 Discharge Plans: 11,300 Medicaid Prescreening: 5,170 Medicaid Applications: 2,477 PA Applications: 775 Referrals: 1,137 Appointments: 3,578 Walking Meds: 3,489 HRA2010e: 441 But Monthly Rate is Closer to 500/Month (~6000/year)
8 Medication Grant Program The Medication Grant Program, authorized under Section 15 of Kendra s Law, provides grants to counties to pay for the cost of medications to treat mental illness and other services needed to prescribe and administer medications for eligible individuals. Enrollment in the program is limited to individuals who have filed a Medicaid application prior to or within seven days of discharge/release from hospital or correctional facility. In addition to Medicaid, most applicants will need Cash Assistance and Food Stamps.
9 MGP Eligibility and Benefits Individuals with mental illness being released from State and local correctional facilities, or discharged from psychiatric inpatient units in hospitals operated or licensed by the Office of Mental Health; Psychiatric Medication expenses; There are 3,800 pharmacies statewide, 2,000 in New York City.
10 Other Walking Meds/Discharge Prescriptions Transitional Healthcare Coordination (THCC) Patients Living with HIV Med-watch list
11 E-Prescribing Challenges Inpatient Prescriptions are OK Class 3 Institutional Prescriber All Outpatient Prescriptions e-prescribing Starting 3/27/15 Even walking meds must be e-prescribed to ourselves Other meds must be e-prescribed to our patients chosen pharmacy
12 Challenges, Cont d What if you don t have an EHR? What if you re not an institutional prescriber?
13 Challenges, Cont d Will the Meds be Filled What will happen when SMI patients have to go to the right place for meds? Health Homes? Potential Solutions We dispense 30 days $ Specialty Pharmacy RFP How do they find the patients?
14 E-prescribing Benefits Workflow centralization Other meds? DM meds HTN meds Epilepsy meds Naloxone for OD prevention Dry skin lotion? Where to draw the line?
15 Thanks Patricia Brown Executive Director, Community and Behavioral Health Initiatives, NYC DOHMH Alison Jordan Executive Director, Transitional Health Care Coordination, NYC DOHMH Danielle Petrocelli, Rommel Babaan Pharmacy Ops Gurus, NYC DOHMH Richard Stazesky Assistant Commissioner, Information Technology Initiatives, NYC DOHMH
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