Hawaii’s Prison Medical Records System Has Reached A Point of ‘Absolute Crisis’

The state correctional system is struggling with an electronic medical records system that hasn’t worked properly since June, and medical staff at Hawaii prisons and jails are unable to access medical records including vaccination data for many inmates, according to corrections workers.

That last point is particularly frustrating because the Department of Public Safety began offering $50 incentive payments to prisoners more than a year ago to encourage them to get vaccinated against Covid-19 to try to slow the spread of the coronavirus inside state correctional facilities.

Many inmates’ vaccination records were scanned and loaded into the electronic system, but those are now unavailable to prison health care workers, according to staff who are familiar with the problem. The missing data includes records for inmates who have been vaccinated since April 2021, staff said.

Christin Johnson, coordinator for the Hawaii Correctional Systems Oversight Commission, described the problem Thursday as “an absolute crisis,” and said “the fact that EMR (Electronic Medical Records system) has been down for over six months is unacceptable.”

“Patient safety and health is at risk without a functioning EMR,” she said, particularly when inmates move between facilities. She told the commission that “this is obviously a massive liability for the department.”

Department of Public Safety spokeswoman Toni Schwartz said in an emailed statement that the department began a process in 2021 to purchase a new inmate database including a new electronic medical records system to replace the old one, but that process is still in procurement. The request for proposals sets a deadline for installing the new system in 2025.

“Unfortunately, the current system failed before the procurement process could be completed,” Schwartz said. In the meantime, the department has been working on an interim solution “and is awaiting vendor quotes” for that shorter-term fix, she added.

The department said the current EMR system is old — it was purchased in 2008 — and “when the system started failing earlier this year, the department acknowledged the urgency of the matter by immediately contacting the vendor and working with them to find a viable solution,” according to the statement.

The department recently purchased and has been testing new servers for the old system but was told by the vendor the next available date to migrate data to the servers is next month.

As for the vaccination records, Schwartz said in her statement that apart from Public Safety’s records, inmates’ vaccination status was entered in the Hawaii Immunization Registry maintained by the state Department of Health. The Public Safety department has so far spent nearly $242,000 on the incentive program to encourage inmates to get vaccinated.

About 6,000 inmates have tested positive for Covid-19 since the pandemic began in March 2020 — some of them twice or more — and 10 inmate deaths have been blamed on the disease.

Staff said the department cannot vaccinate inmates with the new bivalent vaccine booster shots now being recommended by the health department unless it can confirm the prisoners already have completed a first series of vaccines. But to do that, prison officials need access to the inmates’ vaccination records.

Covid-19 clusters have been a continuing problem in Hawaii prisons. Halawa Correctional Facility had 178 active cases and Waiawa Correctional Facility had 39 on Dec. 6, although those numbers have dropped since then as the inmates recovered.

The electronic medical records keeping system failed on June 14, forcing officials to revert to more old-fashioned methods of pen-and-paper record-keeping in many instances. “Health care is currently running their operations manually,” the department said Thursday.

Corrections officials have acknowledged that when Public Safety’s EMR system was first installed, it was set up so the data was stored on a hard drive rather than on the cloud. Tommy Johnson, recently appointed director of the Department of Public Safety, said in August that in the future data would be stored on the cloud and would be automatically backed up.

This week, Schwartz said the department is still waiting to learn from the vendor whether it will be possible to move data from the old system to the cloud.

Tommy Johnson also acknowledged in August that periodic software updates to the old system were not done, and said they would be done going forward. The department also disclosed at the time that some data might be lost and would need to be entered into the system again manually.

The department said in its statement Thursday that health care staff currently has “read-only access” to data in the old system up until September 2021. Corrections staff who spoke this week on condition that they not be identified said about 18 months of patient data is currently inaccessible.

Earlier this year after the system failed the state set up what was supposed to be a temporary, stand-alone system as a substitute for the malfunctioning system, but at times the staff at the facilities have also had to resort to paper charts.

Switching between the systems causes confusion and makes it difficult to track patient records, which has resulted in “dozens” of errors, staff said.

Martha Torney, a member of the commission, proposed at Thursday’s meeting that the commission draft a letter to the new public safety director explaining that “this is unacceptable, and we want to be kept up to date and informed as to what is happening with the electronic medical records system. It cannot continue this way, and we want some results.”

Christin Johnson said she would draft the letter.