because they had no previous history. It was really important to capture [information] at intake time, so if they did return it would only take a few minutes to pull the information up."

Even if the patient didn't come back to the system as an inmate, there were time savings to be realized. "We designed it so that if they come here, or actually come to any of the hospitals in Cleveland that also use Epic, they would at least have the assessment and intake records available," Weir-Boylan said. "Upon their release, we knew that almost 50% of the inmates, when we put them in the Epic system, were already MetroHealth patients."

Modular Integration

Putting the system together to meet the jail's needs involved off-the-shelf software used in very particular ways. "Epic is built on modules," according to Reichert. "They did not have a module specifically for a jail population." He explained that in order to make the system work, "We had to take bits and pieces from different modules. In the jail, they have an infirmary that's like a regular intake process. They have people who are only there for an hour or two, so it's more like an ambulatory care process. And then they have people who may have to be there intermittently, kind of like an [emergency department], so we had to take bits and pieces of each module to design and make it effective."

Donald Reichert, Vice President/Associate CIO

According to Reichert and Weir-Boylan, the jail integration project happened simultaneously with an even larger software push throughout the MetroHealth System. "Through this nine-month implementation, we did an Epic upgrade," Reichert said. "We also implemented Epic's hospital billing system, their OR system, their anesthesia system, their registration system, as well as some new reporting tools. We also implemented the new lab system. So, there was pretty much all hands on deck to make this happen."

Why upgrade and implement all this software at the same time? Reichert explained that it was a mixture of planning and coincidence. "We've been an Epic client since 1998, and we've rolled out modules throughout the years. We made the conscious decision to go Enterprise Epic, which means we buy everything they sell," he said. "In doing that, we identified some projects, particularly billing and OR, where we needed to move sooner rather than later."

On the billing side, the organization was using a 30-year-old system from Siemens, according to Reichert. "We either had to upgrade Siemens or move to Epic," he said. "Through that process was when the jail project came up." From that point, it was a question of resources. "We had to evaluate to see if we had the resources to make it happen, and we were able to, with Epic's help. They were helping with the other implementations as well -- we weren't doing it on our own," he said.

Moving Forward

With the jail project now in the "success" category, we asked whether MetroHealth had plans to expand on the work that had been done for the project. Weir-Boylan and Reichert each said yes, though their answers went in slightly different directions.

Reichert began with a look at where they might go next within the organization. "For the jail, specifically, the next road we want to go down is telehealth. We're piloting telehealth right now with the jail for psychiatry, but it would be nice to have telehealth for all disciplines through Epic," he said. "That's the next big thing, and it's not just the jail -- we're looking at it enterprise-wide."

Mary Weir-Boylan, Vice President, Ambulatory Operations

Weir-Boylan is looking to the broader community for next steps. She noted that many of the inmates, male and female, are parents, and some of the women coming in are pregnant. "Being able to support the re-entry program is important for us," she said. "We want to make sure that we're not just taking care of the inmate, we're extending that out to the family, and hopefully they can turn things around, at least from a health perspective."

Lessons learned in the jail program are already being applied to the wider community, and Weir-Boylan said she sees that continuing into the future.

"As a county-run hospital, one of the things we constantly look at is: How can we better serve the citizens of Cleveland, Ohio? There are many aspects to that. All the dots aren't necessarily connected, but we're trying to connect them," she said. "We have 11 sites now where we're going in and taking care of the children in the schools for things like immunizations. That can have a dramatic impact because, in some cases, especially in the low-income areas, people have trouble affording or getting to a physician. Now, we're coming to them through the schools, and if they show up at the hospital or one of our doctors' offices or clinics, their information is already there and we can give them better treatment."