The electronic health care record-keeping system for thousands of Hawaii prison and jail inmates has been on the fritz since June, temporarily leaving correctional workers without access to tens of thousands of medical records including information needed to provide proper care to state prisoners.

The failure of the electronic medical records system was described as “an absolute crisis” by Christin Johnson, oversight coordinator for the Hawaii Correctional System Oversight Commission.

Johnson told the commission earlier this month the system failed on June 14, and “this is causing the medical staff to rely on a paper-and-pen based system, and there’s no real indication of when the EMR might be back up and running.”

Corrections staff who spoke on condition that they not be identified said health care workers were unable to access nine months of inmate medical records for 10 weeks after the system failed, including lab work, prescriptions, referrals for care, follow-up appointments and more.

Oahu Community Correctional Center.
Inmate medical records at the Oahu Community Correctional Center and other state correctional facilities were unavailable to correctional staffs for 10 weeks after a system failure in June. Cory Lum/Civil Beat/2022

The records failure affected the work of medical providers, the nursing staff and mental health providers, and has created both safety and liability concerns.

Staff said it is unclear if any inmates suffered any serious harm because their medical information was unavailable for parts of the spring and summer, and corrections officials declined to say Friday if any inmates were harmed.

As of last week the system had been patched up to the point that all but two months of records from this spring were available on a read-only basis. Health workers were briefly able to input data into the system late last week, but it quickly crashed again, staff said.

The records problems, which one staffer described as “an epic fail,” also prevented prison medical officials from providing the proper medical clearances for about 150 inmates who were shipped off to a privately run prison in Arizona earlier this month. The proper clearances could not be provided because supporting documentation was unavailable.

Hawaii holds 1,086 inmates at the Saguaro Correctional Center in Eloy, Arizona, which is operated by the private prison company CoreCivic. Medical clearances for inmates arriving from Hawaii are required under the contract between the state Department of Public Safety and CoreCivic.

Tommy Johnson, deputy director of the Department of Public Safety, told the commission on Aug. 18 the system is back up for read-only access to some records but confirmed new data cannot be inputted into the system.

To help cope with that issue, the state had a two terabyte, stand-alone system set up where staff can upload data temporarily, he said. “Prior to that, they were doing hard copy documents, and then scanning them into a folder,” Tommy Johnson said.

As for the old data, if it turns out that some data cannot be recovered, “then that information might have to be input into the system,” he said.

When the system was installed nine years ago, it was set up so the data was stored on a hard drive rather than on the cloud, Tommy Johnson said, adding that going forward the data will be stored on the cloud and automatically backed up.

“The second thing that happened was periodic updates to the system weren’t being done, and now they will be done,” Johnston said. He said the department agreed to pay the vendor an “additional amount” to try to recover the inaccessible data.

“We don’t have a set date when a system will be up and running, but it’s not from lack of trying on our part and not from lack of due diligence on the vendor’s part,” Tommy Johnson said.

The department said in a written statement Friday all records up to April 15 are accessible, but data from April 16 to the present “may have to be manually inputted.”

The department declined to answer follow-up questions about the system failure, and Public Safety also did not name the vendor. Staff identified the software company as eClinicalWorks, which has been the subject of federal scrutiny in recent years.

The department also did not respond to requests for more information about what caused the failure, and how much the state is paying the vendor to recover the data.

Hawaii Prisoners Halawa Prison board Omni Air charter Honolulu Airport. 2 feb 2017
Hawaii inmates board a plane to a mainland prison in 2017. Hawaii’s contract with private prison operator CoreCivic requires medical clearances for prisoners before they are sent to a facility in Arizona, but the medical staff could not provide that clearance for prisoners who were shipped out last month. Cory Lum/Civil Beat

Corrections staff said the primary problem with the system is the state was supposed to pay extra for periodic software updates — and the medical staff had been asking for funding for those updates for years — but the money for the upgrades was never made available.

By the time the system failed, the Hawaii prison system was using the original version of the EMR program, but the vendor had issued nearly a dozen system updates or new versions over the years. “Imagine never updating your computer, and expecting it to work,” one staffer said.

Ted Sakai, a commission member who formerly served as director of the department, pointed out that when inmates are sent out of a facility to receive medical care from a specialist, the specialists need to see the medical records of the inmates they are treating.

“The EMR is a critical issue,” Sakai said.

Staff confirmed that concern, saying patient referrals to experts outside the prison health care system for everything from cardiology to neurology were lost or unavailable for weeks.

Also of great concern to staff is the difficulty in getting information on each patient. Health care data on any specific patient may now be found in scanned or paper records in the temporary stand-alone system or in the wobbling old system’s read-only files.

Christin Johnson said the department has been working hard to fix the problem, “but my deep concern is that out in the public, if the EMR goes down in a hospital for even an hour, it’s an absolute crisis for everyone involved, and so for this to be down since June 14 created very serious concerns.”

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