It is your first week as the health information supervisor of a reception facility in a prison system. During your initial interviews with staff, you hear complaints of staffing shortages and poor relationships with other facilities in the system. There are so few trained medical staff that guards and some record technicians have taken on responsibility for documenting inmate histories. Members of the medical staff know they are performing duplicate lab tests, but the medical records are not available to verify previous tests and corroborate inmate complaints. You also learn that several inmates are filing lawsuits claiming deliberate indifference because a tuberculosis test was not performed on another inmate who infected his cellmates after being transferred from your facility. Because the medical records are stored by the discharging facility, they are not available to the reception center. You know by law that the staff must complete a health status within 24 hours and a physical exam within seven 7 days, but most inmates are transferred after four days, which does not provide enough time to transfer records. A cursory examination of the electronic information system indicates that it lacks relevant data on prescription drugs, dates of tests, HIV status, and allergies, and therefore cannot compensate for a lack of medical records. The staff turnover rate at the facility averages 40 percent. 

How will you prioritize the issues you identify?

What recommendations would you make?