Research analysis: The benefits of telemedicine for inmate healthcare
Telehealth programs can increase inmate access to care, lower costs and allow inmates to be seen sooner
Editor's note: Video technology is impacting every facet of modern-day life, shaping the delivery of education and training, transforming how we communicate with each other, and advancing surveillance and security. This special coverage series, Video in Corrections: How Technology is Transforming Prison & Jail Operations, takes an in-depth look at how correctional facilities can use video to improve both operational efficiency and officer and inmate health and safety. Watch for further installments of this series throughout February.
By Catherine R. Counts
The review starts with a summary of the health of the incarcerated in the United States including an inventory of the diseases that disproportionately afflict this population such as:
- Hepatitis C;
- Chronic conditions like COPD, asthma and high blood pressure;
- Various mental health disorders.
Based on their search results, the authors split research on telemedicine in the correctional setting into three categories:
1. Uses and benefits of telehealth in correctional care
Telemedicine can be timed one of two ways. Either by creating a live interaction between the patient and provider, known as synchronous, or in an asynchronous manner when information such as imagery or lab results is sent to the provider to be reviewed at another time.
Given the improvement in encryption technologies, cameras and even electronic monitoring systems, synchronous telemedicine has been applied to psychiatric, surgical and emergency medicine settings. One study in the adolescent population saw a 57% decrease in wait times for medical care referrals, as well as an increase in outpatient visits mirrored by a similar decrease in emergency department visits.
Asynchronous telemedicine is often seen in the context of specialties such as dermatology and radiology.
In both cases, telemedicine removes some of the logistical and transportation barriers associated with providing necessary access to healthcare. This includes the need to have shackled prisoners in a health center waiting area with the general public.
2. Implementing an effective and sustainable telehealth program
The barriers to creating a successful telehealth program are not small. The technological infrastructure required is large, clinical space must exist or be created on site, and the ever present Health Insurance Portability and Accountability Act (HIPAA) of 1996 must be respected.
Health policy, and thus reimbursement, is just catching up with technology such that 29 states plus Washington DC require private insurance to pay for telemedicine visits. All but three state Medicaid programs also cover some of the costs of these visits.
These considerations aside, the capital costs can be offset by the savings created from reduced transportation costs, lower drug expenditures and overall better health potentially resulting in less complications, hospitalizations and lawsuits.
3. The future of telehealth in corrections
The American Medical Association recognizes that telemedicine is medicine in a different format. This means that the roles and responsibilities of the clinicians do not change even if the mechanism by which they interact with patients does.
Given the growing academic focus on correctional medicine, research around this population’s access to healthcare will only increase. This will further allow telemedicine to become a viable route by which inmates receive care as it is more widely accepted both within and outside of corrections.
Memorable quotes about inmate telehealth programs
Here are four memorable quotes from the review article:
“Any reasonable solution must provide quality care, fit within often restrictive federal, state and county budgets, and traverse the often large geographic areas separating healthcare providers from correctional facilities.”
“These data suggest that a telehealth program could increase access to care, lower unnecessary costs, allow inmates to be seen sooner, and facilitate the initiation of appropriate management, potentially improving morbidity, and even mortality.”
“Federal, state and county budgets rarely make room for altruistic pursuits. Therefore, the importance of designing a sustainable business model for the provision of telehealth services cannot be understated.”
“If programs are developed with clear goals, clinical protocols and business models, with a clear understanding of the potential limitations of using telehealth technologies, outstanding care can be provided to the large and diverse correctional population. A need certainly exists.”
Key takeaway for correctional facility leaders
Providing quality healthcare to prisoners in a way that keeps staff safe and operating budgets as neutral as possible is critical to any correctional facility. Telemedicine offers a potential solution to an aging prison population that is only increasing in clinical complexity.
Telemedicine in Action
The South Carolina Department of Corrections and the Medical University of South Caroline (MUSC) have started a telemedicine program that allows doctors to see and treat inmates without the inmates leaving prison.
About the author
Catherine R. Counts is a health services researcher with Seattle Medic One in the Department of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.
Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and prehospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine.
Connect with her on Twitter, Facebook, or her website.