Telemedicine Behind Bars?

Posted by James Baker, Chief Medical Officer | September 12, 2018 |
James Baker, Chief Medical Officer

We’ve seen the studies; telemedicine has been used effectively in treatment modalities ranging from telestroke consultations that save lives to diagnosing a cold or flu in a primary care setting. The commonality between each of these applications includes high expectations and even higher outcomes that have included better quality of care, reduced inpatient volumes, and lowered costs.

Interestingly, one of the biggest benefits of a telemedicine application comes from the convenience of providing care without having the additional time and expense of traveling to see a clinician. Nowhere is that benefit more apparent than in the use of telemedicine to treat inmates behind bars in our nation’s prisons and jails.

bigstock-Prisoner-s-Arms-Resting-On-Cel-7389746

This article will look at how telehealth is reaching these inmates and providing them with better access to treatment, saving taxpayers money, and eliminating the security risks of bringing a prisoner out of an enclosed facility and into a hospital or clinical setting.

Why is Telemedicine Important in a Prison Setting?

The statistics tell us that there are approximately 500 prison inmates for every 100,000 residents in the United States. This population has been increasing steadily for decades. However, most jails and prisons lack adequate professional healthcare services. Inmates, just like the regular population, suffer from chronic diseases and general illness that many times necessitate a trip beyond prison walls for treatment. In fact, some illnesses such as HIV, mental health disorders, and hepatitis C are much more prevalent in the prison population than in the general citizenry. There is also a growing cadre of elderly inmates suffering from the same kinds of chronic illness as any other population. Diabetes, COPD, and arthritis, can all be treated via a remote visit.

While some correctional facilities ship inmates to hospitals or clinics for care, this is a costly endeavor that requires additional security protocols that are expensive and time-consuming. Given that most prisons are located in rural areas, access to specialty care is notoriously lacking.

That’s exactly why telemedicine has been used for years to successfully provide treatment to inmates. Telehealth keeps the general population – and doctors – safer, while getting inmates the care they need much more quickly. An article in Pew suggests that doctors “feel a lot safer these days,” while not compromising the quality of the care they provide.

Telemedicine Applications in the Penitentiary

Telemedicine applications have been used in prisons and jails in the United States since the early 1990s, according to Modern Healthcare.

As far back as 2004, it was reported that more than half of all state prisons and about 40% of federal penitentiaries were using some sort of telehealth application to provide care to inmates. The tool is especially effective for providing preventative education for chronic diseases.

Last year the University of Chicago released a study published in the<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332924/"> Journal of Clinical Medicine that sought to quantify the current benefit of telemedicine applications in a prison setting. They described the problem and the solution in the following way:

The United States (US) has a large correctional population. However, many incarcerated persons lack access to evidence-based, up-to-date medical care, particularly by subspecialty providers, due to limitations of geography, travel, cost and other resources. The use of telehealth technologies can remove these barriers, increasing access to high quality, multidisciplinary care. Studies have shown that, with telemedicine, timely triage and medical management can be provided across many disciplines, which may lead to improved clinical outcomes and significant cost savings.

The cost benefits are likely higher in these settings. That’s because inmates require special secure transportation as well as multiple guards. Each time an inmate leaves their secure environment, risk is created; telemedicine eliminates the costs, time, and risk associated with leaving the prison environment to receive healthcare.

Corrections One reported earlier this year on some of the most typical uses for telemedicine in correctional facilities. They stated, “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.”

Telehealth in Action – at Rikers Island Jail

Modern Healthcare reported on one such application of telemedicine in the Rikers Island Jail in New York City. The article documented that inmates typically spend six to eight hours in small holding pens and stuck in traffic in order to spend five minutes with a doctor. It was a frustrating experience for the inmate who had to go through extensive waiting in order to receive care.

In 2016, Rikers introduced telemedicine to the facility, which holds 55,000 inmates annually. For the past two years, inmates have received virtual visits from infectious disease, gastroenterology, and urology specialty providers. These visits can run to 30-minutes as patients ask questions and receive treatment.

The Modern Healthcare article pointed out that providing healthcare to the incarcerated population isn’t “easy or cheap,” at around $2,000 per inmate per day. With corrections officials feeling increasing pressure to cut back expenditures, telemedicine offers a high-quality yet low-cost solution for providing care.

Rikers is planning on expanding their services, noting:

Rikers and the health system are looking at several possibilities for expanding its telemedicine program, including psychiatric consultations and other specialty services. It also plans to add additional NYC Health & Hospital campuses to the telemedicine network.

An article from the Pew Charitable Trusts quotes the former assistant secretary for the Washington State Department of Corrections as saying, “Telemedicine is perfectly designed for prisons.” While it’s difficult to quantify the costs of transportation and additional guard time, Texas, a state that uses telemedicine extensively, attributes their low cost per inmate (about half the national average) on the widespread use of telehealth services.

But it’s not just the cost savings; the director of the Center for Prisoner Health and Human Rights termed telemedicine, “a godsend and a real gift because prisoners are getting care from providers or specialists that they would have far less chance of getting otherwise.”

Telemedicine for the Non-Incarcerated

It seems that the benefits of telehealth can extend across a variety of settings in the United States. To find out more about OrthoLive’s solution for the orthopedic practice, contact us for a demo of our service.

Topics: "telehealth", "telemedicine", healthcare