Telemedicine in Correctional Facilities

Ronald S. Weinstein, M.D. Ronald S. Weinstein, M.D. DirectorDirector

Arizona Telemedicine Arizona Telemedicine ProgramProgram

Western Governors’ Association Western Governors’ Association Telemedicine Action Report - 1995Telemedicine Action Report - 1995

Barriers• Infrastructure, Planning & Development• Telecommunications Regulation• Reimbursement for Telemedicine Services• Licensure & Credentialing• Medical Malpractice Liability• Confidentiality

Founders of The Arizona Telemedicine ProgramFounders of The Arizona Telemedicine Program

Richard A. McNeely Ronald S. Weinstein, M.D. Rep. Robert “Bob” Burns John J. Lee

Rep. Lou-Ann Preble Rachael Anderson

Founded in 1996Founded in 1996

>>100,000 cases in 2007

55 Health Care Organizations55 Health Care Organizations

10 National Awards

TelemedicineCommunities

Ajo, AZAmado, AZApache Junction, AZAvondale, AZBenson, AZBisbee, AZBloomfield, NMBuckeye, AZBullhead City, AZCameron, AZCasa Grande, AZChinle, AZCibecue, AZCottonwood, AZCrownpoint, NMDouglas, AZEloy, AZFlagstaff, AZFlorence, AZFt. Defiance, AZFt. Duchesne, UTGallup, NMGanado, AZGlobe, AZGoodyear, AZGreen Valley, AZHolbrook, AZKayenta, AZKearny, AZKingman, AZLake Havasu City, AZLaveen, AZMarana, AZMesa, AZMorenci, AZNogales, AZ

TelemedicineCommunities

Oracle, AZPage, AZParker, AZPayson, AZPhoenix, AZPinon, AZPolacca, AZPrescott, AZPrescott Valley, AZQuartzite, AZSacaton, AZSafford, AZSalt Lake City, UTSan Carlos, AZSan Luis, AZScottsdale, AZSells, AZShiprock, NMShonto, AZShow Low, AZSierra Vista, AZSpringerville, AZSt. Johns, AZSupai, AZTempe, AZTohatchi, NMTonalea, AZTsaile, AZTuba City, AZTucson, AZWellton, AZWhiteriver, AZWindow Rock, AZWinslow, AZYuma, AZ

AZ NM

ASPC Lewis

AZ DOC Director’s Office

ASPC Safford

UA AHSC Phoenix Programs

AZ DOC Inmate Health Services Central Office

St. Mary's Hospital

NAU College of Health Professions

UA Rural Health Office

ASPC Perryville

ASPC Tucson

Southeast Arizona Medical Center

ASPC Winslow

Southwest PET Institute

UA AHSC

NAIHS Kayenta Health Center

NAIHS Inscription House Health Center

Scottsdale Healthcare

NAIHS Gallup Indian

Medical Center

Winslow Health Center

LowellElementary

School

ARIZONA TELEMEDICINE NETWORKCurrent and Pending WAN Connections as of May 2006

Regional Network Access Point

DS1 (T1) single or multipleDS3 (T3)

Pending or Planned circuitActive Circuit

N

NAIHS Chinle Hospital

St. Elizabeth of Hungary

Clinic

ASPCDouglas

Desert Vista Behavioral Health Center

ASPC Yuma

Maricopa Medical Center

Tucson

Flagstaff

NAIHS Pinon Health Station

NAIHS Tsaile Health Center

NAIHS Ft Defiance

Indian Hospital

Phoenix

NAIHS Crown-point Hosp.

NAIHS Navajo Area

Office

Mariposa Community Health Center

ASPC Florence

Payson Regional Medical Center

White Mountain Regional

Medical Ctr

Native American Cancer Research Partnership - UA

Native American Cancer Research Partnership - NAU

Map is not to scale and is not geographically accurate due to limited space

Tucson Heart Hospital

ADHS Office for Children with Special

Health Care Needs (CRS)

Tucson Med. Ctr - Children’s Clinics

ADHS-CRSSt Luke’s Medical Center

Ajo Jail

Arizona Department of Corrections or Affiliate

Educational Site

Navajo Area Indian Health Service

Tuba City Regional Health Care Corp

Active ATP Member Site

Pending or Planned site (see color code)

Cobre Valley Community

Hospital

NAIHS Northern Navajo Medical Center

Walter DouglasElementary School

Pima County Institutional Health

Arizona Department of Health Services

Arizona Telemedicine Program Site

(see color code above describing multi-site members)

Juvenile Probation Center

Tonalea Chapter House

Sage Memorial Hospital

NAIHS Tohatchi

Health Center

Adult Detention Center

University Medical Center

ASPC Eyman

Yuma Regional Med. Center + ADHS-CRS

St Joseph’s Hosp. & Med. Ctr + ADHS-CRS

Tuba City High School

Grey Hills High School

Cameron Chapter House

Arizona Regional Behavioral Health

Authority

Affiliate Network with # of locations

Kingman Regional Medical Center

For additional information or questions please visit the Arizona Telemedicine Program Network Web Sitehttp://www.telemedicine.arizona.edu/

Mike Holcomb holcomb@email.arizona.eduAssociate Director, Network ArchitectureArizona Telemedicine ProgramUniversity of ArizonaOffice:520-626-4496 FAX 520-626-1027

or contact:

Node Color Legend

Legend (also see Node Color Legend)

Health Services Advisory Group

Maricopa Correctional Health

Phoenix Area Indian Health Service

Havasu Regional Medical Cetner

Arizona Department of Juvenile Corrections

Banner Health

Gila Health Resources Clinic

Healthwest Yuma PET Center

WirelessVPNModem

1

59

6

4

20

Northern Arizona Healthcare

4

Carondelet St. Joseph’s

Hospital

Yavapai College

UA RHO Mobile Health Program

Sopori Elementary School

University Physicians Healthcare

5

Urological Associates of Southern Arizona PC

Kindred Hospital

Yuma County Health Department

Graham County Health

Department

Pima County Health Department

Copper Queen

Hospital

Cochise County Health

Department

Arizona Telemedicine Program

170+ Sites• Native American Healthcare (Navajo, Apache, Hopi, and others)• Prisons and their service providers • Jails• Non-IHS Rural Hospitals• Community Health Centers• Schools• Distance Learning Affiliates• International sites

Arizona Telemedicine Council Arizona Telemedicine Council

Governance: Non-Statutory Over-Arching Authority

Arizona Telemedicine Program Arizona Telemedicine Program

Arizona

Arizona Department of Corrections Telemedicine10 State Prisions/36,000 prisoners

Many subspecialty consultsare now done by telemedicine

Correctional Telemedicine Selected Corrections Programs

in the United States

• Arizona

• California

• Iowa

• Kentucky

• New Mexico

• New York

• Ohio

• Tennessee

• Texas

• Virginia

Arizona Department of CorrectionsWeb Page

A Texas prisoner is seen by a University of Texas Medical Branch

specialist with the help of the system’s telemedicine program.

Texas

(Left) McMurdo Station, Antarctica: one of several South Pole research stations where UTMB EHN provides services. (Right) Jake Angelo (left), consultant to the Telehealth Center, and Dr. Steven F. Viegas (right), Professor and Chief, Hand Surgery Division, Department of Orthopaedic Surgery and Rehabilitation, bother of UTMB, hold the UTMB flag at the South Pole.

Literatureon

Correctional Telemedicine

New York

American Journal of Gastroenterology© 2004 by Am. Coll. Of GastroenterologyPublished by Blackwell Publishing

ISSN 0002-9270 Doi: 10.1111/j.1572-0241.2004.30310

Treatment of Chronic Hepatitis C Virus in the Virginia Department of Corrections: Can Compliance Overcome Racial Differences to Response?Richard K. Sterling, M.D., Charlotte M. Hofmann, R.N., Velimir A. Luketic, M.D., Arun J. Sanyal, M.D., Melissa J. Contos, M.D., A. Scott Mills, M.D., and Mitchell L. Shiffman, M.D. Section of Hepatology; and Department of Pathology, Virginia Commonwealth University Health System/Medical College of Virginia, Richmond, Virginia

OBJECTIVE: Chronic Hepatitis C virus (HCV) is common in the correctional setting and there are few data on the use of interferon (IFN)/ribavirin(RVN) combination therapy in this population. Given the high proportion of African Americans (AA) in correctional facilities, which may be associated with reduced response rates, the correctional setting allows a unique opportunity to compare the response rates of AA to Caucasians (DA). The present study describes our experience of treating HCV in the inmate population of the Virginia Department of Corrections.

CONCLUSIONS: HCV can be effectively treated in the correctional setting with response rates similar to, if not better than the published literature. In this controlled setting of direct observational therapy, we observed similar SVR in CA and AA

Virginia

BRIEF COMMUNICATION

A Surgical Telemedicine Clinic in a Correctional Setting

Vladimir Lavrentyev, M.D., Arden Seay, R.N., Azhar Rafig, M.D., Deborah Justis, R.N., and Ronald C. Merrell, M.D.

Department of Surgery, Medical Informatics and Technology Applications Consortium, Virginia Commonwealth University, Richmond, Virginia.

Discussion In the standard definition of research, this was not an experimental study. The patients were never identified for data analysis, and only standard clinical care was rendered. Consistent with telemedicine standards and privacy concerns, no images were captured at the patient encounters. All records were paper records using approved encounter forms. There are no electronic records in these consultation encounters. The study as reported is a retrospective uncontrolled review of outcomes from an established mode of clinical practice at tour institution. All telemedicine consults and operations were done by the same surgeon. All clinical care was fully reimbursed at contracted rates.

In this study, the capability for teleconsultation as part of the correctional healthcare delivery system was successfully demonstrated. Telemedicine is a well-established contribution to healthcare for incarcerated persons in the United States. Videoconference consultation in this context can comply with standards of practice for surgical consultation including informed consent. Telemedicine applied by surgeons in correctional care can deliver excellent and effective care to inmates without incurring additional costs such as transportation and security measures. Application of communication standards, together with videoconference technologies and health record documentation, provide an effective solution to surgical consultation and facilitate continuity of care. Prior experience with preoperative care guided design of this program.

Kansas

Iowa

Iowa

It should not be anticipated that hub and spoke hospitals will think as one, share the same bottom-line goals, or employ similar provider incentives when implementing a telemedicine service.

Ohio

Case ReportCase Report

With the traditional mode of delivering health care, not all inmates needing care were served at the time of their request, primarily because of time and resource restraints. Because of this, a large backlog developed, increasing the waiting time between the medical request and the actual medical visit. With telemedicine, the increase in the number of inmates who were served during the same time interval reduced this backlog.

Correctional Telemedicine

Resources / Meetings

American Telemedicine Association

Correctional Telemedicine

Resources / Meetings

American Telemedicine Association

? National Corrections Telemedicine Meetings (Arizona, 1998-2001)

Correctional Telemedicine

• Resources/Training ProgramsArizona Telemedicine Program – 1 day & 2

day Training Seminars

Arizona

www.telemedicine.arizona.edu

Correctional Telemedicine

• Resources/Training ProgramsArizona Telemedicine Program – 1 day & 2

day Training SeminarsUC Davis Health Systems and CTEC –

California Telemedicine and eHealth Center

California

California

Correctional Telemedicine

• Resources/Training ProgramsArizona Telemedicine Program – 1 day & 2

day Training SeminarsUC Davis Health Systems and CTEC –

California Telemedicine and eHealth CenterUTMB (University of Texas Medical Branch

Galveston) – Web Educational Course

Texas

Correctional Telemedicine

Publications

S.F. Viegas, K. Dunn, Telemedicine. Practicing in the Information age. Lippincott-Raven Publishers Philadelphia, 1998.

Implementing Telemedicine in Correctional Facilities. U.S. Department of Justice-U.S. Department of Defense. Joint Program Steering Group Report May 2002

Correctional Telemedicine

Journals: Telemedicine & eHealthJournal of Telemedicine and Telecare

Search Engines:PubMedGoogle/ScholarsTelemedicine Information Exchange

http://tie.telemed.org

Department of Corrections

Site Visits

Corrections Telemedicine

Site Visits

1. Overarching Authority (i.e., Ministry of Health)

2. Division of Health Services

3. Telemedicine Clinics (prisons - spokes)

4. Telemedicine Hub (service center)

Corrections Telemedicine

Site Visits

1. Overarching Authority (i.e., Ministry of Health)

2. Division of Health Services

3. Telemedicine Clinics (spokes)

4. Telemedicine Hub

Arizona Telemedicine Council

Site Visit

Corrections Telemedicine

Site Visits

1. Overarching Authority (i.e., Ministry of Health)

2. Division of Health Services

3. Telemedicine Clinics (spokes)

4. Telemedicine Hub

Headquarters of Arizona Department of Corrections

Site Visit

Arizona Department of Corrections

Site Visit

Arizona Department of Corrections

Site Visit

Arizona Department of Corrections

Site Visit

Corrections Telemedicine

Site Visits

1. Overarching Authority (i.e., Ministry of Health)

2. Division of Health Services

3. Telemedicine Clinics (prisons - spokes)

4. Telemedicine Hub

Tour of an Arizona Correctional Telemedicine Facility

Site Visit

Tour of the AZ-DOC facility

Site Visit

Tour of the AZ-DOC facility

Site Visit

Tour of the AZ-DOC facility

Site Visit

Site Visit

Lunch with the Warden

Site Visit

Lunch with the Warden

Site Visit

Corrections Telemedicine

Site Visits

1. Overarching Authority (i.e., Ministry of Health)

2. Division of Health Services

3. Telemedicine Clinics (spokes)

4. Telemedicine Hub

St. Mary’s Hospital, Tucson, Arizona

Site Visit

Correctional Telemedicine

Multi-specialty, Multi-Organization Programs

AdvantagesAnchor programNeeds basedProven effectivenessSemi-autonomousPublic safety

Other Benefits of Telemedicine

A variety of suggested nonmonetary impacts of prison telemedicine were investigated during this evaluation. These include:

Fewer security risks for transfers and external consultations. Shorter waiting times (or reduced delays) to see specialists. Access to better quality specialists and to specialty care not

previously available. Fewer acts of inmate aggression, or use of force by guards,

due to improved mental health services. Fewer grievances about health care or mental health care.

The National Institute of Justice is a Research and Evaluation Center of the United States Department of Justice

Correctional Telemedicine

Telemedicine Program Challenges

Department and division budgetingSystem upgradesPersonnel turnoverRecruiting and keeping champions

Thank you!

ronaldw@u.arizona.edu