Telemedicine s Potential







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Enhancing Access &

Efficiency of Quality Inmate Care

Lemuel Shattuck Hospital / UMass Correctional Health Experience

Ken Freedman, MD, MS, MBA, CMO, LSH Pat Herald, RN, BSN, CNN, LSH


Learning Objectives

Learning Objectives

Advantages of a well-designed telemedicine program,

including reduced security risks, costs, inmate comfort.

Careful planning steps to set up a telemedicine

program, including management support, equipment

purchases IT connectivity consensus clinical criteria

purchases, IT connectivity, consensus clinical criteria,

staff scheduling and documentation of encounters.

Obt i th



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Obtain the engagement and support of medical staff,


Telehealth: Defined

Telehealth: Defined

Differing modalities designed to exchange health

information and/or deliver health care despite

impediments such as:

impediments such as:

 Time  Geography  PersonnelTransportation  Mobilityy  Finances  Safety


Telehealth: History

Telehealth: History


 Shore-to-ship public health physicians

 Australia’s Royal Flying Doctor Service

 Australia s Royal Flying Doctor Service

United States’ teledoctor


 Pre-hospital  In-hospital  In hospital  Private  Public C ti  Corrections


Telehealth: Modalities

Telehealth: Modalities








Rationale For

Telemedicine Programs

Improve timeliness of care:

 Travel schedule, including correctional officers’ schedules

 Ease of scheduling clinicians

Reduce ED visits and hospitalizations.

Reduce transportation need and community safety


 Reduce discomfort for inmates

 Reduce waiting time - reduce inmate grievances

Decrease costs, improve efficiency and increase

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Clinical Opportunities

Documented experiences in inmates with:

 HIV/AIDS  HCV  HCV  CardiologyDermatology  Psychiatry  Ophthalmology  Orthopedics  GastroenterologyPrimary Care



A Trilateral Relationship

Specialty clinics at LSH

Volume of correctional health care encounters

Volume of correctional health care encounters

Specialty service of high volume correctional clinics



Operational Stages

GI telemedicine history

Interdisciplinary taskforce

Interdisciplinary taskforce

Consensus on milestones



Milestone #1:

Milestone #1:

IT Standardization / Connectivity / Equipment

Lessons learned:

 Standardize IT equipment

Acquire the latest proven technologyq p gy

 Assure training and technical support is available

 Determine ideal setup at remote and HUB locations

How did we apply the lessons:

LSH and DOC purchased three (3) ProvidiaTelemedicine units

 Technical / training service contract / support

 Technical / training service contract / support

Dedicated telemedicine suites

 Dedicated ISDN lines

D di t d DOC IT t ff


Milestone #2:

Milestone #2:

Medical Standardization

Lessons learned:

 Physician support necessary for program growth

 Clinical specialists define appropriate telemedicine encounters

 Clinical specialists define appropriate telemedicine encounters

Pre-encounter planning and review

Telemedicine coordinators strive for “best practice” standard


Inclusion Criteria

Inclusion Criteria

SPECIALTY EXCLUSION (NO) INCLUSION (YES) CLINICAL DATA NEEDED Gastroenterology •Complex medical problems

•Acute medical problems

•Review of pathology •Initial Hepatitis C •Initial, non-acute GER

•Initial non-acute constipation

Intake sheet Problem list MAR/allergies Studies •Initial, non-acute constipation Studies

Referenced SOAP note Referral

Infectious Disease •Follow-up without new complaint.

Intake sheet Problem list MAR/allergiesg Studies

Referenced SOAP note Referral

Orthopedic Surgery •Complex fractures •Infection

•Evaluation as to whether or not elective surgery is needed

Intake sheet Problem list •Dislocation •Non-acute sprain

•Non-acute low back pain •Pre-op identified by Pat Clifford •Post-op identified by LSH ortho

MAR/allergies Studies

Referenced SOAP note Referral


Milestone #3:

Scheduling / Logistics

“Today’s preparation determines tomorrow’s achievement.” – Anon.

Lessons learned:

Lessons learned:

 Define timelines/schedules for clinical, inmate and support staff

availability through LSH, DOC and UMCH

Pre-register all approved telemedicine patients

Prepare medical records/correspondence


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Future Vision

Future Vision

Asynchronous telemedicine encounters

Store and forward encounter data and results

Store-and-forward encounter data and results

Acquire advanced equipment for diagnostic purposes


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Effective Teleconferencing

Effective Teleconferencing


 Be prepared … know the patient.


Optimize position of clinician and patient with cameras.


Try to keep each conference to 7 minutes This ensures all

 Try to keep each conference to 7 minutes. This ensures all

patients will be seen and other sites will have opportunity to have their patients seen.


Effective Teleconferencing

Effective Teleconferencing


 If additional time becomes necessary, plan on follow-up with

Clinical Specialist by phone or in-clinic. Clinical Specialist by phone or in clinic.

Care Coordination




Inmate/Patient DOC Site/Transportation LSH Specialty IT Support UMCH


February Schedule

February Schedule




Please circle the number you feel best describes your experience with teleconferencing/telemedicine Please circle the number you feel best describes your experience with teleconferencing/telemedicine. 1= least describes your experience 2=maybe describes your experience 3= most describes your experience

1 Teleconference/telemedicine improves communication between referring clinician and the Specialist? 1. Teleconference/telemedicine improves communication between referring clinician and the Specialist?

1 3 5

2. Teleconference/telemedicine reduces the amount of wait time for an appointment with a specialist.

1 3 5

1 3 5

3. Teleconference/telemedicine improves quality of care for otherwise difficult to treat patients.

1 3 5

4 T l di i / l f d h f i i li i 4. Telemedicine/teleconference made the process of seeing a specialist easier.

1 3 5


Measurements of Success

Measurements of Success

Timeliness of care …

 Reduction in length of time before specialty consult is scheduled

 Reduction in patient grievances

Reduce trips out …

 Reduction in urgent visits out of DOC facilities

 Reduction in trips to LSH and other hospitals

 Increased community safety





Coordination of care …

 Increase consultative care planning

 Improve communication between primary care provider and

consultative specialist consultative specialist




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