telemedicine in correctional facilities ronald s. weinstein, m.d. director arizona telemedicine...
TRANSCRIPT
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 [email protected] 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!