Telemedicine increases health equity for inmates

Doctor explains patient's tomography on a video call.

Doctor explains patient's tomography on a video call. Luis Alvarez/Getty Images

Colorado’s Department of Corrections is providing medical treatment via remote video consultations and connected scopes over fiber connections, which not only improves health outcomes but also minimizes the security and staffing needs required to transport prisoners to specialists.

Although the Colorado Department of Corrections has used telemedicine for about a decade -- primarily for psychiatric treatment -- options have grown since the onset of the pandemic according to Dr. Randolph Maul, chief medical officer at CDOC. Today, the leading telehealth consultation is cardiology, and Maul plans to expand appointments to include neurology, dermatology and rheumatology.

“We have places where we have incarcerated persons where there aren’t any particular specialists,” Maul said. “We have to be able to provide care, even for those that are remote, and that’s the key that I believe is telemedicine…. This begins to address inequity.”

Besides the pandemic forcing CDOC to get creative with remote treatment, technological advancements in telemedicine tools are driving the department’s telehealth adoption. For instance, Maul called the Horus Digital Scope System, a handheld exam camera designed for telemedicine, “a remarkable device that can have a number of different very specific lenses that allows such detail that really has never been available before.”

That and other devices such as the JEDMED Omni Stethoscope integrate with the Iron Bow Healthcare CLINiC solution that CDOC uses. It’s an all-in-one device that enables remote video consultations, including the use of connected scopes.

“CLINiC utilizes open standards-based [Session Initiation Protocol] and H.323 videoconferencing, enabling integration with existing technologies and supporting the exchange of video calls and media between enterprise environments,” according to a product brochure. “IT administrators experience seamless integration of the CLINiC into existing environments, enabling ease of deployment, management and support.”

To use it, physicians, or consultants, as Maul calls them, sign into the Polycom RealPresence app and dial into CLINiC. At the correctional facility, users log in through a portal that the IT office provides. Most appointments have a one-hour time limit, he added.

In addition to equity, telemedicine addresses staffing shortages; 25% of CDOC positions are vacant. For instance, a physician at CDOC headquarters could see patients at multiple facilities in one day without having to travel to them or transport them to the doctor.

“One of the problems within an incarcerated environment is there is movement time,” Maul said. “The intention was to decrease the number of staff required to transport folks from inside the walls to outside the walls. That can be upwards of three, maybe four people.”

But those shortages are also problematic because for telemedicine to work, there needs to be an intermediary in addition to the patient and provider. This is usually a nurse, medical assistant or certified nursing assistant – someone with basic medical knowledge – but they’re in short supply, Maul said.

“Somebody has to take the stethoscope and put it on the chest, and they have to put it in the right spot. They have to be educated,” he said. “Even during the process they can be educated: ‘No, I’d like you to lower that down’ or ‘I’d like you to put that over here.’ But they have to have some idea of where on the body it would go.”

Another telehealth challenge is connectivity. “We have some remote locations in Colorado, and you can imagine getting fiber-optic cable to each of those facilities has its challenges,” Maul said. “There are some rocks and some boulders that we deal with that are sizes of buildings, so going around and drilling through those are quite a challenge. And then of course we have to come up with funding to get that accomplished.”

One federal funding source that CDOC helped formulate before the pandemic was the Distance Learning and Telemedicine Grant from the Agriculture Department’s Rural Utilities Service. After the public health crisis hit, CDOC used funding from a Justice Department grant to facilitate telehealth.

The use of telemedicine at correctional facilities is not new. The Justice Department published a guide for it in 2002, but overall, telehealth use is now 38 times greater than it was before March 2020. 

“In every adversity, there usually is some silver lining, and if there was a silver lining in the COVID pandemic, telemedicine and the push for telemedicine was one of those silver linings,” Maul said.

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