Sunday, February 21, 2010

Telemedicine Care for Prisoners

The California Prison Health Care Services Office of Telemedicine Services reports that 16,000 telemedicine visits with prisoners are done each year. Another plus is that telemedicine services are about to hit the 100,000 mark in the number of inmate patient appointments conducted since the program started in 1997 and last year has saved California $13 million.

A report published January 2010 by the California Prison Health Care Services (CPHCS) titled “Receiver’s Turn-Around Plan of Action” presents a plan of action for the state prison system and contains updates on the goals and objectives needed to improve care. One of the important goals is to expand and improve telemedicine capabilities.

According to the report the telemedicine staffing and governance continues to improve. The CPHCS has hired two new staff members to conduct the scheduling of specialty services and are presently recruiting for a Health Program Manager. In addition, CPHCS held their initial meeting of the Telemedicine Services Core Leadership Team.

Telemedicine encounters are continuing to grow at a steady pace and today six California institutions are expanding telemedicine. These sites include the North Kern State Prison, Kern Valley State Prison, Richard J. Donovan Correctional Facility, Centinela State Prison, California State Prison at Corcoran, and the Substance Abuse Treatment Facility.

The six institutions are expanding telemedicine by addressing obstacles to care, expanding the provider network, increasing the number of telemedicine specialties, identifying and resolving shortfalls in telemedicine staffing, equipment, and space, and collecting statistics to measure the progress in increasing telemedicine encounters while reducing off-site specialty services encounters.

Linda McKenny, RN, a senior health care services manages oversees the Office of Telemedicine Services (OTS). A cross functional team has been formed at each institution with medical and nursing management, clinical nursing staff members, custody personnel, IT representatives, and other key stakeholders.

Unrika Simon-McCaulley with OTS is leading the effort to expand the telemedicine provider network. In the future, CPHSC expects to complete the six institution initiative, further expand provider networks, and launch initiatives to increase telemedicine at other institutions.

CPHS is actively expanding patient access to telemedicine specialty providers. The addition of new providers has increased the number of specialty services offered from sixteen to twenty with additional plastic/reconstructive, nephrology, oncology, and urology services now available. At this time, the University of California, San Francisco is continuing to transition from on-site services to telemedicine.

The CPHCS team is working with IT experts to identify the most cost-effective approach to use to develop and expand the technology infrastructure needed to support telemedicine services. Recently, CPHCS met with several vendors to review current technologies and equipment including store and forward technology.

CPHCS has implemented various processes and staffing improvements to include reassigning the RN staff from scheduling and administrative functions to clinically focused tasks in the telemedicine program plus the telemedicine scheduling process is being automated.

To support the expansion of the program, contract language has been updated to include telemedicine provisions in all medical general services agreements. The telemedicine program is also working to establish credentialing protocol for telemedicine providers.

The Clinical Data Repository (CDR) project is an effort to establish the framework for electronic medical records within the state prison system. The goal is to establish the CDR to store key patient health information in a standardized manner and to ensure that the information is available to providers at the point-of-care. The current phase of the CDR provides information on current medications, allergies, and lab results.

As of December 2009, the CDR has been rolled out to the Valley State Prison for Women, California Correctional Facility for Woman, and to Los Angeles County institutions. The pilot phase of the project will be evaluated for stability and performance with rollout to additional institutions to begin this month. Once the system is established, the CDR will combine medical, mental health, and dental patient records into a unified accessible format.

To establish a healthcare scheduling and patient inmate tracking system, the “Strategic Offender Management System (SOM) is scheduled to be implemented. SOM will assist the prison healthcare system by providing a unique lifetime ID number, demographic information, continuous real-time location information, along with a comprehensive master schedule and scheduling prioritization protocol information.

Another goal is to evaluate performance and identify the opportunities to improve the quality and delivery system. According to the Rand study that proposed 79 indicators to measure access to care and clinical performance, these measures are now being incorporated into processes and systems. A newly formed interdisciplinary Quality Management Committee is charged with enterprise coordination and evaluation.

For more information, go to the California Prison Health Care Services at then click on Receiver’s Thirteenth Tri-Annual Report January 15, 2010 to download the report.