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A Captive Audience

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Lessons about telemedicine from a secure setting.

Editor's Note: This is adapted from Cheryl Clark's Feb. 3 online column.

Where might be the perfect setting to launch a successful telemedicine project? To maximize your investment in cameras and connections, you'd need a large number of patients with a mix of common yet treatable diseases. You'd need contracts with board-certified specialty providers willing to devote their time. Having a single payer model would help, to simplify the revenue stream.

But, perhaps equally important, having all your patients in one location for easy access would tie the system together. If you guessed the state prison system, you'd be right on the money.

Telehealth for the incarcerated is not a new idea. California's Department of Corrections, with its 170,000 population of adult prisoners in 33 institutions, has had such a system in place for at least 10 years, says Bonnie Noble, director of clinical operations for California Prison Health Care Services. State documents say the first project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.

Noble says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year. Most prisons are located in rural areas, such as the San Joaquin Central Valley, where specialists are in short supply.

So the state provides about 16,000 telemedicine visits with doctors in 22 specialty fields through the use of $20,000 camera systems purchased for each institution, Noble says.

Other states have followed suit. Saint Luke's Health System, an 11-hospital group with 1,321 beds in Kansas City, MO, recently announced it has teamed up with Correctional Medical Services, Inc., and the Missouri Department of Corrections to bring telehealth to Missouri's 30,000-prisoner system.

Steve Kropp, Saint Luke's director of outreach and telehealth, says it is so positive about the medical benefits of telehealth in prisons, the system may look to market a telehealth-for-inmates line of service to other state corrections departments.

"The only thing that limits you is where the physicians are licensed to practice," he says.

Cheryl Clark

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