1. Telemedicine in Correctional Facilities Ronald S. Weinstein, M.D. Director Arizona Telemedicine Program Arizona Telemedicine Program

2. Western Governors’ Association Telemedicine Action Report - 1995 Western Governors’ Association Telemedicine Action Report - 1995 Barriers Infrastructure, Planning & Development Telecommunications Regulation Reimbursement for Telemedicine Services Licensure & Credentialing Medical Malpractice Liability Confidentiality

3. Founders 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

4. Founded in 1996 > >100,000 cases in 2007 55 Health Care Organizations 55 Health Care Organizations 10 National Awards

7. 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

8. Arizona Telemedicine Council Governance: Non-Statutory Over-Arching Authority

9. Arizona Telemedicine Program

11. Arizona

12. Arizona Department of Corrections Telemedicine 10 State Prisions/36,000 prisoners Many subspecialty consults are now done by telemedicine

13. Correctional Telemedicine Selected Corrections Programs in the United States Arizona California Iowa Kentucky New Mexico New York Ohio Tennessee Texas Virginia

14. Arizona Department of Corrections Web Page

16. A Texas prisoner is seen by a University of Texas Medical Branch specialist with the help of the system’s telemedicine program.

17. 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.

18. Literature on Correctional Telemedicine

19. New York

21. American Journal of Gastroenterology © 2004 by Am. Coll. Of Gastroenterology Published 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

22. 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.

23. Kansas

24. Iowa

25. 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.

26. Ohio Case 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.

27. Correctional Telemedicine Resources / Meetings  American Telemedicine Association

29. Correctional Telemedicine Resources / Meetings  American Telemedicine Association  ? National Corrections Telemedicine Meetings (Arizona, 1998-2001)

30. Correctional Telemedicine Resources/Training Programs  Arizona Telemedicine Program – 1 day & 2 day Training Seminars

31. Arizona www.telemedicine.arizona.edu

32. Correctional Telemedicine Resources/Training Programs  Arizona Telemedicine Program – 1 day & 2 day Training Seminars  UC Davis Health Systems and CTEC – California Telemedicine and eHealth Center

33. California

35. Correctional Telemedicine Resources/Training Programs  Arizona Telemedicine Program – 1 day & 2 day Training Seminars  UC Davis Health Systems and CTEC – California Telemedicine and eHealth Center  UTMB (University of Texas Medical Branch Galveston) – Web Educational Course

36. Texas

37. 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

38. Correctional Telemedicine Journals:  Telemedicine & eHealth  Journal of Telemedicine and Telecare Search Engines:  PubMed  Google/Scholars  Telemedicine Information Exchange

39. http://tie.telemed.org

40. Department of Corrections Site Visits

41. 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)

42. Corrections Telemedicine Site Visits 1.Overarching Authority (i.e., Ministry of Health) 2.Division of Health Services 3.Telemedicine Clinics (spokes) 4.Telemedicine Hub

43. Arizona Telemedicine Council Site Visit

44. Corrections Telemedicine Site Visits 1.Overarching Authority (i.e., Ministry of Health) 2.Division of Health Services 3.Telemedicine Clinics (spokes) 4.Telemedicine Hub

45. Headquarters of Arizona Department of Corrections Site Visit

46. Arizona Department of Corrections Site Visit

47. Arizona Department of Corrections Site Visit

48. Arizona Department of Corrections Site Visit

49. 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

50. Tour of an Arizona Correctional Telemedicine Facility Site Visit

51. Tour of the AZ-DOC facility Site Visit

52. Tour of the AZ-DOC facility Site Visit

53. Tour of the AZ-DOC facility Site Visit

55. Lunch with the Warden Site Visit

56. Lunch with the Warden Site Visit

57. Corrections Telemedicine Site Visits 1.Overarching Authority (i.e., Ministry of Health) 2.Division of Health Services 3.Telemedicine Clinics (spokes) 4.Telemedicine Hub

58. St. Mary’s Hospital, Tucson, Arizona Site Visit

59. Correctional Telemedicine Multi-specialty, Multi-Organization Programs Advantages  Anchor program  Needs based  Proven effectiveness  Semi-autonomous  Public safety

60. 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

61. Correctional Telemedicine Telemedicine Program Challenges  Department and division budgeting  System upgrades  Personnel turnover  Recruiting and keeping champions

62. Thank you! ronaldw@u.arizona.edu