TELEMEDCINE TECHNOLOGY ENHANCES INMATE HEALTH CARE IN MARYLAND

By Louis C. Tripoli, M.D.
Adjunct Assistant Professor of Medicine, Infectious
Diseases, Johns Hopkins University

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Cutting-edge technology is affecting the health care of inmates in Maryland prisons. The use of telemedicine is enabling correctional staff and medical personnel to consult with specialists, reduce transportation and health care delivery costs, and effectively manage taxpayer resources.

Maryland's Department of Public Safety and Correctional Services (MDPSCS) and Correctional Medical Services (CMS) have partnered with the Johns Hopkins University School of Medicine and several pharmaceutical companies to provide telemedicine services in several state correctional regions. These regions include the Hagerstown region at the Maryland Correctional Institution-Hagerstown and the Westover region at the Eastern Correctional Institution. The specialists of Johns Hopkins provide consultation for HIV and AIDS cases.

"The partnership allows us greater access to the expertise of some of the nation's leading infectious disease experts," said John Stafford, M.D., medical director for the Maryland Department of Public Safety and Correctional Services.

Experts view partnerships such as the Maryland initiative as important to the future of correctional medicine.

"Telemedicine gives our medical personnel an effective resource for treatment advice. And, it is part of our continuing commitment to provide inmates with the community standard of care," said Karl Kemp, CMS Maryland regional administrator.

Prior to the launch of the telemedicine initiative, the MDPSCS and CMS medical personnel reviewed HIV and AIDS cases with Johns Hopkins physicians through a conference call, called telementoring. An educational grant from the Johns Hopkins University School of Medicine and contributions from several pharmaceutical companies and CMS made it possible to purchase the software and equipment necessary to move from telementoring to telemedicine. This equipment, which includes computer hardware and software, as well as a digital camera and television, has enabled CMS medical staff to do visual consultations with Johns Hopkins.

"We started seeing improvements after the first three months of our work with Hopkins," said Kemp. "Many patients who are on various therapies have charted improvements in viral load counts (the amount of the HIV virus present in the blood) and CD4 counts (the measure of a patient's immune system's reconstitution). By both measures, the health of inmate patients with HIV and AIDS is improving. Our goal is to sustain this progress."

Marked improvements in patient health have enabled CMS medical personnel to appropriately lower medication levels for some inmate patients.

"When any patient makes substantial progress, we recommend variances in medication levels to ensure that their condition is being most effectively managed," said Dr. John Bartlett, chief of the Division of Infectious Diseases at Johns Hopkins. "Close supervision of medication levels is in the best interest of the patient."

Appropriate variances in medication levels can also be important for another reason: the cost to Maryland taxpayers for treating HIV patients. Eighty-three percent of the state correctional system's pharmaceutical budget is spent on HIV/AIDS drugs for inmates.

"Working with infectious disease specialists at Johns Hopkins has helped our continuing effort to appropriately manage taxpayer resources," said Stafford.

Studies have shown that telemedicine can help reduce costs while increasing access to health care for HIV-positive inmates. A 1997 study conducted by the Powhatan Correctional Center, the Virginia Department of Corrections, and the Medical College of Virginia campus of Virginia Commonwealth University found that the Virginia DOC was able to reduce transportation and medical costs by $35,640 and $21,123 respectively (Telemedicine Journal, Spring 1997).

"Telemedicine has saved the state and the taxpayers money on the overtime salaries and extra security costs that often result from transporting inmates to visit specialists," said Stafford.

"Hopkins specialists benefit from the knowledge they gain about medical conditions which occur frequently among inmates," said Bartlett. "With the appropriate approvals, our specialists can use this information for research or as in-class training for medical students."

The next step for the telemedicine initiative is to put individual patients on camera for review by the Johns Hopkins specialists.

"There is added potential benefit to bringing patients in front of the camera," said Stafford. "It gives the specialists a fuller picture of the inmate's condition."

Bringing inmates in front of the camera also expands the type of conditions that can be reviewed through telemedicine.

"The sky is really the limit with this technology," said Stafford. "In the future, we plan to use telemedicine to review psychiatric, cardiovascular, hepatitis C, and other medical conditions with specialists."

Administrators also plan to bring more Maryland facilities into the telemedicine initiative.

"Telemedicine is part of the future of correctional health care. It doesn't replace onsite care from medical staff, but it does provide the staff with access to a wealth of medical experts," said Stafford. "Our goal is to provide the most appropriate level of health care to the inmates in a manner that is effective and efficient for the state. Telemedicine helps us achieve our goal."