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Maryland Invests in Cloud-Based Telehealth to Improve Correctional Health Care, Cut Costs

Because state governments give less funding to corrections each year, IT support at prisons lacking -- and uptime with telemedicine is crucial, which is why the state's Department of Public Safety and Correctional Services chose a cloud-based system.

To get a clear sense of the state of Maryland’s cost issues related to transporting prisoners to medical appointments with specialists, Sharon Baucom, M.D., didn’t have to study spreadsheets or crunch numbers. The executive director of clinical services for the Department of Public Safety and Correctional Services (DPSCS) just had to look in the parking lot at one of the correctional facilities. 

“In the parking lot, not on the doctors’ side, but on the officer transport side, were Mercedes, Jaguars and BMWs, all realized from overtime pay that was approximately $100,000 more than their average salary,” Baucom said in a presentation May 19 at the American Telemedicine Association annual meeting in Baltimore.

In 2013, facing declining budgets and determined to cut transportation costs as well as improve both public safety and inmates’ clinical care, Baucom and the DPSCS’s private-sector partner, Pittsburgh-based Wexford Health Sources, began a journey to enhance the use of telehealth services. “We thought we could reduce overtime, improve public safety, and improve the quality of care through our relationships with providers and hospitals in the community,” she said.

DPSCS cares for 22,000 inmates in 26 facilities, including the Baltimore city jail, the sixth-largest jail in the country and the fourth-most overcrowded, Baucom said, and it contracts with Wexford to provide medical services and utilization management. To cut costs and improve access to providers, the department set a goal of increasing the number of telehealth visits by specialty physicians. 

To estimate the potential savings, they turned to a formula developed initially by the correctional department in the state of Iowa to calculate savings by not transporting inmates off site. They identified a vehicle cost of $72.11 per trip. The custody officers cost $62 per hour, and the average time of a trip was 6.5 hours.

“We realized in our budget we were spending $5 million to $6 million annually in transport and overtime pay to take prisoners to off-site clinics,” Baucom said. “We decided to take a look at the opportunities that enhanced telehealth offers.”

Wexford has been involved in telemedicine for more than seven years, said Thomas Lehman, M.D., the company’s corporate medical director, and handled 12,000 telemedicine visits last year. He said Maryland is not alone in expressing increased interest in expanding its use. “When we look at the new bids and proposals, all corrections departments across the country are now interested, not only from the aspect of public safety and decreasing overtime costs, but also of delivering good care and access to specialists for inmate patients.”

“It didn’t take me long to understand how important this was when I attended a meeting with Secretary Gary Maynard [of the Maryland Department of Public Safety and Correctional Services], and he called it their No. 1 priority for the healthcare delivery system,” Lehman recalled. ”He was very dedicated to supporting this.”

After considering several options, Wexford and DPSCS chose to deploy a system from Santa Barbara, Calif.-based InTouch Health that features 18 RP-Lite telemedicine units. Each provides a moveable platform for delivering remote presence capabilities. It features a pan-tilt-zoom camera system to optimize viewing of patients. Accessories include a stethoscope, a privacy headset, and composite and S-Video ports. They also deployed 28 laptops on the specialists’ end with software linking them into the system.

“It has often been said that in prison, things move at a glacial pace. I think this was a program that moved at a lightning pace,” said Ellen Rappaport, Wexford’s telemedicine program director. “We got it all up and running in a three-month project, including getting them installed, trained and ready to go. It really was an amazing implementation.”

The IT team is crucial to success, Lehman said. “What many people don’t realize is that Internet access in a prison is a security issue. But because state governments are giving less funding to corrections each year, their IT support is not ideal.” With telemedicine, system uptime is crucial. “If I am a specialist and I dedicate two hours to see patients via a telehealth unit and the system doesn’t work, I am not going to be very interested in continuing. It is a waste of my time,” he added. “That’s why we chose a cloud-based system.”

InTouch’s cloud-based technology includes  offering the 24/7 monitoring of the machines. “They know if a machine goes down and they fix it,” Lehman said. “They also have the data, so we can tell how much time each specialist is spending with each patient.”

Because Wexford handles utilization management for DPSCS, it collects lots of data on utilization of various specialty services. “We looked at those services to decide which services we wanted to first utilize this telehealth program,” Lehman explained. “We also looked at volume of trips by region to help decide where to deploy the 18 RP- Lite units.”

Training was an integral part of the rollout. “Telehealth is still new to a lot of specialists in the community and we had to get their buy-in, as well as the buy-in of onsite medical providers and nursing staff,” Lehman explained. “There will always be some sense of not feeling comfortable if you don’t have support on the other end, where the patient is, so we decided early on that we would insist that the site’s medical director be present during each telehealth visit to help the specialist feel more comfortable.”

Since the program was just launched last year, It may be too early to tell if all the envisioned savings will materialize. But Baucom said that the 726 telehealth visits done using the new system have generated an estimated savings of $344,930. The initial investment in equipment and training was a little over $800,000. “We are almost halfway there already,” she said.