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Texas Expanding Telemedicine Use for Inmates

A partnership among three Texas agencies is enabling the state to save money on prisoner health-care costs through telemedicine visits.

Telemedicine has expanded over the last decade thanks to technology improvements and the implementation of electronic medical records. But while widespread adoption of virtual doctor visits will still take time, the practice has flourished in Texas as an option to reduce the health-care costs of inmates.

A partnership among the University of Texas Medical Branch (UTMB), Texas Tech University and the Texas Department of Criminal Justice (TDCJ) has led to $780 million in savings for the department from 1994 through 2008, according to the Dallas Morning News. About 110,000 telemedicine consultations are conducted each year for inmates.

Dr. Owen Murray, vice president of offender health services at the UTMB, expects that number to increase in the years to come. In an interview with Government Technology, Murray noted that the number of telemedicine visits for prisoners has risen by 8 to 10 percent annually.

“Telemedicine has become the backbone of our health delivery system in a lot of areas,” Murray said. “It has improved access to care, and allowed us to recruit good doctors who might not want to work in prisons, but can now work in an office and meet with offenders remotely."

While states have been using telemedicine for inmates for a while, Murray believes Texas’ system is unique due to the timeframe. The three agencies involved have been working together for 21 years. Murray explained that many other states struggle to commit to a model and privatize the work, and change philosophies every few years to improve cost structures.

But Murray said he feels Texas’ commitment to the partnership has enabled the triumvirate to thrive.

“From a technology standpoint, I give a lot of credit to the legislature for the investments they’ve made,” Murray said. “Not just telemedicine, but electronic medical records and our integrated pharmacy system that integrates with the EMRs and our distribution [of those] to our 100-plus [correctional] facilities that we and Texas Tech takes care of.”

The TDCJ had what Murray called a “fledgling” telemedicine practice in the 1990s. The program was meant originally to reduce transportation of offenders going to health-care clinics and get expertise in the correctional facilities themselves. Telemedicine use was expanded once the UTMB and Texas Tech got involved, but didn’t really take off until the late 1990s when EMRs were added.

Technology improvements certainly have had a hand in how much telemedicine consultation is used for Texas inmates who need medical care. But Murray said he felt it’s now less about further tech upgrades and more about how they can expand the use of what they have into other areas of care delivery, particularly as the prison population is getting older.

The increasing age of prisoners is also driving up health-care costs in Texas and across the U.S.
A 2013 report by the Pew Charitable Trusts indicated that the cost of inmate health care increased by 28 percent nationally from 2001 to 2008. That’s one of the reasons Texas is continuing to focus on telemedicine expansion.

“The number of prisoners over the age of 55 increased in the majority of states, but in Texas it went up by 32 percent from 2007 to 2011,” Maria Schiff, director of the State Health Care Spending Project at the Pew Charitable Trusts, told the Dallas Morning News.

Next Steps

Murray explained that each state has what are called “infirmary beds” for those inmates who need intensive care. But because there is a limited number of beds, the state has a vested interest in turning those over, so work is being done to see how telemedicine technology can help facilitate the care those extremely ill patients need.

One of the more recent uses of telemedicine technology for Texas inmates has been for dialysis patients. Texas provides dialysis at two different facilities 150 miles apart. But there is only one person to conduct appointments with inmates for both locations. Thanks to telemedicine, however, that’s no longer a problem.

The state now conducts some of those dialysis appointments through video conferencing. A patient is hooked up to a dialysis machine, while the doctor can be anywhere in the state, receiving the data from the dialysis machine in real time while speaking with the patient virtually.

But if there’s one thing Murray would like to see improved on the technology side, it’s the incorporation of digital imagery. He explained that there isn’t a great solution for doctors to get the electronic images of MRIs and CAT scans into prison facilities.

“I can get the report, but I can’t see the film itself during a telemedicine encounter, and providers like to look at the images,” said Murray. “[This] is something we need to work on, so that’s a goal down the road. It’s not something that impacts the ability to see patients, but from a provider perspective, I’d like that to be available.”

Brian Heaton was a writer for Government Technology and Emergency Management magazines from 2011 to mid-2015.