The fact is, there aren't many specialists practicing in rural areas near many of the nation's prisons, and that's true in Saint Luke's service territory, which extends from Missouri to Kansas. "They have a very difficult time finding specialists who agree to contract and come in and take care of those patients," Kropp says, echoing the situation in California. "For specialty care, often they go without or it means a high taxpayer expense to transport them to a tertiary facility."
With high-resolution digital cameras and a good zoom lens, providers "can see the capillaries in the patient's eyes. They can review an EKG or echocardiogram, look at a CT image of the heart and lung and get all kinds of reports."
Providing care across a T-1 line avoids having to pay for gasoline, transport vehicles, drivers, and guards (who often require overtime pay) to transport the inmate the long distances to Kansas City. It also avoids the security risk, however unlikely, of managing a patient who becomes unruly or tries to escape during transit.
"Telemedicine has become a real advantage for us," says George Lombardi, director of the Missouri Department of Corrections, who adds that he wants to expand telemedicine to inmates in 13 of the system's 20 facilities. "We're hoping to expand it to cardiology, orthopedics and many other specialties. Of course if there's an emergency with a serious wound, they'd go to the hospital right away."
So far, Lombardi says, even the prisoners say they like it.
Kropp says Saint Luke's 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, especially those having trouble finding specialists.
"The only thing that limits you is where the physicians are licensed to practice," he says.
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