Abstract
This paper focuses on the implementation of telemedicine services in correctional facilities to ensure high quality of care is delivered to an underserved population. Telemedicine is defined as, "The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of diseases and injuries" (Koivunen & Saranto, 2017, p.24). Furthermore, the ethical, legal, cultural and environmental issues that arise are exemplified. In addition, the positive and negative impacts on health care when utilizing telehealth/telemedicine in correctional facilities are addressed and displayed throughout the paper. Two of the six Institute of Medicine (IOM) aims (safe and equitable) are identified and founded to be most relatable to telemedicine. Subsequently, multiple scholarly articles are referenced throughout the paper to support the use of telemedicine in correctional facilities.
Keywords: telehealth, telemedicine, correctional facilities, high quality care
Telemedicine in Correctional Facilities
In correctional facilities, access to subspecialty care is often lacking. Correctional facilities are commonly located in rural areas and relatively far from larger cities with tertiary care providers. "Incarcerated individuals often do not have easy, or any access to medical professionals with subspecialty training and experience due to common barriers of geography, limited transportation, and cost" (Young & Badowski, 2017, p.6). Without access to primary or specialty care, the inmate's chronic conditions cannot be treated appropriately or the lack of continuum of care is substantial. This large correctional population contains a diverse array of individuals, many of whom suffer from both acute and chronic diseases. It is imperative that the facility ensures that the management of a prisoner's condition is addressed appropriately and that they are delivered high quality care. Therefore, the introduction and adoption of telemedicine in correctional facilities will allow prisoners to have their acute or chronic conditions addressed by a specialized trained multidisciplinary team.
Telemedicine is considered as the use of technology to deliver health care services and information at a distance in order to improve access, quality, and cost (Kvedar, Coye & Everett, 2014). This is an innovative technology service for patients that are in rural or medically underserved areas who may not have access to the specialist needed to monitor and treat their health concerns. "Telemedicine has been used for medical information exchange and to facilitate diagnosis, referral, monitoring, and interventions to offset higher costs associated with hard-to-access patients" (Deslich, Thistlethwaite & Coustasse, 2013, p. 2). The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. Therefore, the focus of this paper is concentrated on the implementation of telehealth services in correctional facilities.
Ethical, legal, cultural or environmental issues
When utilizing telemedicine services it is important to be aware of the legal, cultural, ethical and environmental issues that can arise. When considering the legal issues, a significant barrier is the multiple licensures needed by a provider who delivers care across state border lines. Nurses and physicians providing care through telehealth services may reside in Pennsylvania but provide care to a patient in a New Jersey Correctional Facility. It is imperative for that nurse or physician to obtain licensure for the different states they provide telehealth services to. It is also required for the provider to pay the appropriate fees and meet the continuing education requirements of each individual state they have a license for. As noted by McGonigle and Mastrian (2018), "A possible solution is the development of the federally sponsored physician Interstate Medical Licensure Compact and Nurse Licensure Compact to facilitate portability of licensure across state lines" (p. 382). Although this would alleviate the issue of having to receive individual licensure and meet individualized requirements, not all states are on board to follow this solution.
An ethical issue that arises from providing telehealth services is ensuring patient confidentiality and the privacy of the exchange of clinical information. It is vital that telehealth providers in prisons follow all data privacy and confidentiality guidelines and remain cautious to ensure that all involved have the appropriate training in these particular issues (McGonigle & Mastrian, 2018). Patients should be educated on the risk and benefits of using telehealth services. It is imperative that informed consent is on a continuous basis, as patients are new to the experience. The more the service is utilized, it allows patients to have a better understanding on what ethical issues can arise from using telemedicine in a correctional facility. Furthermore, cultural diversity should be considered in cultural sensitivity training when focusing care in a correctional facility. Providers have to coordinate and deliver individualized care to eliminate obstacles that often lead to stress, frustration and misunderstanding if they are not addressed appropriately. One should identify and work in close collaboration with others to address staff's ability to adapt or overcome these needs to working effectively with others different from their own. At last, an environmental issue that arises is the population growth in correctional facilities. This issue can cause scarcity of resources, the inability to treat all prisoners efficiently, and limited technological support to connect patients to providers.
Positive impact on healthcare
Telemedicine connects physicians to underserved areas; improve access to mental and behavioral care, set patients with specialist regardless of location, address health problems, and cut costs and time for patients (Kumar, 2017). Not only do virtual visits reassure patients that their physicians are accessible and involved in their care; they are able to have questions addressed, report early warning signs, and make follow-up appointments. Through the use of telemedicine, specialists and other health care providers are able to expand their reach, helping patients stay in the prisons and avoid traveling long distances. In a study conducted by Deslich et. al. (2013) telepsychiatry provided improved access to mental health services for inmates, which saved correctional facilities from 12,000 to more than one million dollars. The use of telemedicine to provide psychiatric care, increased access and lowered costs for patient's residing in correctional facilities. In addition, "This approach facilitates remote diagnosis and treatment, continuous monitoring and adjustment of therapies, support for patient self-care, and the leveraging of providers across large populations of patients" (Deslich et.al., 2013, p.195).
The implementation of telemedicine services can decrease risk to public safety and security, which is a barrier for bringing inmates to providers for treatments. Furthermore, many providers are resistant to provide treatment to inmates in a private practice setting because of increased danger to the providers and the other patients. Additionally, "Correctional facilities usually use two prison staff members to transport inmates, which generates a need to replace those two officers in the prison to avoid a security risk because of understaffing the facility" (Deslich et. al., 2013, p. 2). Telemedicine in correctional facilities are proven to be effective in overcoming these barriers, from multiple research resources.
Negative impact on healthcare
Telemedicine is still new to the health care system; therefore, the laws pertaining to it have yet to keep pace with the technology (Kumar, 2017). Factors slowing more widespread adoption of telemedicine include concerns of privacy, the fear of diminishing human contact in health care, and limited reimbursement. Although privacy concerns in prisons may hinder acceptance, the same standards of confidentiality and protection of health information that govern traditional practice are applicable to telehealth services. Additionally, patients prefer a hands-on assessment to make sure all complaints are addressed appropriately. Furthermore, securing reimbursement for cognitive services remains an issue for telemedicine. Financial support for programs involving telehealth can be particularly complex since federal, state and county budgets rarely make room for altruistic pursuits (Young & Badowski, 2013). These restrictions limit the incentive and cost-effectiveness of telemedicine services for facilities. On balance, the benefits of telemedicine are substantial; with more research it will potentially reduce or eliminate the obvious shortcomings.
Identify and relate topic to 2 IOM 6 aims
When relating telemedicine in correctional facilities to the six IOM aims, safe and equitable care were the two aims that were most significant. When providing care in a hostile environment, it is imperative to ensure that the safety of all individuals involved are maintained. If telemedicine was not implemented in correctional facilities, prisoners could place providers at great harm if they are unhappy with their course of treatment. This would cause providers to be tentative when providing care in prisons and in return can negatively impact the prisoner's health outcome. The adoption of telemedicine in prisons decreases the risk of workplace violence and can promote a safer work environment. In addition, the second aim that relates to the use of telemedicine in correctional facilities is providing equitable care. Providers have to accept the fact that they are providing care to a diverse population of individuals that are confined and are wardens of the state. They have to separate their biases and see the individual as a person and not judge them for what decisions were made to place them in custody. Race, ethnicity, gender, and income should not prevent anyone in the correctional facility from receiving high quality care.
Telemedicine has become an increasingly cost-effective alternative to face-to-face care and has evolved into an integrated technology used in correctional facilities. For the incarcerated, technology-based solutions must be utilized to improve access to care, connecting patients with providers in a way that removes geographic barriers and the health care restrictions of the correctional environment (Young & Badowski, 2013). Furthermore, when acute medical complaints arise, the use of tele-triage may lead to more appropriate decision-making, regarding the transportation of ill inmates to Emergency Departments. This potentially decreases the unnecessary use of resources while also evaluating those in need of immediate evaluation or inpatient admission with expediency (Young & Badowski, 2013). The adoption of telemedicine will play a major role in the future and the advancement of health care when delivering high quality care to an underserved population.