Telemedicine’s Unusual Applications: Prisoner Health

Telemedicine has obvious potential to revolutionize how Joe the Plumber (and his cousin, Mike the Systems Analyst) interact with their doctors and other healthcare providers. But what about the more institutional uses for this field of technology? It turns out that prisons have been using telemedicine technology for decades, and they’re anxiously waiting for more of it to go mainstream.

Why? Simple: one of the biggest expenses in dealing with prisoner health issues is the danger involved in bringing a medical team into a prison — or a violent inmate out into a medical facility. According to a study in North Carolina, the most basic prisoner transport (which still requires two guards and a State vehicle) costs $700 each way. And while every prison has a small medical ward, they’re often woefully inadequate to any but the most basic healthcare tasks.

Enter Telemedicine

Many states are looking into providing telemedical consultation services for prisoners, hoping that by giving them the chance to talk to a doctor — be it to discuss preventative health or get a diagnosis or discuss side effects of medicines — they can reduce costs in time, money, and lives. Colorado, North Carolina, and Texas already have state-wide medical teleconferencing in their public prison system; some dozen other states are watching carefully to see if the programs deliver the expected results.

Private Prisons, Private Practices

It was the private sector, however, that first adopted telemedicine for prison populations as the primary method of dealing with prisoner health. The Corrections Corporation of America, owners of the Leavenworth Detention Center, has instituted a ‘tele-first’ policy and claims that it takes only 16 successful telemedicine interactions per month for their program to pay for itself and start saving the prison money with each successive diagnosis or consultation. They have contracted with a variety of private practices to acquire the services of more than 31 doctors across 15 specializations for their prison population.

Prisoner’s and Practitioner’s Preference

Perhaps unsurprisingly, the CCA also reports that their prisoners prefer telemedicine visits to being handcuffed and transported to a facility under constant watch by nervous armed guards. Similarly, doctors — even those accustomed to working in adverse conditions — would much rather be on the opposite side of a hundred-mile gap from a violent criminal if conditions allow.

The Quality Question

Prison Legal News managing editor Alex Friedmann posed the all-important question at a national healthcare conference in late 2013: “The vast majority of medical consults outside the prison setting are face to face, in-person examinations. If that is the community standard of care, to what extent does telemedicine applied specifically to prisoners represent a deviation from the standard of care?”

Currently, the law requires that prisoners be given the opportunity to decline telemedical services in favor of traditional face-to-face medicine — so long as that remains true, any deviation is at the discretion of the prisoner… an acceptable scenario, one must believe, for all involved.

Understanding Care Services: NHS Continuing Health Care

What Is NHS Continuing Health Care?

In England, NHS Continuing Health Care (NHSCHC) is care funded by the NHS. It is available for people aged 18 and above and is provided to meet physical or mental health care needs that have arisen through disability, accident or illness. NHSCHC is care that takes place away from a hospital. Care can be provided in your home or in residential accommodation.

Who Qualifies for NHS Continuing Health Care?

You will qualify for NHSCHC if you are assessed as having a primary health need. The NHS Choices website provides a very unhelpful circular definition of this. A primary health need, it is explained, is one that is on-going and substantial and is related to your health. An assessment will take into account the nature and complexity of your needs; the intensity and severity of your needs, and the unpredictability of your needs.

How Do You Get NHS Continuing Health Care?

In short, you need to be assessed. The assessment is carried out by a multidisciplinary NHS team. There is no right to an assessment, but if it seems that you might need NHSCHC then the Clinical Commissioning Group (CCG) for your area must carry out an assessment.

The fact that you have a long term medical condition is not, of itself, a qualification for NHSCHC. However, the following circumstances are likely to suggest that an assessment is appropriate. 1. Where you are due to be discharged from hospital and you have long term needs, 2 Where a period of intermediate care has come to an end, 3. Where your health declines significantly, 4. Where you are approaching the end of your life, 5. Where you reside in a nursing home and your health care needs are under review and 6. Where your health and social care needs are being assessed as part of a community care assessment.

In most circumstances, there is a two stage assessment process. The first stage is an initial assessment. The purpose of this is to decide if you need a full assessment. The initial assessment may be completed by a doctor, social worker or other health care professional.

The full assessment is carried out by two or more health and/or care professionals. The assessment looks at the following criteria: behaviour, cognition (understanding), communication, psychological/emotional needs, mobility, nutrition (food and drink), continence, skin (including wounds and ulcers), breathing, symptom control through drug therapies and medication, altered states of consciousness, other significant needs.

Each of those criteria (or domains) is assessed on the following scale: no needs, low needs, moderate needs, high needs, severe needs or priority needs. The criteria in bold are assessed, on the full scale, from low through to priority. The criteria in italics are assessed from low to severe. The remainder are assessed from low through to high.

You will be eligible for NHSCHC if one or more criteria are assessed at the priority level or two or more criteria are assessed as severe. You may also be eligible if one criteria is assessed as severe and you have needs assessed in a number or other criteria or a number of criteria are assessed as high and/or moderate.

A two stage assessment is obviously a little time consuming. It can take 28 days from the initial assessment to determine you eligibility by way of a full assessment. Clearly in some cases this is far too slow. There is, therefore, a fast track procedure that can be used where your condition is worsening and/or you are terminally ill.

What Is the Cost of NHS Continuing Health Care?

There is no cost to you if you qualify for NHSCHC.

Who Provides NHS Continuing Health Care Services?

NHSCHC services can be provided by any number of health professionals including physiotherapists, occupational therapists, speech therapists and domiciliary carers. When you are assessed as being eligible for NHSCHC, you will be allocated a personal health budget. This is an amount of money that is used to support the needs that you have. It is similar to the personal budgets allocated by social services to support social care needs.

Just as with a social care personal budget, you can ask for your personal health budget to be paid to you in the form of a direct payment. A direct payment puts you in control of choosing who supplies your services. You don’t have to do this. You may, however, enjoy the freedom and choice that direct payments give you.

Importance of Medical Equipment Innovation

With ongoing research and development in medical technologies, doctors are better equipped to treat the patients with a greater chance of cure.

Medical Research and Technology

Scientists are constantly testing out new equipment and procedures to shorten operation periods whilst boosting life span. Moreover, they are also trying out new drugs for better treatment and even cure of prevalent disease.

With the help of medical technology, scientists reached into cellular level of germs and their antibodies. We already know how the discovery of vaccines helped control malaria, MMR, polio and other such illnesses, saving thousands of lives worldwide. As per the World Health Organization, vaccines save 3 million lives each year.

Importance of Innovation in Medicine

The life cycle of a medical product ranges from 18-20 months. This is still better that many industries, such as Information technology, but improvements still need to be made. Also note that innovation isn’t just about improving the quality of care; it is also about maintaining and sustaining better healthcare systems.

And even while less than 10% of national health budget was apportioned to medical equipment innovation during the fiscal year of 2000-2008, advances in medical technology have decreased the prolonged hospital stays by 13%.

Moreover, huge cost savings have been recorded with the inception of outpatient care from in-patient care. Quality of life has improved over the period as well. Given the amount of ageing population and the current economic climate, medical cost saving was imperative.

For instance, Cataract surgery, which was previously a 3-5 day inpatient session, has now been reduced to a day care centre operation. Also, total knee replacements are proving to be better in terms of saving costs and locomotion of patients. And these are just a few examples we can find.

If we move further, chronic conditions such as arthritis and cataracts prevented patients from returning to their daily routines. With medical equipment innovation, the time taken to return back to their everyday lives has been significantly reduced. This also boosts the self-esteem of patients whose medical condition can hinder their physical independence.

In the long run, medical innovation not only creates healthier and happier people, but stronger economies as well. This is because healthier people can contribute more effectively to a country’s GDP.

Emerging Medical Equipment Technologies

Melanoma biopsies

Melanoma is a chronic form of skin cancer. Melanoma is extremely dangerous mole looking harmless on the outside until a surgical biopsy isn’t conducted. Now, dermatologists have come up with a portable tool, approved by FDA for analyzing tissue morphology. MelaFind optical scanner is now used to determine the need of biopsy.