Telemedicine and Telehealth News 10/15/2008
On a computer monitor in his office in the high-tech hub of Bangalore, Indian radiologist Arjun Kalyanpur examines a scan of the skull of a six-year-old boy who fell off his bicycle. A few minutes later, thousands of miles away, doctors at a hospital in Philadelphia prepare the boy for surgery after receiving an urgent email from Kalyanpur diagnosing a subdural haemorrhage in the child's brain.
It's the middle of the night in the United States, but it's daytime in Bangalore and Kalyanpur and his team of 35 radiologists are reading hundreds of scans sent by hospitals across the United States during the night shift.
"ERs in the U.S. find it difficult to staff at night. There's a radiologist shortage in the U.S. as well," Kalyanpur told Reuters.
Bangalore, the outsourcing capital of the world, is becoming a global centre for telemedicine thanks to a pool of Western educated doctors, extensive outsourcing infrastructure, lower costs and a convenient time zone to diagnose medical conditions during the U.S. night.
Teleradiologists in India read x-rays, CT scans, MRIs and other medical images of patients in the United States, Singapore and a host of other countries around the world.
It's ideal for hospitals facing ballooning costs and a shortage of radiologists. And it's not just teleradiology, experts say just about every area of medicine that does not require direct patient interaction could be outsourced in the future.
This could include scans of pathology samples, ECGs, EEGs and other diagnostic systems used to determine a preliminary diagnosis. "Telemedicine is on the rise," said Avinash Vashistha, the CEO of Tholon Inc, a private equity advisory firm, who has written a book about outsourcing.
"Once it acquires critical mass in 2 to 3 years, we expect the thrust to come from insurance companies as they recognize the cost benefits and lower premiums for the plans that have components of telemedicine."
There are some concerns, though, that it might lead to dangerous misdiagnosis and even those in the industry admit that regulation hasn't caught up with technology when it comes to medical malpractice, ethics and legal liability.
Liability, privacy and malpractice issues pose challenges as this new industry expands without a supporting international regulatory framework as well as an ethical code of conduct.
"In the end the challenge really is when you're doing something for the U.S. and something happens, who's liable for it?," said Vashistha.
The business is lucrative and already there are 10 or more teleradiology firms in India as well as several in the United States, some of which are listed companies.
Kalyanpur's clinic can make as much as $1,500 per scan, about 35 percent less than the price charged in the United States. With an average of 1,000 scans read a day, that adds up to hefty revenues.
Hospitals are in favor because by stepping in at night, teleradiologists in India save U.S. hospitals the need to put radiologists on night-shifts, allowing them to save on salaries.
"This kind of outsourcing which is time zone related is very beneficial. The same job done as a day job is much more productive," Kalyanpur remarked.
Kalyanpur and his wife, Dr. Sunita Maheshwari founded Teleradiology Solutions from a home office in Bangalore six years ago. Both are U.S. board certified physicians and are graduates from Yale University.
Today, they have a 118-member team in a swank, five-story setup where they provide radiology services for over 70 hospitals in the U.S., 10 hospitals in Singapore, a few in the former Soviet republic of Georgia as well as hospitals and medical clinics in cities and villages across India.
"We make the process more efficient by using technology and time zone advantages," said Kalyanpur.
The maximum time at Teleradiology Solutions for a radiologist to read an x-ray and provide analysis is 45 minutes. Diagnosis are provided within 10 minutes for urgent cases such as acute strokes.
Teleradiology Solutions has a sales office in Connecticut and radiologists in China, Netherlands and U.S. who backfill when the India operation is closed.
Ironically, India faces an acute shortage of radiologists even as teleradiology clinics sprout up in Bangalore. The biggest players are Kalyanpur's firm and his main competitor Wipro Ltd, a leading software services exporter.
"We are currently focused on consolidating this service line and building our expertise in this as this practice requires strict adherence to quality and norms," said Achaiah Palekanda of the clinical processing services of Wipro Technologies. The firm has five permanent radiologists and several who work part time.
Indian hospitals such as Apollo, Fortis and Wockhardt are other players that are gradually increasing their imaging clientele by reading scans for hospitals in the United States.
Other U.S.-based players include Virtual Radiologic Corp which provides teleradiology services to over 900 medical facilities in America. Nighthawk Radiology Holdings Inc. is another U.S. based teleradiology company whose physicians are located in the U.S., Australia and Switzerland.
Patients are not always aware their scans are being read abroad, although they are told if they ask.
"We act as an extended arm, offering 24X7 services, thereby enhancing productivity for the doctors and 3D lab teams in the U.S.," said Wipro's Palekanda. "However, they are the final sign-off authority and quality approvals on our services."
The teleradiology business has not penetrated into the Europe as yet, largely due to data protection laws in the European Union and difficulties in obtaining accreditations by authorities, according to an Indian government planning commission report.
"There are other issues as well ... such as malpractice policies, liability insurance and jurisdiction issues for settling disputes that might arise," said the report.
Kalyanpur feels teleradiology is just the beginning.
"Telecardiology, telepathology, teledermatology, telephathology and robotic telesurgery," he said, naming a few.
Regardless of whether the medicine is practised in person or remotely, the most important factor for patient care is the quality of the doctor doing the diagnosis.
"The first and the foremost requirement here is a qualified doctor at the other end. That's very important," said Dr Sanjiv Sharma, the head of cardiac radiology at the All India Institute of Medical Sciences (AIIMS) in New Delhi.
(Source: Reuters, October 15, 2008)
For years, health advocates have been banking on long-distance medicine as a way to help address a critical shortage of specialists in the central San Joaquin Valley of California. But even as the state pumps more money into telemedicine, a problem is becoming clear: Many specialists don't want to see patients who lack private insurance, even through a high-tech hookup.
"It's difficult to pay the specialists who need to see the patients," said Jennifer Smith, who manages a telemedicine project at UC Merced. "And it's also just that telemedicine is new. There's not a lot of specialists who have this equipment themselves."
Nobody doubts the potential of telemedicine. Clinics across the Valley increasingly are giving it a try.
One of the newest projects in the Valley is a teledentistry service offered by Children's Hospital Los Angeles to children in Lindsay, Woodlake and Cutler-Orosi elementary schools. The first remote dental examination was done in December.
More centers are on the way. In November 2006, voters approved Proposition 1D, a bond measure that provides $200 million over two years to expand the University of California medical schools and telemedicine programs.
As a result, the Fresno campus of the University of California at San Francisco received $2 million for teleconferencing and telemedicine. The money will be used to connect specialists with patients in rural Valley areas, said Dr. Joan Voris, associate dean at the Fresno medical school campus. The first consultations are expected to begin by July.
At Sierra Kings District Hospital in Reedley and United Health Center in Kerman, telemedicine centers are set to open this fall. Those two centers received funding from UC Merced to pay for high-speed Internet connections.
The Reedley hospital couldn't have done it without the university's help, said hospital CEO Pamela Ott. The university helped them get a super-high-speed connection.
Another large chunk of money came from a $22.1 million grant that California secured from the Federal Communications Commission last year. The three-year grant pays for high-speed Internet access in rural areas. The state kicked in $3.6 million in matching funds.
The California Telehealth Network -- a collaboration of government, business and private groups -- has been set up to administer the federal grant for the state.
Even as telemedicine becomes more available, however, the technology has not yet shown it can make up for a statewide doctor shortage. State health officials say that by 2015 there will be 17,000 fewer physicians than needed across California.
In the Valley, the shortage of doctors with specialty training is especially acute. There are only 43 specialists for every 100,000 Valley residents. The statewide average is 87.
"Telemedicine doesn't create more specialists," said Tom Nesbitt, director of the Center for Health and Technology at UC Davis. "What it can do is redistribute the knowledge of specialists over a larger geographic area."
There's little to entice specialists to take time out of busy urban practices to connect with patients hundreds of miles away in small towns. Telemedicine isn't lucrative. Unlike many states, California covers this type of examination, but it doesn't pay doctors much.
Most patients in small Valley towns receive Medi-Cal, the federal-state insurance for the poor. The government insurance doesn't pay as well as private insurance, and doctors balk at seeing Medi-Cal patients because of the meager payments.
This has been the stumbling block to finding specialists for telemedicine projects in the Valley.
It's been difficult recruiting doctors for six proposed sites, said Jennifer Smith, the telemedicine project manager at the UC Merced. "We're scouting for physicians who are willing and able to see these patients," she said.
Many telemedicine centers turn to doctors associated with university medical centers to treat patients rather than those in private practice.
The University of California at Davis has been providing specialists for telemedicine sites since 1992, said Dr. Javid Siddiqui, associate director of the Center for Health and Technology at UC Davis.
UC Davis provides specialists to more than 60 sites in the state. One of them is the Madera Family Medical Group.
The university's doctors remotely see patients at the Madera clinic on Fridays. The service began a decade ago, said Dr. Aftab Naz, a pediatrician in the group. Blue Cross of California paid for equipment that allows the doctors in Sacramento to see and talk to the patients in "real time" over computer connections, Naz said.
Patients from as far away as Stockton and Hanford come for consultations, primarily in dermatology. Almost all are Medi-Cal patients who are unable to find dermatologists willing to accept the government insurance, Naz said.
The telemedicine center in Madera is not a money-maker, Naz said. He gets paid about $16 from Medi-Cal to do a quick physical assessment and take pictures for a 15-minute telemedicine visit. "It's just a community service kind of thing we do," he said.
To make telemedicine work, the United States needs a system for reimbursing doctors for the service that makes their time worthwhile, said Nesbitt of UC Davis.
"We're trying to apply telemedicine over a broken model of health care," he said.
But Nesbitt and his colleague Siddiqui of UC Davis see more doctors embracing telemedicine in five to 10 years as better high-speed computer access in California makes it easier to open centers.
More doctors also will be willing to participate as more become trained in use of the computer equipment, Siddiqui said.
"I see it in inpatient, outpatient, for speciality care. In every aspect of medicine, I feel telemedicine can have a presence," he said. "It's simply limited by imagination."
(Source: Fresno Bee, September 24, 2008)
The eHealth Initiative (eHI) recently published a new guide to help clinicians switch from paper to e-prescribing systems. According to eHI Chief Executive Officer Janet Marchibroda, The "Clinician's Guide to Electronic Prescribing" will remove some of the mystery around e-prescribing and help physicians realize some of the many benefits e-prescribing can provide.
The guide was released at the CMS National e-Prescribing Conference held in October 7n Boston to help clinicians make informed decisions on how and when to transition from paper to electronic prescribing systems. A multi-stakeholder Steering Group comprised of clinicians, consumers, employers, health plans, and pharmacies developed and worked in partnership with the eHealth Initiative (eHI), the AMA, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management.
The guide meets the needs of two target audiences. The first section targets office-based clinicians who are new to the concept of e-prescribing and seek a basic understanding of what e-prescribing is, how it works, benefits, challenges, and the current environment impacting its widespread adoption. The second section targets office-based clinicians who are ready to move forward and bring e-prescribing into their practices. The guide presents fundamental questions and steps to follow in planning, selecting, and implementing the system.
Last June, the Center for Improving Medication Management released a report on e-prescribing and found:
The U.S. Department of Agriculture (USDA)'s Rural Development Agency recently announced the selection of 105 recipients in 41 states for distance learning and telemedicine grants totaling $28.2 million.
"These funds will increase the range of educational opportunities available to students in
rural communities and improve access to health care for countless numbers of rural Americans," said Agriculture Under Secretary for Rural Development Thomas C. Dorr.
Of the grants, 47 will provide access to medical services. . In California, for example, Central Valley Health Network has been selected to receive $74,500 to expand teleconferencing linkages between hub and end-user sites in rural areas. These interactive connections will allow healthcare workers to conduct live training sessions to increase the public's awareness of medical issues and to establish linkages to community resources.
The College of Siskiyous, in Weed, Calif., has been selected to receive $289,430 for teleconferencing projects at the college and eight Siskiyou County high schools, as well as for rural health care providers in the area.
In Maine, the Spring Harbor Hospital in Westbrook was selected to receive $51,850 to
establish a telepsychiatry project to expand the availability of mental health care services in rural areas.
Funding of each recipient is contingent upon their meeting the conditions of the grant
agreement. A complete list of the selected recipients is posted on the USDA Rural Development web site[PDF].
(Source: USDA Press Release, September 18, 2008)
Jefferson County Comprehensive Services (JCCS) in Mt. Vernon, Illinois, recently announced it had recieved a grant from Verizon that will will bring telepsychiatry capabilities to the area via broadband, said Lorianne Schmider, director of mental health services at JCCS.
The telemedicine technology will let the agency access not only ongoing psychiatric services but also to utilize specialists from either Chicago or the St. Louis area, Schmider said.
"With the establishment of telepsychiatry practices, our clients will not have to avoid care because they cannot get to another town for the doctor or because the waiting list is six months long," Schmider said.
"Our doctor who presently comes into the local office every other Saturday will be able to continue care from his home community should he choose, and we have recruited another physician to also provide care via telepsychiatry. We are excited to embark on this new venture."
(Source: The Southern, October 15, 2008)
Local patients who receive treatment at Shriners Hospitals for Children in Evansville, Indiana, now may receive routine checkups via a video hookup at the University of Southern Indiana (USI). That will mean fewer long trips from Evansville to larger cities for patients such as 17-year-old Casey Reutter, who had surgery on her right foot and right hand in St. Louis.
"Last year, I had to go back monthly for my foot," Reutter said, and each time, she had to miss a full day of classes at Reitz High School.
Hadi Shrine in Evansville regularly transports local kids with burns, orthopedic conditions, cleft lips or spinal cord injuries to hospitals in St. Louis, Chicago, Cincinnati and Lexington, Ky., and the partnership with USI will mean fewer trips, said Frank Nolte, a volunteer with the Hadi hospitals program.
Reutter and two other Evansville residents who have been treated at Shrine hospitals — Xiaoli Magary, a 10-year-old Cynthia Heights Elementary School pupil; and Justin Batteiger, also 10, from Stringtown Elementary School — participated in a demonstration of the technology Monday at USI.
The remote checkups will be done with two-way videoconferencing on a secure line. The process, known as telemedicine, allows doctors at the Shrine hospitals to see and talk to their patients.
Xiaoli sat in a chair during Monday's demonstration while Karen Parker, a faculty member in USI's nursing department, used a camera to show her injuries to a doctor watching in Cincinnati.
Cincinnati's hospital has telemedicine sites in Tampa, Fla.; Greenville, S.C.; Savannah, Ga.; and Minneapolis in addition to Evansville. But USI is the first university to become involved in the partnership.
Nursing students at USI will observe and participate in the checkups.
"The popularity of telemedicine is exploding, and we're able to be on the cutting edge of it, which is where we want to be," said Nadine Coudret, dean of USI's College of Nursing and Health Professions.
Nolte said it remains to be seen how many trips the technology will save Hadi Shrine. About a dozen trips are made monthly, and Shrine hospitals, by tradition, provide services to all families regardless of ability to pay.
(Source: Evansville Courier & Press, October 13, 2008)
The robot roaming the corridors and treatment wards of Grande Ronde Hospital, in La Grande, Oregon is a little over 5 feet tall, and moves at a very modest crawl. But EDGAR, as the unit is called, is making big waves: encouraging cooperation between big, metropolitan medical centers and rural hospitals, changing state laws and doing its best to eliminate geography as an obstacle to receiving medical treatment.
Since receiving the remote-presence robot, or RP-7, from St. Alphonsus Regional Medical Center in Boise, Grande Ronde Hospital has risen to the cutting edge of telemedicine, which facilitates remote consultations, diagnostics and treatment via communications technology.
Doug Romer, executive director of patient care services at GRH, said, "What I'm excited about it how far we've come in a year." EDGAR -- an acronym for Educated Doctor Guided Assisting Robot -- has resided at GRH since the summer of 2007.
Controlled by a wireless software-equipped laptop computer and special joystick, the robot can rove about on its wheels, all the while transmitting the virtual presence of a doctor, nurse or other consultant who might be thousands of miles away.
InTouch Technologies Inc., a California-based robotics company, designs and manufactures RP-7s.
As he maneuvered the robot through GRH from a Portland living room, Yair Lurie, an InTouch representative, emphasized its dexterity and versatility. With high-resolution zoom capabilities, flexible neck, camera eye, telephone for private conversations and printer for generating doctor-approved prescriptions, EDGAR is no slouch.
"It has almost a sixth sense, if you will, so it definitely expands my capabilities as a human," Lurie said.
The St. Alphonsus grant, which derives from the U.S. Army Medical Research and Material Command, initially meant to provide training opportunities for hospital nurses. To connect a Boise instructor with La Grande nurses, the RP-7, which normally costs $5,000 a month, was provided to GRH free of charge.
GRH belongs to the IDA/ORE Telehealth Network, an affiliation of Eastern Oregon and Western Idaho hospitals centered, in "hub and spoke" fashion, around St. Alphonsus.
But while EDGAR excels in the virtual classroom, it's also a capable tender of patients. It brings advanced specialists into the wards of GRH to work diagnoses and confer with doctors, nurses and staff in real-time.
"It doesn't take but a few seconds to realize that that's not a robot -- that's a person who happens to be (broadcast) on a robot," Romer explained.
Plugged into the port of the appropriate machine, for example, the RP-7 can transfer the remarkable images generated by an echocardiogram -- which paints a picture of the heart using sound waves -- to a remote cardiologist for interpretation.
The hospital was the first in the nation to send echocardiogram data via robot -- a striking update to a process that used to involve packing the sonic images on VHS tapes and shipping them through the mail.
EDGAR has revolutionized the maternity process at GRH as well, sending detailed images of newborn infants to neonatologists at St. Alphonsus to determine whether the baby might need a transfer to Boise.
And even in that event, a mother confined to a La Grande hospital bed may still bond with her child via the RP-7's mile-spanning monitor.
While a patient often must make an initial visit to St. Alphonsus for complicated procedures, EDGAR can arrange the inevitable follow-ups, eliminating the stress and costs of travel.
"(It's a) perfect application for this, because patients get to stay in La Grande," Romer said.
That would be a major relief to many area patients, especially those forced to make the drive to a bigger city across mountain roads made treacherous by winter ice and snow.
Remote doctors controlling EDGAR can also pull up electronic medical records and display relevant data on the screen. The multi-talented robot's success at the hospital has had reverberations far beyond the Grande Ronde Valley.
As Romer puts it, "We made history for the whole state of Oregon in telemedicine."
Earlier this year, GRH had expressed interest in contracting with Advanced ICU Care, a St. Louis-based company that connects its specialists remotely with ICU units in community hospitals.
But an Oregon Medical Board regulation required that physicians pursuing licenses for practicing across state lines needed to examine patients "in person," preventing Advanced ICU doctors from practicing telemedicine in La Grande.
This past summer, GRH, with Lurie's help, made two presentations to the medical board, conducting demonstrations with EDGAR -- real-time ulstrasounds, echocardiograms, EKGs, etc -- in an attempt to convince lawmakers of the utility of remote-presence technology.
So impressed was the board that it quickly passed a temporary rule allowing for out-of-state physicians to achieve Oregon telemedicine licenses. The regulation will become permanent next year; the temporary ruling, which went into effect in July, simply allowed for its immediate adoption.
Romer said Advanced ICU care became available at GRH at the end of August, although the need to use it hasn't yet arisen (not necessarily a bad thing).
In addition, GRH is investigating the possibility of offering an outpatient dermatology service at the new Regional Medical Clinic on Fourth Street. A dermatologist in Indiana has expressed interest in doing business in La Grande in such a manner, after successfully testing the high-resolution capabilities of EDGAR in examining skin condition.
Romer said that, should negotiations with InTouch pan out, the Regional Medical Clinic might eventually be installed with a "head-only" remote-presence robot to render these types of services.
And the possibilities don't end there. Romer said GRH, St. Alphonsus and the UCLA Medical Center in Southern California may synchronize their stroke treatment procedures via telemedicine to process patients.
So groundbreaking is the work being done in La Grande that the hospital was chosen as the site of next week's second-annual IDA/ORE Telemedicine Network Conference.
The gathering will bring together professionals from within the IDA/ORE system and well beyond -- representatives from hospitals small and large, from as far away as Boston.
Romer said the original St. Alphonsus grant expires in about a year, but he's confident the robot will remain.
(Source: La Grande Observer, Sept. 27, 2008)
To improve health care for patients in northeastern Pennsylvania, an outreach program will begin this fall to get more doctors to adopt health information technology and use high-speed broadband telecommunication networks. A study from the "Connect The Docs" project points out that the challenges include Pennsylvania's large rural regions and its elderly population.
Dr. Tim Welby, president of the Lackawanna County Medical Society, had high praise for the program, saying it would help people, especially senior citizens, who live hours away from medical services.
"This is a way for a senior, or anyone, to get sub-specialist care without having to travel," he said, adding that more use of telemedicine is on the way.
Connect The Docs is a project of the Pennsylvania Medical Society, with help from Affinity Technology Consultants, Harrisburg. Implementation will take place through the outreach program.
Darlene Kauffman, associate director, payer relations with the state medical society, said the project is aided with a grant of $404,500 from the State Department of Community and Economic Development (DCED).
The Connect The Docs study suggests, according to the state medical society, that connecting doctors electronically through high- tech communications tools, such as telemedicine, could help alleviate the problem of reaching the elderly and those in rural areas.
"Making telemedicine available in rural communities would give patients and their local physicians computerized access to consultations with specialists, such as radiologists, dermatologists and cardiologists without having to drive long distances," the study said.
For physicians, according to the study, "better telecommunications connectivity means they can effectively use new tools that improve the efficiency of their practice. Tools include electronic prescribing, consulting electronically with specialists on radiology and other diagnostic tests, and communicating more quickly and efficiently with hospitals."
Lund said that "investments in communications technology within health care would ultimately help Pennsylvanians gain better access to medical care."
He added that "this is particularly true for rural communities, but even urban locations will benefit to the extent that improved connectivity makes it easier for physicians to access critical health care information about their patients."
According to the study, nearly 300 physicians throughout the state do not have access to basic broadband service.
(Source: Northeast Pennsylvania Business Journal, October 6, 2008)
Tthe North Shore-Long Island Jewish Home Care Network in New York is using a home telehealth program to keep elderly patients out of the emergency room or a nursing home.
"The virtual visit can do almost everything a home visit can do except touch the patient," said Renee Pekmezaris, vice president for research with North Shore-LIJ Health System's Office of Community Health. Pekmezaris, a health services researcher studying older people, notes their numbers are multiplying rapidly.
"People are living longer. In 1776, the year our country was born, people could expect to live 35 years," she said. "We've more than doubled life expectancy."
But the number of geriatricians, doctors who specialize in care of the elderly, has decreased 30 percent since 1998 while the number of people over 65 increased 100 percent over the last 10 years, she said. To counter that situation, North Shore is cross-training young doctors to care for the old, she said.
Usually after discharge from a hospital stay the client, who may live alone or with a caregiver, gets a home patient station that includes a video monitor, high-resolution camera, blood pressure machine, stethoscope, pulse oximeter and digital scale.
A registered nurse/case manager, such as Diana Morris, provides instructions to the patients on how to take their own blood pressure, when to take medication and how to measure their own weight, pulse rate and other vital signs. Morris, who manages 25 to 30 cases, many of whom have a history of heart failure, will televisit each patient one to three times a week. If, however, the patient reports shortness of breath or another emergency, Morris will quickly notify the patient's doctor, who will give her instructions on what to tell the patient. She'll recheck the patient later in the day or the next morning.
Morris, 46, who has been a home care nurse for most of 20 years, keeps a running documentation of each patient, which she constantly checks on a second TV.
Televisits have some limitations, she said. "If the patient has leg swelling, for example, I can't visualize how much," she said. "Or I can't visualize the patient's mobility. I have to find out by asking a lot of questions."
One of two nurses working with LIJ Home Care combines actual home visits with the virtual visits. That way, she can make sure the home is clean and safe and the telephone is in easy access.
The Telehealth Program, now four years old, is expanding with 67 new machines replacing older equipment, said nurse manager Kathleen Pecinka. Plans call for eventually adding wound monitoring to the present workload and also expanding to Franklin Hospital Medical Center in South Nassau.
(Source: Newsday, September 28, 2008)
Until recently, California's record of health care for its prison inmates was abysmal. After lawsuits and a federal takeover, however, the state stands to have one of the best systems in the country in the next few years. It will be fueled by a massive investment in health information technology.
By the end of next year, if things go as planned, a high-speed fiber-optic network will link California's 33 prisons, and each institution will have a fast local-area network connecting all its buildings. The goal is to have the entire system's medical recordkeeping and other processes fully electronic by 2013.
Overall, state officials are tackling more than 20 projects, initiatives and programs as part of an ambitious plan to improve the prison health care system.
"The adoption of both basic IT and health IT is absolutely central to our ability to deliver quality health care," said J. Clark Kelso, a former California chief information officer whom the court appointed to oversee the reform efforts.
U.S. District Judge Thelton Henderson appointed Kelso to the post in January. Kelso takes over from Robert Sillen, who had held the position since April 2006.
Henderson established the California Prison Health Care Receivership, which Kelso now leads, in 2005 after the state lost a class-action lawsuit in 2001. The suit claimed that the state violated prisoners' constitutional rights by not providing them with adequate medical care, contrary to the Eighth Amendment's protection against cruel and unusual punishment.
At the time he made his decision, Henderson said the California prison health care system "is broken beyond repair."
The core of the reform program is the construction of a clinical data repository to hold all of the prison system's health information. Jamie Mangrum, CIO of the state's California Prison Health Care Services (CPHCS), called it the program's Rosetta stone project.
That database would be the hub for all CPHCS health IT activity, Mangrum said. It would allow physicians to see basic information about a patient on a single screen, using standard medical protocols.
"We've already kicked that off and hope to be piloting it by March of 2009," he said. Officials haven't chosen the four institutions for the pilot test, he added, but they intend to deploy the database at most of the state's prisons by the end of 2009.
Applications built on top of the database will offer timely access to lab reports and radiology images from outside providers, easier ways to capture prescription information, and access to a network of medical professionals so prison-based providers can communicate with specialists and hospitals.
Those applications will link to prisons' systems for registering and discharging inmates. In theory, medical professionals will have easy access to inmates' records no matter where the individuals are in the prison system and will also be able to access the records after inmates are released so they can follow up on needed treatments.
One of the first applications officials plan to focus on is telemedicine. Several California prisons already have basic telemedicine capabilities, but the goal is to enhance them and extend them to all prisons.
"It's so costly and time-consuming to get clinicians to go to prisons or to transport prisoners to an outside facility for appointments," Mangrum said.
"Telemedicine is such a good fit for that, so [improving those capabilities] is a big requirement," he added.
Providing an electronic medical record system is also a necessity, but it probably won't happen right away.
"One of the reasons why our prison health system is so deficient is because of the lack of [an electronic] medical health record," Kelso said. "But it's at the end o f our list of requirements right now because of its complexity."
There are much more basic needs for officials to tackle. For example, fixing the scheduling system is a top priority because one of the biggest problems is getting inmates to show up for appointments, Kelso said.
"We have an enormous number of missed appointments," he added.
Some observers say they believe the California program could become the model for other state prison systems, many of which are struggling with the same concerns.
Overall, the U.S. health care system is about 20 years behind the commercial sector in its level of IT use, and prison systems are another 10 years behind that, said Howard Salmon, chief operating officer at Phase 2 Consulting, a health care management and consulting company.
"Almost every jail and prison we have been asked to consult for [has] significant problems just with the use of basic IT systems," he said. "Rarely do they have any expertise with side-by-side systems that also deal with health care."
Salmon agrees that California's efforts could light the way for other states. "After all, what happens in California usually rolls across the rest of the country after a time," he said.
However, Kelso and his organization must first overcome some significant hurdles. One is the disorganized state of the paper-based system. Mangrum said there is no universal process for handling inmate records, and it would be pointless to try to deploy IT until such a foundation has been established.
Then there's the inevitable problem of funding, made worse by California's budget woes. Kelso has asked for $7 billion to finance the program — $70 million of which is needed in the current fiscal year, about $3.5 billion in fiscal 2008-2009 and lesser amounts in the following two years.
The California State Senate failed to pass a bill in May that would have authorized the sale of bonds to cover the requested funds, something Kelso attributed to political maneuvering. He filed suit in U.S. District Court to compel the state to provide the funds. The court agreed to the motion Aug. 13.
Kelso said he isn't concerned because the state legislature has approved all the projects he is pursuing, and there is broad bipartisan support for his efforts. He added that he expects to eventually receive all the money he has requested.
(Source: Government Health IT News, October, 2008)
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About the authors: Josie Henderson is the Director of the Telemedicine Research Center. Will Engle is the Executive Director of the Association of Telehealth Service Providers.
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