CONTACT: DAVE PEDERSEN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
Release: Jan. 24, 2000
UI telemedicine experts assess statewide prison telemedicine project
IOWA CITY, Iowa -- More Iowa prison inmates are receiving health care services
at the University of Iowa without leaving the correctional facilities due
to advanced, two-way video systems and diagnostic equipment that allow long-distance
consultations between Iowa Department of Corrections (DOC) and UI medical
Moreover, the quality of telemedicine care to prisoners and its cost-effectiveness
will only improve as the number of consultations increases, according to a
UI telemedicine expert.
"A couple of years ago, only a handful of states were developing prison
telemedicine programs. So in many ways we've been at the forefront of providing
this type of service," said Michael Kienzle, M.D., professor of internal
medicine and associate dean for clinical affairs and biomedical communications
in the UI College of Medicine. "However, as telemedicine expands -- not
just in serving the prison population but in other areas of health services
delivery -- it will be a common way to do certain medical consultations."
The collaborative prison telemedicine project between the UI and the Iowa
DOC began in March 1997, using the Iowa Communications Network -- the nation's
first state-owned, statewide fiber optic network established in 1989 -- and
existing ISDN (Integrated Service Digital Network) technology. Both the UI
and the prison telemedicine sites have high-resolution television monitors
that allow the consulting physician at the UI and inmate/patient to interact
visually and audibly in real time. Digital diagnostic equipment, including
a digital exam camera, electronic stethoscope and radiologic light box, are
also available to the referring medical staffs at the prisons' telemedicine
The first connections between the UI Hospitals and Clinics and the DOC were
established at the Iowa Medical and Classifications Center at Oakdale and
the Iowa State Penitentiary in Fort Madison. Today, all nine Iowa correctional
facilities use the telemedicine services.
Each prison medical director determines which inmate/patient cases to present
for telemedicine consultation. The medical director, or sometimes a nursing
staff member, presents the case. Medical specialists at the UI Hospitals and
Clinics provide the consultations.
"For the UI physicians, it's a regularly scheduled clinical assignment,
just like any other clinical assignment," Kienzle said. "Each department
determines who staffs the consultations."
The first telemedicine consultations with the DOC involved orthopaedics,
dermatology and internal medicine. Cardiology consultations soon followed.
Within a few months, consultations in gastrointestinal, general urology, surgery
and otolaryngology also were available.
Traditional inmate/patient visits, in which a prisoner is escorted to the
UI Hospitals and Clinics, have numbered around 4,500 visits per year. Since
the prison telemedicine program began in 1997, 731 consultations have been
conducted. Roughly half of these consultations are routine medication checks,
or surgical or other medical procedure "follow-ups," Kienzle noted.
"Doing follow-ups via telemedicine means that we could conceivably
have prisoners at several facilities waiting to come online with a consulting
physician here at the UI," he said. "In terms of just the logistics
of running a clinic, it's much more efficient -- not to mention the time saved
in transporting a prisoner here and in direct communication between the referring
and consulting physicians."
Security and public safety issues are also obviously minimized, since telemedicine
eliminates the need for some prisoners to be brought to the UI, Kienzle added.
Ultimately, the cost-effectiveness of the prison telemedicine program will
determine its viability. Kienzle, Susan Zollo, director of the UI Telemedicine
Resource Center, and Paul Loeffelholz, M.D., medical director at the Iowa
Medical and Classification Center at Oakdale, published a study in the Fall
1999 issue of Telemedicine Journal evaluating the program costs.
The researchers analyzed data from 274 telemedicine consultations from the
program's first year (March 1997 to February 1998). They developed cost estimates
for the nearly 4,400 Iowa prisoners transported to the UI Hospitals and Clinics
during this period, as well as for the equipment, circuitry and personnel
costs needed on both ends of the telemedicine network.
The analysis showed that the average cost to the state's prisons for an
on-site visit to the UI was $115 during the study period. The researchers
found that each of Iowa's correctional facilities would need to average 275
prison telemedicine sessions per year to reach this "breakeven point"
of $115. The breakeven point for the UI would be around 2,000 telemedicine
sessions annually. The cost studies did not include medical care, which was
assumed to be relatively comparable for both on-site and telemedicine services.
These breakeven numbers for Iowa's prisons -- 275 telemedicine sessions
per prison per year -- may seem high, considering that the total number of
telemedicine consultations among all the prisons has been around 275 per year
since its inception, but the goal is attainable, Kienzle said.
"If half of the 4,500 prison medical cases that are sent here each
year were handled by telemedicine, both the correctional facilities and the
UI would be very close to their breakeven marks," he said. "Telemedicine
is not going to totally replace sending prisoners to the UI Hospitals and
Clinics for certain types of care. But with careful planning, it can initially
be cost-acceptable. As the volume of telemedicine consultations increases,
and as telemedicine is reimbursed as a health service, it will certainly become
Medicaid has paid for some telemedicine services since January 1999, Kienzle
noted, but so far reimbursement has been limited.
"We're starting to see more interest in certain types of telemedicine
services," Kienzle said. "My prediction is that in 2000 we'll see
more reimbursement for telemedicine from Medicare/Medicaid and from third-party
University of Iowa Health Care describes the partnership between the
UI College of Medicine and the UI Hospitals and Clinics and the patient care,
medical education and research programs and services they provide.