Telemedicine for HIV Care: Bringing Specialty Care to Inmates

Author:
Diana Finkel, DO
Rutgers New Jersey Medical School

Citation:
Finkel D. Incorporating telemedicine into HIV care [published online February 15, 2019]. Infectious Diseases Consultant.

As an assistant professor of medicine in the Division of Infectious Diseases at Rutgers New Jersey Medical School in Newark, New Jersey, I provide traditional infectious disease, hepatitis C virus, and HIV care at University Hospital and in the infectious disease clinic.

In addition, for the past 8 years I have been the infectious disease consultant at a local correctional facility in Kearney, New Jersey. Two years ago, the correctional facility switched from face-to-face appointments to telemedicine via video conferencing through a federally qualified health center (FQHC) clinic.

Before transitioning to telemedicine, I had been visiting the correctional facility 6 hours a week—trips that added miles to my commute and stress to my day. Because the FQHC clinic had been awarded funds to provide infectious disease services, the use of technology was explored as a more efficient and cost-effective way of providing care.

Not only did the implementation of telemedicine eliminate my travel time to the correctional facility, but also it promoted continuous communication between my University Hospital staff and me—because cell phones are not allowed in correctional facilities—and improved patients’ level of care after they were released from the correctional facility—because their electronic health records (EHRs) were still available through the FQHC.

Working With Video Conferencing

In my practice, we work with video conferencing as the source of telemedicine technology. A typical telemedicine conference proceeds this way: The patient enters the designated examination room, has his or her vitals taken by the nurse on site, and signs any consent for service forms (if needed) prior to beginning the video conference. Then the nurse at the correctional facility accesses the portal, and I get an alert on my phone to join the visit via my portal. After accepting the query, we get an audio and video connection and proceed with the visit.

The connection feels similar to a well-functioning, smoother Skype connection. The patient’s data, assessment, plan for treatment, and next appointment are documented in the EHR at the FQHC. At the end of the visit, a copy is forwarded electronically (or via fax) to the facility while the medication orders are e-scribed to the contracted outside pharmacy for delivery within 24 hours.

At every visit, patients are provided with numbers for contact personnel at community clinics for chronic care management after they re-enter the community. Laboratory and imaging results, outside records and any other necessary information is exchanged 24 hours in advance of the visit and is available remotely via a protected portal connection to the correctional facility EHR. The visit is essentially a synchronous, encrypted, HIPAA-compliant interaction between the patient and clinician.

Using Telemedicine in Correctional Facilities

Telemedicine has the potential to provide state-of-the-art specialty care to inmates for HIV and hepatitis C and B without difficult off-site transfers and unnecessary additional limits on mobility and individual liberties in an already marginalized population. For example, inmates have to be handcuffed during transfers; their daily routine gets interrupted to visit an outside facility; and these outside visits cause inmates to miss appointments with attorneys, continuing education classes, or visits with family. While some facilities have in-house consultants, not all facilities have equal access to high-quality care. 

For specialists practicing in correctional facilities, telemedicine permits us to see more patients efficiently from one central location. A single provider can cover a large area with a high volume of patients by connecting daily via video conferencing to different facilities hours away from each other. This would be especially efficient if all the facilities in the system were able to use the same EHR, and all the records would be available from each location equally. After re-entry into the community, these centralized records could be accessed by the community provider to better coordinate care.

This has been such an important topic, even the Infectious Diseases Society of America (IDSA) has commented on it in its position paper on telemedicine.¹ In sum, the IDSA supports the use of telemedicine for resource-limited populations in which cost-effective and timely care can be delivered via telehealth technologies.

“Other cost-savings estimates suggest that $4.28 billion could be saved with the use of store-and-forward, real-time communication, and remote patient monitoring when used in emergency departments, prisons, nursing home facilities, and physician offices.”¹

Reference:

1. Siddiqui J, Herchline T, Kahlon S, et al. Infectious Diseases Society of America position statement on telehealth and telemedicine as applied to the practice of infectious diseases. Clin Infect Dis. 2017;64(3):237-242. https://doi.org/10.1093/cid/ciw773.