Service descriptions and their impact
| Citation | Loc* | Service description | Service type | Main findings |
| Haridy.43 An eHealth model of care in the management of chronic disease: Chronic hepatitis C infection. | AU | The HEALTHeLINK system provides asynchronous communication and records sharing between primary care providers (PCPs), allied health, patients and hepatitis specialists. | Single specialty: hepatology— hepatitis C virus (HCV). | Five nurses and six medical officers within three prison systems initiated 77 patient with HCV assessments. Those treated through the eHealth model vs current standard showed non-significant differences in proportion who achieved sustained virological response 12 weeks post-treatment. Adherence to guideline-based care was significantly higher in the eHealth model. The model was acceptable and displayed good usability for most users (specialists, general practitioners and patients). |
| Yogesan et al.10 (2001) Online eye care in prisons in Western Australia. | AU | Internet-based eye care system used to store and transmit prisoners’ medical and ophthalmic history, visual acuity, intraocular pressure and digital images of the retina and eye to ophthalmologists. Responses arrive in 24 hours. | Single specialty: ophthalmology. | Data from 11 patients were successfully transmitted and the ophthalmologist replied within 24 hours. Only one of six scheduled in-person appointments was still needed after the consultation, the specialist made one surgical referral, and the remaining patients were given appropriate medications if necessary. There was a cost saving of $A440 per consultation. |
| Morosini et al.28 (2014) Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders. | BR | Allows users to either (1) upload clinical intraoral images to a file-sharing service for download by a distant consultant, or (2) record them on a compact disc and send them to the consultant. | Single specialty: dentistry. | This study found ‘strong’ to ‘almost perfect’ agreement between traditional (in-person) and remote examination assessments. This was true of both modes of image transmission. Sensitivity ranged from 48% to 73%, and specificity was either 97% or 98%. |
| Gavigan et al.26 (2016) Patterns of skin disease in a sample of the federal prison population: A retrospective chart review. | CA | Secure online platform allowing referring physicians to send patient history and clinical photographs to dermatologists for consultation.† | Single specialty: dermatology. | The three most common dermatological diagnoses made via eConsult (acne, psoriasis and rosacea) are similar to those made through in-person assessment (acne, psoriasis and other superficial mycoses). eConsult is an effective tool for dermatological diagnosis. |
| Laucius.32 Ottawa-made platform cuts wait time for consults. (30 July 2018) | CA | Web-based platform offering doctors and nurse practitioners asynchronous communication with specialists via managed specialty groups. Available across Ontario and extended to federal corrections facilities in the province in August 2018.† | Multispecialty. | No data from evaluation in correctional settings are reported. Evaluation in community settings shows high patient satisfaction and acceptability. About two-thirds of queries can be answered without the need for a face-to-face appointment. |
| SEAMO.33 eConsult available at all eight Ontario CSC facilities. (4 July 2019) | CA | Ontario eConsult offers a secure online application facilitating communication between PCPs and specialists. Available province-wide and extended to Correctional Services in 2018.† | Multispecialty. | At least one physician and delegate team was registered at each CSC facility in Ontario. eConsult usage by CSC physicians grew by 333% from the last 100 days of 2018 to first 100 days of 2019. Sixty eConsult requests were sent between 1 January and 30 June 2019. The top three most requested specialties were Dermatology (34%), Cardiology—Electrophysiology (20%) and Haematology (10%). |
| Barrera-Valencia et al.24 (2017) Cost-effectiveness of Synchronous vs Asynchronous Telepsychiatry in Prison Inmates With Depression. | CO | Asynchronous platform through which patients’ clinical information can be sent to a psychiatrist for diagnosis and advice on management/treatment. | Single specialty: psychiatry, specifically depression. | The asynchronous platform and a synchronous patient-to-psychiatrist video conferencing telepsychiatry model used for comparison were both effective in treating depression in prisons. The asynchronous model was significantly more clinically effective (p<0.001). The mean response time of the psychiatrist was 8 hours. On average, the asynchronous modality is most cost-effective. |
| Bertin et al.25 (2017) (Teledermatology between two French hospitals: Two years of experience). | FR | Secure teledermatology platform (WebDCR) through which medical files and photos are submitted, automatically generating an email sent to the expert centre. Response is provided by PDF file and required within one business day.‡ | Single specialty: dermatology. | Teledermatology was used to assess a breadth of pathologies. Photos and information provided by the requester were rated as good quality in 82.8% and 96.1% of cases, respectively. The median response time was 2.9 hours. A definite diagnosis was made for 36.5% of requests, and treatment was proposed in 83.6% of cases. Responses led to requests for examinations in 44.2% of cases. Only 25/231 (10.8%) of cases required an additional consultation with a dermatologist, and 5/231 (2%) required hospitalisation. |
| Khatibi et al.27 (2016)(Teledermatology in a prison setting: A retrospective study of 500 expert opinions). | FR | Requests for remote advice sent by two internists via e-mail on the secure intranet. Responses were required within a maximum of 5 working days.‡ | Single specialty: dermatology. | A breadth of issues were addressed. Of the 500 consultations, 47 led to a treatment based on additional tests requested though the consultation, 11 were to see patients for a follow-up related to their treatment, and 13 consultations by the internist physicians were related to treatment failure or relapse of the disease. The dermatologist spent an average of 8 min per case and responded to 10 consultations per week. |
| Zarca et al.30 (2018) Tele-expertise for diagnosis of skin lesions is cost-effective in a prison setting: A retrospective cohort study of 450 patients. | FR | Dermatology tele-expertise network and platform on secure server (SESAN Group, http://www.sesan.fr/), used in eight prison primary care units and two hospital dermatological departments.‡ | Single specialty: dermatology. | Median response time was 5.0 days. Requesting providers spent under 7 min making the request in 50% of cases, and dermatologists spent less than 6 min analysing and responding in 50% of cases. 82% of patients had a completed treatment plan (vs 35% when tele-expertise was not used). Only 2.9% of all patients required a later face-to-face appointment or hospitalisation. Service costs became less than the traditional model after 186 cases/year (over eight implementation sites). Tele-expertise was well accepted among physicians with most responders (n=9/10) willing to continue using it. |
| Aoki et al.23 (2004) Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population. | USA | A hypothetical store-and-forward teleophthalmology system in which retinal images are sent to a University of Texas Medical Branch (UTMB) ophthalmologist for diabetic retinopathy screening. | Single specialty: ophthalmology. | This study demonstrates that teleophthalmology is more cost-effective than non-teleophthalmology, increases the number of quality adjusted life years, and reduces the occurrence of retinopathy followed by blindness in patients with type 2 diabetes. |
| Russell et al. Telemedicine Risk Management Considerations.31 | USA | Defines telemedicine services as the remote delivery of healthcare services and clinical information using telecommunications technology. The above UTMB service is discussed as an example of use in correctional facilities. | Single specialty: opthalmology. | Telemedicine is used in prison systems. No primary data are reported. The report cited the above study23 and their findings. |
| Cusack et al. The Value of Provider-to-Provider Telehealth Technologies.42 | USA | Describes non-emergent store-and-forward consultation as the collection and storage of clinical data/images by a provider for forwarding to a second provider who interprets and responds at a different time and place. | Multispecialty. | This report identifies associated costs/savings of telehealth use in correctional settings. The cost savings from store-and-forward consultation outweigh implementation costs; however, a hybrid store-and-forward/real-time system was found to be most cost-effective. |
| Delaware Department of Corrections Introduces Telehealth e-Consults via Connections Community Support Programmes and CeCN. (5 October 2017)37 | USA | A national network (Community eConsult Network) delivering rapid response eConsults to primary care providers in every state and territory. | Multispecialty. | No primary data from correctional settings are reported. Data from community health settings shows that only 31% of eConsults necessitated a face-to-face visit with a specialist. Anecdotally, implementation of eConsult is expected to result in cost savings by reducing offender transportation and associated costs (eg, escort by correctional officers); more timely care; better health outcomes; fewer in-person specialist appointments; and reduced burden on community health systems on re-entry. |
| Kansas Department of Corrections Proposal #EVT000-6973— Comprehensive Healthcare Services. Kansas Health and Recovery Solutions, PC and Wellpath. (10 January 2020)39 | USA | eConsult; details not specified. | Multispecialty. | No primary data reported. Innovations from Wellpath include use of eConsult to facilitate provision of medical and behavioural healthcare in jails, prisons and other facilities. |
| Kendig.40 Telehealth Expansion, Correctional Health Connection Newsletter of the Coalition of Correctional Health Authorities. (January 2014) | USA | National teledermatology service providing national consultations (eg, evaluation, diagnosis and treatment recommendations) to 118 institutions. | Single specialty: dermatology. | No primary data reported. The brief update states that most teledermatology cases can be evaluated with a written clinical history and emailed digital pictures of the rashes alone. |
| Nash-Wong.36 Safety Net Connect and HubMD Partner to Expand Timely Access to Virtual Specialty Care for Underserved and Correctional Healthcare Patient Populations. (7 May 2020) | USA | Telehealth platform (converge) integrating eConsult, eReferral and Televisit technology. Built on partnership between two existing organisations (HubMD and Safety Net Connect). | Multispecialty. | No primary data reported. The article states that the platform enables care delivery in the primary care office or medical home, reducing the patient’s need to travel. Other cited benefits are increased access to care, improved care coordination, promotion of evidence-based practices and improved quality. |
| Pan et al.29 (2008) The value of provider-to-provider telehealth. | USA | Computer simulation comparing store-and-forward, real-time video and hybrid telehealth models for (1) correctional facilities to emergency departments and (2) correctional facilities to physician offices. | Not specified. | Using a store-and-forward model, an estimated 411 000 transports between correctional facilities to physician offices can be avoided annually, resulting in an annual cost avoided of US$162 000 000. With initial investment and annual costs, the national net benefit to correctional facilities would be US$3.33 billion annually once in steady state. Of the three models, the hybrid model was found to be the most cost-effective. |
| Introcaso et al.38 Perspective on teledermatology’s present and future. (December 2018) | USA | A store-and-forward telehealth platform (AristaMD) allowing consultation through secure messaging. Responses requested within 24 hours. | Multispecialty; single specialty discussed: dermatology. | No evaluation data are reported. The interviewed physician stated that teledermatology addresses barriers of access, including patient’s financial resources, geographical location, lack of health insurance, transportation, time off from work and childcare. They also identify the educational value of teledermatology. |
| Centre for Healthcare Strategies. RubiconMD. (updated July 2018)34 | USA | Web-based eConsult service. Includes several EMR integrations and HIPAA-compliant mobile applications. | Multispecialty. | No primary data reported. Article cites the following results: over 75% of cases (across various care settings) have resulted in improved care plans and 84% of eConsults receive responses in under 4 hours. |
| RubiconMD Who We Serve. (2020)35 | USA | As described above. | Multispecialty. | No primary data reported. Impact of eConsult in corrections is described: it enables timely access to quality specialists, allowing for on-site treatment, resulting in improved patient care and reduced costs. |
| The Florida Senate Committee on Criminal Justice. Use of Telemedicine in Inmate Healthcare. (September 2011)41 | USA | Defines store-and-forward telemedicine as clinical information being obtained at one site and uploaded and stored on a remote server until downloaded for review by a specialist at another location. | Multispecialty. | No primary data are reported. The Brief outlines current use of telemedicine in inmate healthcare across the USA, benefits of its use, and drawbacks. It identifies Florida as the only one of the 10 largest US state correctional systems that does not use telemedicine. Benefits cited include increased access to specialists, reduced transportation, reduced security risk, cost savings and more timely provision of care. Primary concerns of use are data transfer speeds (not applicable for asynchronous models), equipment and infrastructure needs, and quality of the clinical experience. |
*Location: AU=Australia; BR=Brazil; CA=Canada; CO=Colombia; FR=France; USA=United States of America.
†The literature from Canada discussed a teledermatology service, the Champlain BASE eConsult service, and the Ontario eConsult Program. These services are now combined under Ontario eConsult.
‡The literature from France discussed a dermatology tele-expertise network offered through a teledermatology platform, secure intranet and tele-expertise platform. These studies were describing the same teledermatology service using WebDCR by the SESAN group.
CSC, Correctional Services Canada.