Report

Telemedicine as traditionally practiced by the University of Texas Medical Branch (UTMB) at Galveston is dead. That's the bad news. The good news is that UTMB has given birth to a near relative that promises to render an even higher level of care to Texas prison inmates at less cost.

UTMB, which contracts with the Texas Department of Criminal Justice to provide primary and specialty care to more than 105,000 prisoners at 70 separate facilities in the eastern half of the state, has named the newborn Cybercare.

Cybercare is the medical delivery system of the future, said Leon Clements, UTMB associate vice-president for Correctional Managed Health Care.

Clements said conventional telemedi-cine - a practice pioneered by UTMB to bring distant patients and physicians together through closed-circuit television consultations - proved costly in a correctional setting because time-pressed specialists often found themselves idle while waiting for patients to be escorted and readied for examination. The routine transfer of offenders from one unit to another also proved problematic because their entire medical records, especially lab results and hospital discharge plans, often didn't immediately follow them and had to be tracked down at the time of consultation, Clements said.

A joint effort between UTMB and Texas Tech University Health Science Center, which provides medical care to more than 31,000 offenders at 25 TDCJ units in the western half of the state, will eventually digitize all offender medical records into an electronic library. Beginning at the Central Unit in Sugar Land, the building of the network will continue throughout the year on a unit-by-unit basis.

It will be the largest installation of electronic medical records ever in the history of the United States, Clements said.

Because medical information can be retrieved from the electronic library without delay, Cybercare physicians are able to see more patients, Clements said. UTMB specialists had averaged about 1,200 telemedicine consultations a month, the majority of which did not result in the transporting of patients.

We think it will at least double, and probably triple the number we're able to treat he said. And it will give much better care because we will have complete access to the medical information for the patients we're seeing, which may or may not have been the case before.

Cybercare physicians consult with TDCJ patients from a pair of studios in downtown Galveston. Sitting at a console, the attending physician is provided information displayed on a series of electronic monitors. One set of monitors provides the physician with the latest medical protocol, and another set displays the patient's entire medical history. Two large screens above the console connect the doctor and patient by way of closed-circuit television.

The Cybercare console allows the physician to jump from one prison unit to another at the touch of a button. Instead of sitting idle while one patient is escorted from a unit examination room and another is brought in, the doctor can push a button and instantly switch from the Wynne Unit in Huntsville, for example, to the Telford Unit in Texarkana.

A second studio is used to provide primary and psychiatric care to patients. Clements said closed-circuit consultations have proven especially effective in treating patients with psychiatric disorders because it allows the physician to observe and interact with them.

UTMB has about 170 mid-level practitioners and physicians working in TDCJ units within its region. Another 600 specialists work out of Galveston. Since TDCJ switched from a traditional health care delivery system to managed care in 1994, more than $142 million has been slashed from projected costs under the old system.