Demonstration project planners chose this constellation of facilities and medical centers in part because administrators in each were interested in the project and were willing to host a test site. Because nonmonetary benefits, including better security, were important, the demonstration was run in high-security prisons where inmate transfers pose the greatest threat. FMC-Lexington has some specialists on staff who were available to prison health care providers in the three remote sites. VAMC also offers a deep pool of medical specialists. Because both are Federal agencies, services were available at cost, acquisition was simplified, and legal obstacles were eliminated.

To accommodate the equipment and the special needs of the demonstration, physical space in the Lewisburg and Allenwood penitentiaries and in FMC-Lexington and VAMC had to be renovated.

Telemedicine suites were created, soundproofing and air-conditioning were installed, and dedicated telecommunications lines were brought into the suites. At each of the four sites, a full-time telemedicine coordinator was hired to operate the equipment and perform tasks associated with the demonstration, such as scheduling sessions, keeping records, and collecting data. These telemedicine coordinators were employed by Tracor Systems Technologies, Inc., the firm that implemented and operated the demonstration. Indeed, all the equipment, installation, and facility renovation costs were covered entirely by the demonstration project’s funds. As a result, the cost perceived by the prisons was lower than the actual cost -- a fact that made the telemedicine demonstration appealing and encouraged its utilization.

Each of the three Pennsylvania prisons began using telemedicine services as soon as they became operational and quickly integrated them into the provision of health care in the prisons. As time progressed, the frequency of use increased. Between September and December 1996, before the USP-Lewisburg suite became operational, 21 to 52 telemedicine encounters occurred each month (see table C.1 in appendix C). Numbers climbed higher during the first 4 months of full-scale implementation (January through April 1997), reaching 116 per month in April. From April onward, the total number of encounters ranged between 90 and 122 per month. Figure 1.1 shows the month-to-month frequency of telemedicine consultations at each of the four remote prisons throughout the demonstration period.

By the end of the demonstration, a total of 1,321 teleconsultations had been conducted. USP-Lewisburg had used telemedicine the most, with a total of 485 teleconsultations. The total volume throughout the entire period was slightly lower at USP-Allenwood (427 teleconsultations) and at FCI-Allenwood (281).

FMC-Lexington did not become an active remote site until later in the demonstration (February 1997). By the end of December 1997, FMC inmates had received only 128 telemedicine consultations from VAMC specialists. Health services administrators at FMC-Lexington chose to continue existing practices for specialist consultations. The facility’s budget for medical care is much larger than the budgets at the three Pennsylvania prisons, reflecting its mission as a medical center. A rich network of consulting specialists was already in place, and administrators were averse to disrupting it for the purposes of testing telemedicine. Consequently, FMC activity as a remote site focused on podiatry, a specialty not available there prior to the demonstration. FMC operated as an active hub site, however, and the FMC psychiatrists and dietician provided many specialist consultations to Pennsylvania prisoners.

Telemedicine consultations were more frequent in some specialties than others. From the beginning, it was apparent that psychiatric services would be the specialty most commonly used in the prisons (see figure 1.2). At USP-Lewisburg, 54 percent of consultations were with a psychiatrist, as were 65 percent of USP-Allenwood’s consultations and 83 percent of FCI-Allenwood’s. FMC-Lexington served as the hub for psychiatry and hence received no remote psychiatry consultations. (See table C.1 in appendix C for the monthly telemedicine frequencies by specialty and by prison.)

Judging from the frequency of telemedicine consultations alone, the project demonstrates that health care clinicians in the prisons found the technology a useful way to deliver a wide variety of specialty medical services. (Health care providers found telemedicine to be more feasible for certain types of specialty consultations than others, as discussed in chapter 2). This quick start and heavy utilization resulted from the extensive planning and needs assessment that preceded selection and installation of the equipment; in addition, the inclusion of full-time telemedicine site coordinators eased the scheduling, paperwork, and inconvenience problems that have plagued many other telemedicine programs. A number of nonprison telemedicine demonstrations have been considerably less successful in realizing such high utilization so soon after being implemented.²

² Studies by Abt Associates Inc. of all rural telmedicine programs in the United States, including several that have prison sites, did not find comparable levels of utilization. See Hassol, Andrea, Gary Gaumer, Carol Irvin, Dena Puskin, Carole Mintzer, and Jim Grigsby, "Rural Applications of Telemedicine," Telemedicine Journal 3 (3) (1997):215-225.