South Carolina prisons are finally embracing technology-driven health care, a shift the state's prisons director thinks will save money and improve public safety.
Up to now, prisons have been using a combination of paper records and an electronic system developed in the 1980s for the department's roughly 20,000 inmates. Bryan Stirling, director of the Department of Corrections, said he has wanted to change to an electronic system since he was appointed in 2013.
A new records system has been in place as a pilot at two facilities since February 2017. All of the prisons should be on board with the new system by this September.
Prisons generally have been slow to adopt electronic health records. The Affordable Care Act came with some money to reward doctors and hospitals that made the switch. But with no such financial incentive, a long to-do list and a transient population, Stirling said it has taken some time to make the change in prisons.
Still, the switch should yield some cost savings. A University of Illinois at Chicago study found a similar shift in the much larger Texas prisons system saved taxpayers about $1 billion.
In South Carolina, the opportunity to expand the telemedicine capabilities within the prison system sweetened the deal.
The state's Telehealth Alliance has offered a new way for prisoners to receive medical attention. Health care providers at the Medical University of South Carolina, for example, can now video-conference with inmates.
Palmetto Health and the University of South Carolina are planning to offer "urgent and specialty care" through telehealth to two of the system's prisons, according to a report from the Telehealth Alliance. The program is slated to go live this fall.
These partnerships benefit the prisons because it can be expensive and risky to take inmates to appointments outside of the facility, Stirling said. Telemedicine allows the patients to keep these appointments without leaving prison.
"I figured if we could bring the services inside the fence it would make our facilities and the public safer," he said.
South Carolina isn't alone. Prison systems across the country are relying upon telemedicine to fill in the gaps in what they can provide, according to a report by Pew Charitable Trusts.
The shift to telemedicine is not the only reason the prisons are adopting electronic records. Right now, some inmates' medical records are also incomplete, Stirling said. Without the electronic records, staff have, at times, had to build records from scratch.
The company supplying the technology, NextGen Healthcare, has customized the system for the prisons. It allows for screening for suicide and substance abuse upon intake, for example.
Doctors and nurses, with their already loaded schedules, have historically found it difficult to adopt electronic medical records. A survey of private doctor's offices found 43 percent said the systems were slowing them down, the nonprofit RAND Health found in 2013.
That's not a problem unique to the private sector. Terre Marshall, deputy director of health services for the Corrections Department, has worked in other prison systems across the country. She said it has always been painful to bring the entire staff up to speed. But they will adjust.
"It is always more difficult at first in implementing a new system," she said. "Eventually it will be seen as a dramatic improvement."
Dr. Ed O'Bryan, a Medical University of South Carolina doctor who is coordinating the telemedicine effort with the prison system, said telemedicine will be much easier to provide to the prison population now that the Corrections Department has adopted electronic medical records.
O'Bryan said MUSC providers were recently able to follow up on a handful of inmates who had strokes. The Corrections Department saved hundreds of dollars by not having to transport the patients to see neurologists, he said.
Some procedures will still have to be done in person, O'Bryan said. But telemedicine opens up a lot of new possibilities.
"You’re able to provide a very, very high level of care, much higher than most people think," he said.