U.S. Department of Justice

Office of Justice Programs

National Institute of Justice

Implementing

Telemedicine

in Correctional

Facilities
U.S. Department of Justice

Office of Justice Programs

810 Seventh Street N.W.

Washington, DC 20531

John Ashcroft

Attorney General

Deborah J. Daniels

Assistant Attorney General

Sarah V. Hart

Director, National Institute of Justice

Office of Justice Programs National Institute of Justice

World Wide Web Site World Wide Web Site 

http://www.ojp.usdoj.gov http://www.ojp.usdoj.gov/nij
Implementing Telemedicine

in Correctional Facilities

U.S. Department of Justice–U.S. Department of Defense

Joint Program Steering Group Report

Peter L. Nacci, Ph.D. 

National Institute of Justice

C. Allan Turner, D.P.A. 

National Institute of Justice

Ronald J. Waldron, Ph.D. 

System Planning Corporation

Eddie Broyles 

Space and Naval Warfare 

Systems Command (SPAWAR)

May 2002

NCJ 190310
This program was supported under award number 98–IJ–CX–A014 to Tracor, Inc., by the National Institute of Justice,

Office of Justice Programs, U.S. Department of Justice. Findings and conclusions of the research reported here are those

of the authors and do not reflect the official position or policies of the U.S. Department of Justice. 

Reference herein to any specific commercial products, processes, or services by trade name, trademark, or manufacturer,

or otherwise does not constitute or imply its endorsement, recommendation, or favoring by the United States Government.

National Institute of Justice

Sarah V. Hart

Director

The National Institute of Justice is a component of the Office of Justice Programs, which also includes the Bureau

of Justice Assistance, the Bureau of Justice Statistics, the Office of Juvenile Justice and Delinquency Prevention,

and the Office for Victims of Crime.
Contents

iii

CONTENTS

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Implementing the Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Evaluating Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Determining Cost-Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Demonstration Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Implementation Decision and Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Implementation Decision Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Implementation Planning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Technology Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Cost Estimation Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

A.Areas of Inquiry for the Medical Requirements Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

B. Telemedicine Review and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

C. Telemedicine Cost-Benefit Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

D. Medical Requirements Analysis Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

E. Medical Requirements Analysis—Clinic Survey Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

F. Position Description—Telemedicine Coordinator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

G. Developing Telemedicine Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

H.Glossary of Telemedicine Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Executive Summary
Implementing Telemedicine in Correctional Facilities

2

An experiment in the late 1990s and an independent

evaluation of the experiment determined that providing long-distance health care to inmates is feasible

through a system called telemedicine. Telemedicine

uses telecommunications equipment that allows health

care providers to see and diagnose inmates in prisons

located far from health care providers’ offices. The

experiment showed that prisons could improve inmate

health care by providing remote access to more medical specialists while reducing prisoner transport costs

and related security management costs.

The National Institute of Justice (NIJ) and Bureau of

Prisons, U.S. Department of Justice; and the U.S.

Department of Defense cooperated in the experiment.

Several Federal prisons with different missions and

security levels were connected via a telemedicine network. One of the Federal prisons was a medical center. A Veterans’ Administration hospital in Lexington,

Kentucky, was also part of the network.

An independent evaluation of the experiment showed

that telemedicine could play an important role in

delivering quality health care in correctional systems.

The costs and benefits vary according to the type and

nature of institution requirements, but the costs of

telemedicine equipment are continuing to decline. NIJ

published a report of the evaluation in 1999

(McDonald, Douglas C., et al., Telemedicine Can

Reduce Correctional Health Care Costs: An Evaluation

of a Prison Telemedicine Network, Washington, DC:

U.S. Department of Justice, National Institute of

Justice, March 1999, NCJ 175040).

The success of the telemedicine demonstration project led to the decision to use the information from

that study to develop a manual on implementing correctional telemedicine. The information in this manual can be used by correctional administrators who are

evaluating whether telemedicine is an acceptable

approach to providing medical care in their facility.

Planning

The first section guides the reader through the decision process. A medical requirements analysis must

be conducted to determine the services currently provided. The satisfaction of the inmates with the current

health care services should be evaluated. Alternatives

must be evaluated. If telemedicine is selected, an

action plan must be developed.

Implementing the Plan

Implementing the plan requires stating the medical

requirements in terms of telemedicine. One must

know how the telemedicine system will be used in

the facility. The performance requirements of the

telemedicine system should be determined after

careful analysis of state-of-the-art technology.

Communications requirements must be determined,

then evaluated based on the needs of the facility.

Plans for facility requirements and necessary

modifications must be made and implemented.

Personnel must be recruited and trained for the

telemedicine operation.

Evaluating Needs

The technology of telemedicine is unique and must

be carefully evaluated and implemented. The hardware, software, and system features that are most

cost effective must be identified and implemented.

A variety of communication options are available,

and these also must be evaluated for cost and

capability based on the services to be provided.

Space must be identified and, if necessary, modified to meet the needs of telemedicine. Through a

careful and thorough planning and contracting

process, a successful suite of telemedicine equipment and space can be acquired and installed.
Executive Summary

3

Determining Cost-Benefit

In the final analysis, cost is an important factor. 

It has been demonstrated that telemedicine can

improve services, but in view of the limited funding often provided to correctional facilities, a full

cost evaluation should be completed. To further

assist in the implementation of telemedicine in corrections, the appendixes contain tools useful for

evaluating and planning the costs of a telemedicine

program. 
Introduction
Implementing Telemedicine in Correctional Facilities

6

only limited access to outside medical specialists.

When specialized medical care is required and

available, prisoners must be transported outside

the secure perimeter of the prison to external medical facilities. Telemedicine allows authorities to

improve health care by providing access to more

medical specialists, while reducing prisoner transport and related security management costs.

Demonstration Project 

In 1994 the U.S. Department of Justice and U.S.

Department of Defense signed a Memorandum of

Understanding to establish a Joint Program Steering

Group (JPSG). The JPSG manages technology

development and application programs to enhance

the effectiveness of the participants in fulfilling

assigned missions. The telemedicine demonstration

project, a 3-year effort that concluded at the end of

1998, was part of the JPSG’s Biomedical Technology

Program. Figure 1 presents the top-level organization of the project.

Objectives. The demonstration project was designed

to assess the effect of a correctional telemedicine

network in terms of improved prisoner access to

specialty health care, lowered security risks, and

more reasonable health care costs. Secondary

objectives were to identify the practical issues

encountered when designing, implementing, and

integrating a telemedicine system into an actual

prison health care environment and to derive a

cost model and develop an informational tool to

use when determining the suitability of telemedicine in other applications.

Description and design of the demonstration.

The JPSG wanted the project to objectively assess

the effectiveness of telemedicine in a prison environment and determine the effect on cost, security,

and overall access to health care. The project

Purpose

This report provides a model for estimating the

relative costs of telemedicine—the provision of

health care over a distance using telecommunications technology—under varying conditions in a

correctional setting. With the information tools provided in this document, the correctional administrator will be able to determine if telemedicine is

a cost-effective option. Information in this report

is based on a study of the cost-effectiveness of

telemedicine in a correctional system. The companion report, Telemedicine Can Reduce Correctional

Health Care Costs, should also be consulted for

information on estimating the cost of telemedicine.

Much of the information included in this report is

based on the findings of the March 1999 study. The

report is available online at http://www.ncjrs.org/

telemedicine/toc.html.

Background

Telemedicine has been under development in the

United States for nearly 40 years. In the 1970s and

1980s, the number of telemedicine programs in

the United States, Australia, and Canada increased.

However, the technologies were expensive, and the

programs were often canceled when project funding ceased. Recent technological improvements in

equipment and telecommunications have made

telemedicine more affordable. As a result, various

telemedicine programs are being implemented in

the United States and around the world.

Telemedicine is most useful in situations where

physical barriers hinder contact between patients

and health care providers. Thus it has great potential for use in correctional institutions. Although

many U.S. prisons maintain quality health care

programs, they usually have only a small number

of physicians on staff, and many institutions have
Introduction

7

included installing a telemedicine network to provide remote medical consultation and electronic

medical data transfer. The institutions selected for

the demonstration—the U.S. Penitentiary (USP) in

Lewisburg and USP–Allenwood (including prisoners from the Federal Correctional Institution (FCI)

in Allenwood)—are high-security facilities located

in rural Pennsylvania that incarcerate large, aging,

long-term inmate populations requiring access to a

wide variety of specialized medical care. Both prisons employed consultants to deliver these services

in their health care programs. The third site was

the Federal Medical Center (FMC) in Lexington,

Kentucky, an urban, referral medical center for

both medium- and low-security inmates. Both

FMC–Lexington and the Veterans’ Administration

Medical Center (VAMC) in Lexington provided

hub site telemedical consultation services for the

demonstration. FMC–Lexington was also a remote

site because it obtained services from the VAMC.

The locations of the facilities used in the demonstration are shown in figure 2.

Telemedicine demonstration system. The telemedicine equipment leased for the project included a

PC-based computer workstation with required software, an interactive videoconferencing system with

multiple cameras, compatible medical peripheral

devices (such as an electronic stethoscope and a

micro/intraoral camera), and telecommunications

equipment. The various systems were linked via a

telecommunications network. A generic telemedicine

system is shown in figure 3.

Results

The demonstration showed that telemedicine could

play an important role in a quality correctional

health care delivery system. The costs and benefits

of telemedicine will vary with the type and nature

of institution requirements. Based on data from the

study, the cost-benefit analysis concluded that a

telemedicine consultation would cost an average of

$71, compared with $173 for a conventional (faceto-face) health care consultation—a savings of

nearly 60 percent. The costs of telemedicine equipment are continuing to decline due to advances in

technology, so the costs of telemedicine consultations should also continue to drop.

U.S. Department of

Justice (DOJ)

U.S. Department of

Defense (DoD)

National Institute 

of Justice (NIJ)

Defense Advanced Research

Projects Agency (DARPA)

Joint Program

Steering Group (JPSG)

Telemedicine 

Program

Figure 1. Top-Level Organization of

Telemedicine Demonstration Project

FMC, Lexington, KY

VA Medical Center

Lexington, KY

USP, Lewisburg, PA

USP/FCI, Allenwood, PA

Hub Site Remote Site

Figure 2. Demonstration Facility Locations
Implementing Telemedicine in Correctional Facilities

8

Communications can be one of the most bothersome and expensive aspects of telemedicine operations. Sufficient telecommunications bandwidth is

key to the success of telemedicine, and available

resources will vary significantly from site to site.

In this project, bandwidth on demand was found

to be the best technical solution for an operational

system and the most economical.

Well-defined participant roles and missions, agreed

to in advance, are an integral part of a telemedicine

program, and training participants is essential.

Up-front training and continuing education should

address the specific needs of all participants.

Conclusions

This project demonstrated convincingly that

telemedicine can be established within a prison

environment and can be widely embraced by officials

and prisoners. Telemedicine was adopted quickly and

used frequently in several medical specialty areas.

Telemedicine consultations were effective substitutes

for in-person consultations in some specialties, particularly psychiatry. Telemedicine also improved

some indicators of the quality of care available for

prisoners, including the time between referral and

actual consultation, the availability of different

medical specialists, and access to doctors with more

experience in treating prisoners.

Savings from such a program are most likely to

result when in-prison consultations by outside

contract doctors are replaced by telemedicine consultations. Savings from averted trips to nearby

medical facilities are more modest.

An ideal or model telemedicine system—one with

all the “bells and whistles”—is not necessary to

realize significant cost savings. A simple video

teleconferencing system with a close-up camera

is adequate for many telemedicine consultations

(for dermatology, for example). Document cameras

are nice, but a fax machine will usually serve just

as well. Electronic stethoscopes were found to be

expensive, not often used, and not universally

accepted by doctors. Store-and-forward (see appendix H, p. 71) is good technology, but it was not

evaluated in this study since personal consultation

on interactive video was readily available.

The full report, Telemedicine Can Reduce Correctional Health Care Costs: An Evaluation of a Prison

Telemedicine Network, demonstrated that correctional agencies can add telemedicine to their medical programs and expect health care costs to

decrease.

Specialty Care Site

(Health Care Provider)

Primary Care Site

(Patient)

Primary Care Site

(Patient)

Primary Care Site

(Patient)

electronic medical data

electronic medical data

Telecommunication Links

(ordinary telephone lines, ISDN,

 fractional to full T1's, ATM, Internet, 

intranets, and satellites)

Figure 3. Demonstration Facility Locations
Implementation

Decision and Planning
Implementing Telemedicine in Correctional Facilities

10

The effectiveness of telemedicine as a means of

providing health care to a prison population was

established in the pilot project. However, each

institution, be it a prison or another isolated

patient facility, has unique problems and requirements and must determine whether telemedicine

can be used effectively in its particular situation.

This section discusses the process of deciding

whether to implement a telemedicine program in

a particular institution. To assist in completing

this section, appendix A describes what data and

information need to be collected and analyzed.

Appendix B contains a list of implementation questions and considerations. Appendix H contains a

glossary of terms that will be useful in evaluating

telemedicine options.

Implementation

Decision Process 

Generally, telemedicine is most effective under the

following conditions:

■ The medical services requirements cannot be

effectively met within the facility because—

❏ The cost for onsite medical specialists is high.

❏ Medical specialists are not available when

needed.

❏ The small number of requests for specialists

does not warrant a contract for outside 

services.

■ The cost to transport patients to outside medical

services is very high because—

❏ Security requirements demand additional

security officers and vehicles.

❏ Staff overtime is required for most outside

trips.

❏ Medical services are distant from the facility.

■ Other benefits will accrue from implementing

telemedicine, including—

❏ Improved safety to security personnel by

avoiding the outside transport of high-risk

inmates or other detainees.

❏ Improved safety to community and medical

staff because detainees remain in the 

institution.

❏ Improved quality of medical care.

❏ Shorter waiting lists.

❏ Improved response time to inmates’ medical

needs.

To address these and other related issues, a coordinating committee or a decision support group

should be assembled to help conduct the review

process. This group should include not only policymakers and decisionmakers, but also those who

are familiar with the patient population and those

medical staff who might be involved in implementing the project. Once the committee is assembled,

it can use a simplified decision matrix (figure 4) to

evaluate the need for telemedicine capabilities.

Step 1: Conduct a medical requirements analysis.

A survey should be conducted in conjunction with

other information gathering to determine whether

change is required within a facility. If change is

indicated, this information will help in designing

optimal solutions and evaluating the cost of these

options. The following issues should be addressed:

■ Evaluate target population demographics:

❏ Numbers.

❏ Age.

❏ Sex.

❏ Security threat.

❏ Other unusual situations.
Implementation Decision and Planning

11

■ Review facility health care statistics:

❏ Daily caseload of facility staff.

❏ Consultations required or desired.

❏ Transfers to outside facilities.

❏ Other factors.

■ Evaluate consultation statistics:

❏ Types (if any).

❏ Frequency (emergency, routine).

❏ Waiting time.

❏ Location, availability, and qualification of 

consultants (bilingual?).

❏ Time required for consultation.

❏ Average cost for visit (internal or external).

❏ Supplemental costs (such as security, transportation, etc.).

Step 2: Evaluate level of health care satisfaction

within the target population. Besides routine

client surveys and health care statistics, indicators

of satisfaction or dissatisfaction with the current

state of health care within a facility can be gauged

in several ways. Health care dissatisfaction may be

indicated by—

■ Grievances filed.

■ Inmate complaints to prison administrators,

politicians, and media.

■ Inmate refusals of medical treatment by prison

medical staff.

■ Legal cases.

■ Surveys of inmate health satisfaction.

Decision: Is change indicated? Any evident problems should be evaluated to determine whether

more specialist help is required or if basic medical

services need to be augmented. If the information

indicates that a change in health care procedures is

necessary or desirable, alternative solutions should

be evaluated. 

Medical Requirements Analysis

Select

Telemedicine?

Target

Population’s

Demographics

Health

Care

Statistics

Consultation

Statistics

Evaluate Level of Health 

Care Satisfaction

End

No

Develop and Implement 

Action Plan and Milestones

Review Alternate Solutions

Identify

Resources

Required

Conduct

Cost-Benefit

Analysis

Yes

Change

Indicated?

Yes

No Select

Another

Option

Figure 4. Flowchart for Deciding To Implement Telemedicine
Implementing Telemedicine in Correctional Facilities

12

Step 3: Review alternate solutions. The data

available from the medical requirements analysis

(step 1) will indicate the scope of support required.

If telemedicine is being considered, the availability

and concentration of a cadre of medical specialty

providers legally authorized to practice within the

facility are important to consider. These providers

should be identified and a close working relationship established to help build the program. Other

resources that should be identified in order to

project a budget and collect sufficient information

to complete a cost-benefit analysis include facilities, staff, and equipment.

A preliminary cost-benefit analysis should be

conducted prior to undertaking the telemedicine

program (or any other solution) to provide necessary information to support requests for budget

and program assistance. Through interaction with

the medical staff of the health care provider at the

hub organization, the facility staff can use data

collected in the medical requirements analysis to

develop top-level system specifications for vendor

surveys of telemedicine hardware and telecommunications interconnects. Cost information can be

derived from these surveys. Completing the short

form for the cost-benefit analysis (found in appendix C; online at http://www.ojp.usdoj.gov/nij/

pubs-sum/190310.htm) may provide sufficient

information for preliminary decisionmaking.

Decision: Select telemedicine? Telemedicine is not

intended to replace in-facility medical care, but it

may supplement in-facility care as needed. If specialist help is indicated, other factors concerning the

availability of that help should be evaluated, such

as the location and availability of medical specialty

support. Other important considerations are the

legal, political, and human factor implications of

implementing telemedicine in an institution.

Step 4: Develop and implement action plan 

and milestones. Once the telemedicine program

is approved, an action plan and milestones can be

prepared. These documents identify the many

actions required to implement a successful telemedicine program. Although the schedule is important,

several other elements should be addressed, including the types of resources required to complete the

action, detailed funding sources for the implementation, and the identity of responsible offices and individuals. It is important that the responsible parties

recognize and agree to what is expected of them. 

The milestones identified for the project are the

significant steps along the path to implementation.

For example, preparing the site within the facility

where the telemedicine consultations are to take

place may consist of several different activities—

such as carpentry, electrical work, and environmental control—all of which have scheduled completion

dates. Although completing each activity is important, the milestone is the completion of the entire

facility to permit installation of the telemedicine

hardware. The components of a detailed action plan

with milestones are contained in the next section.

Implementation

Planning Process

Once the decision has been made to proceed with

telemedicine, a carefully orchestrated implementation process is important. With thoughtful planning

and attention to detail, a facility should be able to

acquire, install, and place in service a telemedicine

system without significant problems. The planning

described in this section is intended to help develop

the action plan and milestones for implementing

the program. The interrelationships of the planning

tasks are illustrated in figure 5. Unless otherwise
Implementation Decision and Planning

13

noted, these steps are applicable to either hub or

remote site planning. Each task in the process is

described below. (Some of the detailed surveys

may have been completed during the decision

process described in the preceding section.)

Define medical requirements. The medical specialties to be provided with telemedicine must be

defined before the telemedicine system can be

configured. The medical diagnostic needs should

have been determined in the medical requirements

analysis (step 1 of the implementation decision

process described above). The telemedicine system

should be configured to meet all current requirements and should allow graceful expansion (adding

or modifying system components, rather than

replacing them) to accommodate anticipated needs.

Appendixes D and E will be helpful in determining medical requirements.

Define telemedicine system usage. Nonmedical

aspects of telemedicine must also be defined before

the telemedicine system performance can be established. For example, should the system be portable

so it can be operated from multiple locations within

the institution? Does it have to interface with or store

and transfer medical records? Is store-and-forward

capability of video, audio, or data needed? Will the

system be used for training? These features may

cost money, and additional costs must be justified.

Some features, however, may save money.

Define telemedicine system performance requirements. Defining performance requirements is probably the most important step in implementing a

telemedicine system. If this assessment is not accurate, the system that is ultimately acquired may

fail to meet actual needs or may have costly features and capabilities that are not used.

Follow these general principles: 

■ Acquire the latest proven technology. Do not

buy obsolete goods or become a beta test site

for unproven products. 

■ Make sure training and technical support are

adequate—both will be needed. 

No

Define

Medical

Requirements

Define

Telemedicine

System

Usage

Define

Telemedicine

System

Performance

Requirements

Define

Communications

Requirements

Define Facility

Requirements and

Needed

Modifications

Prepare

Telemedicine

Acquisition

Documents

Prepare

Facility

Modification

Documents

Modify

Facility

Acquire

Telemedicine

System and

Equipment

Acquire and Install

Communications

Equipment

Select

Communications

Services Provider

Integrate

Telemedicine

System

Train

Personnel

Start

Telemedicine

Operations

Figure 5. Telemedicine Implementation Process
Implementing Telemedicine in Correctional Facilities

14

■ Do not acquire a system unless it meets all 

applicable industry standards, especially those

relating to communications compatibility.

Once the basic performance requirements have

been defined, the telemedicine system can be configured to provide optimum support. Initially, it

should be configured to meet only those requirements (medical specialties) that are most frequently

used. Once this baseline system configuration has

been established and all associated costs have been

defined, it is important to verify equipment needs

versus medical needs. The cost-benefit model (see

appendix C) can be used to compute the total costs,

benefits, and payback period. The procedure should

then be repeated for the less frequently used medical specialties, and the cost-benefit recomputed. 

Define communications requirements. Defining

the communications technology required to provide

satisfactory telemedicine system performance at

the lowest available cost can be challenging. During

the useful life of the system, the communications

costs will far exceed the system acquisition costs.

The communications requirements depend on the

bandwidth needed for each medical specialty and

the system utilization time (minutes per month)

for each specialty. This utilization pattern can then

be evaluated for each communications protocol

(switched 56, ISDN, DSL, frame relay, TCP/IP, etc.;

see the glossary in appendix H for an explanation

of these and other terms). Once this information

has been collected, the communications costs can be

reviewed with communications services providers.

A different pricing strategy is generally used for

the various communications protocols. In addition,

the communications services providers may have

different pricing strategies, such as discount plans

and package deals. The communications costs generally are based on line usage (number of lines

times total minutes per line times cost per minute),

or a fixed monthly fee plus line usage, or a fixed

monthly fee for a prescribed number of data packets.

Because of the different pricing schemes, the communications utilization pattern must be accurately

defined to ensure that the least expensive communications protocol has been selected. 

Define facility requirements and modifications.

The facility modifications that a telemedicine system requires can range from modest to extensive,

depending on conditions at the institution. The

following descriptions should help planners define

the tasks and costs involved in preparing a facility

for telemedicine.

■ System location. Ideally, the telemedicine system

should be installed near the health care clinic.

The system must be readily accessible both to

medical personnel (to save time, especially for

accessing medical records and supplies) and

to inmates (to save time and costs for inmate

movement). Figure 6 depicts possible telemedicine equipment locations.

■ Communications requirements. Generally, placing the telemedicine room near the telephone

demarcation room reduces both equipment and

installation costs for communications services.

Separating them by great distances can be costly

for some communications technologies because

of the special equipment needed. (The equipment and communications providers can help

determine whether special equipment is needed.) The telemedicine room must be equipped

with a telephone in order to set up videoconferences and perform any necessary troubleshooting. A fax machine should be available in the

room or nearby. 

■ Space requirements. The telemedicine room

must be large enough to accommodate the

telemedicine system (allowing adequate 
Implementation Decision and Planning

15

viewing distances for cameras and displays)

and the personnel who operate it. If the

telemedicine room is used for training, additional seating space will be needed. The lighting and HVAC systems of a typical office

building should be adequate for telemedicine.

In some cases, especially if the floors are not

carpeted, acoustic abatement (sound absorption) will be needed. Unless the existing electrical power service is both clean and reliable, a

power-line conditioner should be installed to

protect the telemedicine equipment from damage caused by power irregularities. The

telemedicine room must also be equipped with

the furniture, fixtures, and equipment found in

a typical doctor’s examination room (examination table, sink, x-ray view box, chairs and

tables, and various medical supplies).

Prepare telemedicine acquisition documents and

facility modification documents. The documents

needed depend on the institution’s administrative

procedures and the implementation or acquisition

method chosen. If the major tasks are being 

subcontracted, a telemedicine system performance

specification and statement of work, a drawing

package for the facility modification subcontractor,

and (probably) drawings and performance specifications for the communication equipment installer

will be needed. If the telemedicine system is being

implemented by in-house staff, purchase orders

must be prepared for each vendor that will be supplying equipment, material, and services.

Select communications services provider. The

communications services provider that meets the

previously defined requirements at the lowest cost

should be selected. To reduce costs, this should be

a competitive process.

Acquire and install communications equipment,

acquire telemedicine system and equipment,

and modify facility. After all modifications and

installations are complete, the telemedicine system

Telemedicine

hardware rack Telephone

X-ray

viewer

Patient

bed

Sink

20"

monitor

Room

camera

Monitor

Visual

presenter Scanner

Fax

machine

Closed-circuit security camera

22'

11'-6"

Camera with tripod

Figure 6. Telemedicine Room
Implementing Telemedicine in Correctional Facilities

16

is ready for integration and performance evaluation testing. Complex systems integrating many different components from various manufacturers

should be fully integrated at the telemedicine vendor’s facility before delivery. This integration testing should reveal most problems at the vendor’s

facility (where they are easily correctable), rather

than at the facility in which the telemedicine system will be implemented (where they are difficult to

correct), and should ensure that the equipment

meets all requirements. Both the hub and remote

systems should be tested using the communications method selected for each, and all performance requirements should be tested under the

most realistic conditions achievable. These steps

may not be necessary for straightforward installations of what is basically video teleconferencing

equipment.

Integrate telemedicine system. After all equipment

is installed, the system must be fully integrated and

evaluated. All performance parameters should be verified, and all problems should be corrected before

the system is accepted. It is extremely important

that all integration testing be performed accurately

and completely.

Train personnel. All personnel who will operate or

maintain the telemedicine system should be thoroughly trained. All users should be able to perform

basic operations and troubleshooting; separate personnel are not required for these tasks. Because

the medical procedures for conducting telemedicine

consultation differ from those used in conventional

medicine, training must also encompass these tasks.

The demonstration project found that a telemedicine

coordinator was essential to the success of the project. Appendix F contains a position description of a

telemedicine coordinator.

Operator training is minimal due to the simplicity of

the system. Depending on the telemedicine system

chosen, the system may be operated in one of two

ways:

■ With a keyboard or mouse and an on-screen user

interface that leads the operator through the

required steps. 

■ With a remote control device (similar to a television remote control) that allows the operator to

proceed through the required steps using onscreen cues.

System maintenance training is also minimal because

of the self-diagnostic capabilities of the telemedicine

system. Most maintenance problems are displayed

to the operator. In addition, most systems allow the

equipment manufacturer to perform remote diagnostics by dialing into a modem attached to the system

and performing additional testing. The failed item

can then be exchanged with a replacement item sent

by the vendor (assuming the institution has a maintenance agreement with the vendor).

Operators who will use the system for telemedicine

consultations require the most intensive training.

This training should be planned well in advance of

the needed date. Hub personnel and remote site

personnel will need different training.

Start telemedicine operations. Once all the

previous steps have been successfully completed,

the telemedicine system should reliably support

all telemedicine needs. Appendix G contains

guidance on how to develop procedures for conducting a telemedicine consult. 
Technology Evaluation
Implementing Telemedicine in Correctional Facilities

18

■ If a systems integrator is being used, the integrator should conduct the technology evaluations.

In fact, the integrator should maintain current

information on the status of each supplier of

telemedicine equipment and services and should

be able to recommend a system that provides

optimum performance to meet requirements and

stays within budget.

■ If the major telemedicine project tasks are being

subcontracted, all potential subcontractors should

provide the technology evaluation status of the

products they are proposing. Information should

be obtained from several candidates so that a

variety of equipment from different manufacturers can be compared.

■ If all tasks are being performed in-house, each

supplier of telemedicine products should be contacted to acquire the technology evaluation data.

With an array of manufacturers, products, and

technologies to choose from, the system can be

configured using the best combination of products and technologies to meet the facility’s needs

and budget.

More and more institutions are opting for a telemedicine system that is nothing more than a videoconferencing system mounted on top of a monitor, with

one specialty camera. Several manufacturers offer

videoconferencing systems of this type. Another

option is to modify videoconferencing systems for

telemedicine applications. The modifications usually involve expanding the interface to accommodate

additional cameras and medical devices. These

added features may be considered third-party

equipment, for which the system vendor does not

provide technical or maintenance support and for

which no performance guarantees are made. Unless

separate agreements have been made with the suppliers of third-party equipment, the implementing

This section discusses some important issues to consider when selecting a suite of telemedicine equipment that meets the requirements already described.

The equipment selection process translates the telemedicine technical performance requirements into

hardware and software requirements. The information

presented here should be useful in making informed

decisions when evaluating and selecting the technological capabilities of a telemedicine system. The

intent is to provide guidance in the process, rather

than to define the latest telemedicine technology

(which is constantly evolving and would soon be

obsolete).

By now, the steps described under “Implementation

Decision Process” should be completed. This information is needed to identify performance requirements

for telemedicine, communications, and facilities.

It also helps identify the equipment for which relevant technology information should be reviewed

and evaluated. 

The technology evaluation process consists of

three steps:

1. Determine the required hardware, software, and

system features that are most cost effective.

2. Determine the system features needed for

making upgrades, expanding performance, or

changing requirements.

3. Conduct surveys of hardware, software, and

system providers to identify the sources of

telemedicine products and the equipment and

services offered by each.

The extent to which the implementing organization

participates in the technology evaluation process

will depend largely on the means chosen to acquire

a telemedicine capability:
Technology Evaluation

19

institution will likely be responsible for the design,

performance, and support of such equipment.

Additional guidance for each technology evaluation

area is provided below.

System functions. The telemedicine system should

be designed to meet only those medical requirements that are currently needed or that will be

needed in the future. However, providing room for

upgrades to software and hardware through module replacement can minimize future obsolescence.

The telemedicine system must be easy to operate

and simple to maintain. All users must be trained

to use and maintain the system. If the system is

configured properly, user training should require

no more than one session of 2 to 4 hours.

Communications. Most innovations in telemedicine technology are occurring in communications.

This is also the part of the system that will incur

the most cost over its useful life. The communications protocol selected now may not be the most

cost-effective solution in the future. Therefore, the

cost-benefit analysis should include the option of

upgrading communications at a later date.

Computers. Although the versatility and operating

speed of computers continue to improve, these

improvements should not require constant upgrades

to the telemedicine system. The computer should

be upgraded only to address additions to system

performance requirements or changes to communications protocols. These upgrades can usually be

accomplished by adding or replacing modules.

Generally, telemedicine systems that do not incorporate medical records or store-and-forward technology will not require a computer.

CODEC. The technology used to transmit telemedicine data is called an analog-to-digital coder/decoder

(CODEC). The CODEC should meet all current standards, especially those relating to communications

compatibility. Failure to meet all standards could

result in incompatibility with other telemedicine

systems.

The requirements for a facility’s interface between

data terminal equipment and data communications

equipment (RS–232) should be carefully evaluated.

If possible, the data ports on the CODEC should be

used for signal and data transmissions. The signals or data are thus transmitted as “in-band”

signals and do not require additional communications channels (as opposed to transmitting them

“out of band” using separate communications

channels). This feature can significantly lower

communications costs.

Technological advances have enabled telemedicine

equipment designers to incorporate the CODEC

and a small video camera into one small, relatively

inexpensive unit that sits on top of a video monitor. For many telemedicine programs, this design

is adequate to capture many telemedical consultations for considerably less than the cost of a conventional CODEC.

Displays. Telemedicine users consider the display

(monitor) to be the most important piece of equipment, because that device provides the visual image

viewed by the medical practitioner. The resolution

of the display must be adequate for clinical needs,

but a larger viewing screen is not necessarily better.

The medical users of the system should be consulted before making a final selection. Provisions must

be made for maintenance (calibration of colors

and alignment) to prevent degradation of display

quality. A quality television with a standard highresolution connector (S-video) is often adequate

for telemedicine.
Implementing Telemedicine in Correctional Facilities

20

Cameras. The types of cameras needed and their

capabilities depend on the medical specialties

selected for the system. As with displays, cameras

should be selected only after consulting with the

medical users of the telemedicine systems. Early

systems relied heavily on an expensive “threechip” camera for adequate video quality. Modern

single-chip cameras are much more economical and

can provide excellent video quality.

Peripheral medical devices. No specific guidance

is provided for selecting peripheral medical devices.

The specialty services to be provided to the inmates

will determine the peripheral devices needed. The

medical staff should be consulted before purchasing this equipment. 

Maintenance. Unless the implementing institution

has personnel with extensive electronic technical

skills, maintenance support should be arranged

through system suppliers. The implementers are

not likely to experience enough malfunctions to

maintain proficiency in system troubleshooting

and repair.
Cost Estimation Model
Implementing Telemedicine in Correctional Facilities

22

A cost estimation model has been designed to help

determine the benefits of applying telemedicine in

a particular institution. This model was specifically

developed to estimate the costs and benefits of

using telemedicine in a prison environment. The

results of applying a similar model are discussed

in detail in the demonstration project final report.

The model described here (and presented in appendix C; online at http://www.ojp.usdoj.gov/nij/pubssum/190310.htm) differs somewhat from the one

developed for the demonstration project. Although

it follows the computational methods described in

the demonstration project report, this version is

more straightforward and eliminates the mathematical complexities associated with processing large

databases.

The cost-benefit model presented in appendix C is

in two forms—simplified and detailed. The simplified model is provided for situations where budgetary estimates are desired or where detailed cost

data are not available and must be estimated. The

detailed model is presented as a series of eight

linked Microsoft® Excel spreadsheets. It allows

entry of detailed cost data and should be satisfactory for calculating the costs and benefits of most

telemedicine projects. The detailed model can also

be tailored to the needs of a particular institution.

The cost-benefit model facilitates comparing the

cost of telemedicine acquisition and operation with

that of conventional health care. The detailed

model allows the following:

■ Estimating the cost of any facility modifications

that may be needed for telemedicine installation.

■ Estimating acquisition costs of the telemedicine

system, network and communications equipment, and telemedicine room fixtures.

■ Estimating training costs.

■ Estimating the cost to operate and maintain the

telemedicine system.

■ Estimating the cost to provide medical personnel

to conduct the medical consultations.

■ Estimating the medical cost savings that accrue

by replacing conventional medical care with

telemedicine.

■ Estimating the transportation cost savings that

accrue by replacing conventional medical care

with telemedicine.

■ Calculating the annual cost savings that accrue

from telemedicine acquisition and operation, the

period required for the savings to pay back the

telemedicine acquisition cost, and the annual

savings that continue to accrue after payback

of telemedicine acquisition cost.
Appendix A 

Areas of Inquiry for the Medical 

Requirements Analysis
Implementing Telemedicine in Correctional Facilities

24

This appendix provides sample areas of inquiry

useful in conducting a medical requirements analysis. The analysis is useful in defining the clinical

and health care requirements of an institution to

ensure a good fit between the telemedicine system

design and end-user needs.

The methodology for the analysis includes interviews with medical and administrative staff to

identify the medical consultative and diagnostic

requirements for each specialty area and to gain

familiarity with the medical operations and prisonerpatient issues. Surveys can be administered and

statistics compiled on the volume and frequency of

internal and external medical consultations (i.e.,

visits to the prisons by medical consultants and

trips to local medical facilities, respectively) and

numbers of prisoners on waiting lists. From these

statistics, the telemedicine opportunities, clinic

requirements, and other telemedicine capabilities

(e.g., mode of interaction, type of information that

would be transferred during a consultation, resolution requirements, medical peripheral devices) can

be determined. The analysis also shows the areas

with the greatest medical needs.

The medical requirements analysis is important for

two reasons. First, it helps ensure that the technology system procured will suit the medical needs of

the organization. Second, it educates the staff on

telemedicine, helps develop a rapport between the

project team and telemedicine site staff, and fosters

local site support for the program.

Prison Demographics

■ Location.

❏ Environment.

❏ Security level.

■ Prison population.

❏ Total number.

❏ Population statistics.

—Age.

—Gender.

■ Prison health clinic statistics.

❏ Daily case load (average).

❏ Daily case load.

—Percent handled by in-house medical staff.

—Percent handled by outside consultants.

❏ Specialty areas (specify).

—Percent handled by in-house medical staff.

—Percent handled by outside consultants.

❏ Case types (specify).

—Percent handled by in-house medical staff.

—Percent handled by outside consultants.

❏ Consultations.

—Percent handled by in-house medical staff.

—Percent handled by outside consultants.

❏ Percent transferred to medical centers for

consultations.

■ Medical staff.

❏ Positions.

❏ Required credentials or training levels.

❏ Organizational structure.

Onsite Biomedical

Technology and

Capabilities 

List existing features.
Appendix A: Areas of Inquiry for the Medical Requirements Analysis

25

Medical Applications:

Statistics 

■ External consultations (the inmate must leave

the facility).

❏ Outpatient (local).

—Specialty area.

—Type cases.

—Routine versus emergency—percent of total

external consultations.

—Frequency of consultations (in clinics and

on-demand).

—Location of consultations.

—Costs of consultations.

—Percent of total consultations appropriate

for telemedicine.

—Time required per consultation (average).

—Data required.

—Static or dynamic images, textual.

—Source of data (x-ray, EKG strip, etc.).

—Frequency of data production and transmission.

—Frequency of data recalled for later use.

—Format of data for presentation

(color, hard copy, etc.).

—Response time for data transmission.

—Equipment used during consultation.

—Number of prisoners on waiting list.

—Factors causing waiting list.

—Total number of outpatient consultations.

—Total estimated hours.

—Medical operational procedures for consultations.

❏ Inpatient (local).

—Specialty area.

—Type cases.

—Routine versus emergency—percent of total

external consultations.

—Frequency of consultations (in clinics and

on-demand).

—Location of consultations.

—Costs of consultations.

—Percent of total consultations appropriate for

telemedicine.

—Time required per consultation (average).

—Data required.

—Static or dynamic images, textual.

—Source of data (x-ray, EKG strip, etc.).

—Frequency of data production and transmission.

—Frequency of data recalled for later use.

—Format of data for presentation

(color, hard copy, etc.).

—Response time for data transmission.

—Equipment used during consultation.

—Number of prisoners on waiting list.

—Factors causing waiting list.

—Total number of inpatient consultations.

—Total estimated hours.

—Medical operational procedures for consultations.

■ Internal consultations (in prison).

❏ Specialty area.

❏ Type cases.

❏ Routine versus emergency—percent of total

internal consultations.

❏ Frequency of consultations (in clinics and

on-demand).

❏ Location of consultations.

❏ Costs of consultations.

❏ Percent of total consultations appropriate for

telemedicine.

❏ Time required per consultation (average).

❏ Data required.
Implementing Telemedicine in Correctional Facilities

26

❏ Static or dynamic images, textual.

❏ Source of data (x-ray, EKG strip, etc.).

❏ Frequency of data production and transmission.

❏ Frequency of data recalled for later use.

❏ Format of data for presentation

(color, hard copy, etc.).

❏ Response time for data transmission.

❏ Equipment used during consultation.

❏ Number of prisoners on waiting list.

❏ Factors causing waiting list.

❏ Total number of internal consultations.

❏ Total estimated hours.

❏ Medical operational procedures for consultations.

■ Relocations to outside medical centers (Transfers:

The inmate must be removed from the facility for

treatment, and he/she may be transferred for an

indefinite stay at another prison hospital with

broader health care capabilities, or he/she may be

transferred to a private hospital.).

❏ Frequency of transfers in each specialty area.

❏ Medical costs.

❏ Transportation costs.

❏ Administrative and overhead costs.

❏ Percent of total consultations appropriate for

telemedicine.
Appendix B

Telemedicine Review and 

Implementation
Implementing Telemedicine in Correctional Facilities

28

This appendix provides a list of considerations to

review before implementing a telemedicine program.

The list has been developed in coordination with

the implementation planning process described in

the main section of this report.

The appendix is intended to give guidance in considering those factors involved in implementing a

telemedicine program. In this sense, it is a reminder

to consider and evaluate all technical, performance,

and cost areas so the institution can acquire the

telemedicine system that best meets its needs.

Thus, this list duplicates some information found

in other parts of the report.

Implementing a telemedicine system is usually an

iterative process. As you proceed through the required steps, you will need to reevaluate prior steps

to ensure that the decisions made are still the best

choices. You may determine that previous choices

must be changed and the succeeding steps repeated.

Can Telemedicine

Satisfy Your Institutional

Requirements?

■ Can telemedicine save money? This is often the

most difficult question to answer in advance.

The cost-benefit analysis conducted for the

telemedicine demonstration project1 clearly

shows that telemedicine can save money for

facilities similar to the demonstration project.

Completing the cost-benefit model in appendix C

will help answer this question for your facility.

■ Can telemedicine provide better health care?

If access to health care is limited because of a

remote location, limited availability of nearby

health services, excessive costs of local health

care, security concerns, or contractual or administrative restrictions, telemedicine can often be

especially beneficial. Telemedicine usually provides more accessible medical care where local

conditions restrict access to physicians or medical facilities.

■ Can telemedicine reduce liability? If telemedicine

is used correctly, it may reduce medical liability

by making medical services more readily available and by fully documenting (through audio

or video recording) the medical consultations

of sensitive cases.

■ How will telemedicine affect inmate management?

■ Which organizations (departments) should be

involved in implementing and using telemedicine?

■ What resources are available for implementing

telemedicine (resources within your facility that

have sufficient time to devote to telemedicine

acquisition)?

❏ Management.

❏ Contractual.

❏ Financial.

❏ Technical.

■ Based on the resources available, which acquisition method should be used?

❏ Contract the tasks to a full-service organization.

❏ Manage the project, but subcontract major tasks.

❏ Perform the acquisition and installation tasks

using in-house resources.

■ What type of contract (or interagency agreements)

will be required to establish the remote-hub

working relationships?

1. See Telemedicine Can Reduce Correctional Health Care Costs: An Evaluation of a Prison Telemedicine Network, a report by the

U.S. Department of Justice, National Institute of Justice, Washington, D.C., March 1999, NCJ 175040.
Appendix B: Telemedicine Review and Implementation

29

■ Who schedules consultations? What are the

logistics of scheduling consultations, resolving

schedule conflicts, and handling emergencies?

■ How will cost invoicing and reimbursement be

managed?

Define Medical

Requirements 

■ Which medical specialties and subspecialties are

required to meet current health care needs?

■ Can telemedicine serve the medical diagnostic

requirements for the specialties and subspecialties needed?

■ Will the telemedicine system use rate be sufficient to justify its acquisition (i.e., how many

consultations per specialty per month would be

conducted using telemedicine)?

■ Remote-site issues: Where will the hub site be

located? Can it support our health care needs at

the required utilization rate? What are the individual (or per hour) consultation costs for each

medical specialty?

■ Hub-site issues: Will we be working with one 

or many remote sites? Will there be enough

(or too many) requests for consultations for

each specialty?

Define Telemedicine

System Usage (Both

Medical and Nonmedical

Applications) 

■ In addition to medical consultations, what will

the telemedicine system be used for?

❏ Inmate counseling (social, psychiatric, 

medical).

❏ Training of inmates or staff.

❏ Medical training and recertification of health

services personnel.

❏ Arraignment.

❏ Judicial proceedings.

❏ Video conferences (prison staff).

❏ Attorney-inmate conferences.

■ From how many locations within the facility

must the telemedicine system be accessible?

❏ One (fixed system location).

❏ More than one (portable system or multiple

systems).

■ Will the telemedicine system be integrated 

(initially or in the future) with our local area

network or wide area network, or should it be

separate?

■ Will the telemedicine system be used to generate, transfer, or maintain medical records or

administrative data?

■ Will the telemedicine system be integrated with

medical or administrative systems?

■ Will remote (not located in the telemedicine

room) consoles be needed to view the consultations or examine records?

■ Should the telemedicine system have a store-andforward capability, or should the consultations

be interactive? If the former, which store-andforward capabilities are needed?

❏ High-definition video still images.

❏ Video clips.

❏ Audio clips.

❏ VCR recordings.

❏ Data files (medical or administrative records).

❏ Storage devices (type and capacity).

■ Should the telemedicine system incorporate 

radiology?
Implementing Telemedicine in Correctional Facilities

30

Define Telemedicine

System Performance

Requirements 

This task translates the medical and other system

usage requirements into performance requirements

for the telemedicine system. If you are employing

a full-service contractor or are subcontracting the

major implementation tasks, the contractor should

help you prepare a performance specification for a

telemedicine system that is appropriate for your

needs. If you are performing all tasks in house,

you must determine the performance requirements

for the hardware and software that you need. This

is not as difficult as it may seem, because several

vendors sell videoconferencing or telemedicine

systems that are already integrated and may meet

most of your needs. You may have to add thirdparty equipment to complete your system.

Once you know the telemedicine system performance requirements, you can research which available products meet your needs. Use the Internet

and trade magazines to locate vendors offering the

products and services. You can often download the

necessary technical, availability, and cost data from

the Internet. Otherwise, contact the vendor directly

for the necessary information.

Now you are ready to configure the telemedicine

system that best meets your needs and budget

from the array of available products and services.

Define Communications

Requirements 

Based on the information developed thus far, you

should know the types of medical consultations to

be performed each month, the estimated time (minutes per month) online with each medical specialty,

and the communications bandwidth necessary for

each specialty. Now you need to determine which

communications protocols are available at your

location. Consider the following (see glossary at

appendix H for details):

■ Switched 56.

■ Integrated services digital network (ISDN).

■ Digital subscriber line (DSL).

■ Asynchronous transfer mode (ATM).

■ Frame relay.

■ Transmission control protocol (TCP)/Internet 

protocol (IP).

Your selection of communications protocols may be

limited because—

■ An existing protocol must be used at your facility.

■ You must match the protocol used by a remote site.

■ The desired protocol may not be available at

your location.

When selecting the communications protocol, you

must consider any unusual conditions that may

exist at your facility. Since most communications

services providers will terminate the communications lines in the telephone demarcation room,

your proximity to the demarcation room may influence your selection of protocols. Carefully evaluate

communications performance if the telemedicine

system must be operated from multiple locations

or if the distance from the telemedicine room to the

demarcation room requires the electrical signals to be

converted and transmitted over a fiber-optic cable.
Appendix B: Telemedicine Review and Implementation

31

Define Facility

Requirements and

Needed Modifications 

Facility modifications can range from none to

extensive. Usually, older facilities require more

extensive modifications than newer ones.

■ Location considerations.

❏ Near communications facilities.

❏ Near medical records.

❏ Easily accessible by medical staff.

❏ Conveniently located for patients (if remote site).

❏ In a quiet area without background noise.

❏ Security can be maintained and not 

compromised.

■ Configuration considerations.

❏ Room shape allows proper placement of

equipment and fixtures.

❏ For jails and prisons, inmate examination

area allows egress route for medical personnel.

❏ Space is available for auxiliary seating if

equipment or room is used for training,

videoconferences, or visitors.

❏ Ingress and egress do not require patients to

cross over cables or interfere with camera

views and do not allow them to tamper with

equipment.

❏ For jails or prisons, doors are not lockable

from inside. (Doors should be locked when

the telemedicine system is not in use.)

■ Lighting.

❏ Adequate lighting, evenly distributed, without

glare or shadows.

❏ Variable light intensity (desirable—not required).

■ Acoustics: Most rooms require some type of

acoustic treatment for good audio performance.

There should be no distracting background noises.

This is critical when using electronic stethoscopes

(at both hub and remote sites). Confidential medical discussions should not be audible outside the

telemedicine room. Treating acoustic problems

generally proceeds in the following order:

❏ Carpet the floor.

❏ Insulate the ceiling, especially if a suspended

ceiling is used.

❏ Insulate the walls.

❏ Install sound absorption on the walls.

■ Electrical.

❏ 110-volt, 15-ampere service is adequate for

most systems.

❏ An uninterruptible power supply (UPS) is not

normally required, but is highly desirable. If

your facility experiences frequent power outages, voltage drops or surges, or spikes on

the power line, a UPS is essential.

■ HVAC: The temperature and environmental controls of a typical office building are satisfactory.

Additional HVAC may be needed for training or

videoconference equipment.

Prepare Telemedicine

Acquisition Documents 

The specific acquisition documents needed will

depend on your administrative procedures and the

acquisition method chosen.

■ Administrative documents.

■ Contracts, subcontracts, purchase orders.

■ Statements of work.

■ System performance specifications.

■ Technical specifications for equipment.

■ Testing procedures, both factory acceptance and

onsite acceptance.

■ Maintenance and support agreements.

■ Shipping instructions.
Implementing Telemedicine in Correctional Facilities

32

Prepare Facility

Modification Documents 

If facility modifications are required (and especially

if they are to be subcontracted), all modifications

should be described in documents that are standard

to building practices in your area for the building

trades involved. As a rule, the documentation

formats established by the American Institute of

Architects should be followed.

Most facilities require approval of the facility manager before any modifications are permitted. After

the facility is modified, the building drawings and

specifications should be updated to the “as-built”

conditions:

■ Building or modification permit (if required by

local code or regulations).

■ Drawings or specifications (for each building

trade to be subcontracted).

■ Inspection records.

Select Communications

Services Provider 

Sometimes selection of the communications services provider is controlled by conditions outside

the telemedicine project:

■ Your organization already has a service agreement with a particular provider.

■ Operation with the hub (or remote) site restricts

your choices.

■ Other users of the communications services may

affect your decision.

Unless there is some overriding reason to the contrary, the communications services provider should

be selected based on lowest cost. However, lowest

cost is sometimes difficult to determine, because each

service provider has different cost structures. If

available, your expected communications utilization

pattern should form the basis for cost comparisons.

Acquire and Install

Communications and

Telemedicine System

Equipment; Modify

the Facility 

All these tasks should be accomplished on the

basis of documents developed earlier. You will need

to maintain cost and schedule control during this

period to avoid exceeding your budget or missing

deadlines. 

Integrate the

Telemedicine System 

Your telemedicine system should be integrated

twice: first at the system integrator’s facility (or

at your facility if you are integrating the system)

and again after the system is installed. This step

assumes that you are acquiring both hub and

remote systems.

The systems should be fully integrated and all performance parameters verified while the systems are

at the same location. System performance can be

verified and problems resolved more efficiently and

with a smaller technical staff if all parties can witness the performance of both the hub and remote

systems. If possible, during testing at the system

integrator’s facility, use the same communications

methods and protocols that will be used for the

final installation, even to the extent of transmitting the signals outside your facility in a loopback

configuration.
Appendix B: Telemedicine Review and Implementation

33

After the hub and remote systems have been

installed onsite, the integration tests previously

performed should be repeated. (The difficulty

of resolving any remaining problems will quickly

illustrate the value of the previous integration testing.) If the integration testing is performed thoroughly and all problems are corrected, you should

not experience any major technical problems when

operating your telemedicine system.

Train Personnel

Conduct training in accordance with training plans.

If possible, training should be conducted onsite,

using the actual telemedicine system implemented

for your program. All personnel using telemedicine

for the first time should be permitted an additional

period of hands-on operation to thoroughly familiarize themselves with their new tasks.

Start Telemedicine

Operations 

Congratulations! You have now completed the

telemedicine acquisition process. You will probably

be surprised how quickly everyone adapts to telemedicine and takes advantage of all the benefits it

provides.
Appendix C

Telemedicine Cost-Benefit Model
Implementing Telemedicine in Correctional Facilities

36

The cost-benefit model presented in this appendix

allows you to calculate the cost of acquiring a

telemedicine system, the fiscal savings you can

expect from using such a system, and other costbenefit values. Two models are provided: a simplified model for initial cost evaluation and budget

planning and a detailed model for calculating more

precise and comprehensive costs based on estimates received from material providers, equipment

suppliers, and subcontractors; telemedicine system

operating costs; and financial savings that accrue

from using telemedicine. The simplified cost estimation model is a single page, whereas the detailed

model is eight pages. (In electronic form, these

pages are linked spreadsheets.)

The cost models used in this report were developed

using Microsoft® Excel; however, other commercial

spreadsheets would be suitable for this purpose.

Electronic copies of the spreadsheets used in

this report are available online at http://www.ojp.

usdoj.gov/nij/pubs-sum/190310.htm. The embedded formulas in the electronic copies are not detailed

in this summary. The reader is strongly encouraged

to download electronic copies of the model spreadsheets and become familiar with the formulas.

In both models, highlighted cells have been protected and do not permit data entry (without

password), to prevent inadvertent alteration of the

model. These cells either require no data entry or

contain equations. Results will be presented in the

highlighted cells when sufficient data have been

entered in the nonhighlighted cells to allow the

models to complete the calculations. Provisions

have not been made in the models for accumulating total medical costs within an institution for

either telemedicine or conventional health care.

The following types of information should not be

entered into the models: costs common to both

telemedicine and conventional health care (e.g.,

medical records update and maintenance) and costs

for those conventional medical practices not

addressed by telemedicine (e.g., invasive medical

procedures).

Simplified Cost

Estimation Model 

The Simplified Cost Estimation Model is presented

in figure C–1. The model is divided into the following categories and subcategories.

■ Costs incurred by telemedicine.

❏ Capital cost.

❏ Operating cost.

❏ Medical personnel cost.

■ Costs avoided by telemedicine.

❏ Medical personnel cost.

❏ Patient escort and transportation cost.

■ Other telemedicine system uses.

■ Telemedicine costs and benefits.

Costs incurred by telemedicine 

These are costs for acquiring and placing in service

all capital assets, the cost of operating and maintaining the telemedicine system, and the cost of medical

services.

Capital cost. The total cost of each capital asset

is to be entered in the cells provided. Suggested

values for the service life of each asset have been

entered; however, you can change these if desired

by overwriting the cell values. The model will calculate the total capital cost, as well as the cost per

year. Straight-line depreciation, without salvage

value, is assumed.

■ Installation. Enter the cost of all modifications

and improvements needed to prepare the facility

telemedicine room. Some facilities may require
Appendix C: Telemedicine Cost-Benefit Model

37

COSTS INCURRED BY TELEMEDICINE

CAPITAL COST LIFE (yr) TOTAL COST COST/YEAR

Installation 20

Telemedicine System 10

Network/Communications Equipment 10

Telemedicine Room Fixtures 10

Training 5

Total Capital Cost

OPERATING COST HRS/MO $/MONTH COST/YEAR

Telemedicine System Operation

Communications 

Maintenance/Support

Total Operating Cost

MEDICAL PERSONNEL COST MIN/CONSULT CONSULTS/YR $/CONSULT COST/YEAR

Psychiatry

Dermatology

Orthopedics

Other

Total Medical Personnel Cost

Total Cost Incurred

COSTS AVOIDED BY TELEMEDICINE

MEDICAL PERSONNEL COST CONSULTS/YR $/CONSULT COST/YEAR

Internal Consultations

External Consultations

Medical Center Consultations

Other Medical Cost

Total Medical Personnel Cost

PATIENT ESCORT/TRANSPORT COST ESCORTS/YR $/ESCORT COST/YEAR

Internal Consultation—Escort Labor/Other Cost

External Consultation—Escort Labor/Other Cost

External Consultation—Transport Cost

Medical Center—Escort Labor/Other Cost

Medical Center—Transport Cost

Total Patient Escort/Transport Cost

Total Cost Avoided by Telemedicine

Figure C–1. Simplified Cost Estimation Model

continued . . .
Implementing Telemedicine in Correctional Facilities

38

no changes, while others may require extensive

changes. (Refer to the worksheet in the detailed

cost model for an explanation or breakdown of

costs if more information is needed.)

■ Telemedicine system. Enter the acquisition cost

of the telemedicine system, assuming that it is

purchased and installed as an integrated system.

Otherwise, enter the total cost of all equipment,

plus the labor cost of integration. Include the

cost of installing and testing the telemedicine

system.

■ Network/communications equipment. Enter the

cost of any equipment required to connect your

telemedicine system with your communications

services provider. Examples of equipment in this

category include inverse multiplexers, fiber-optic

converters, and communication cables.

■ Telemedicine room fixtures. Enter the cost of

everything needed in the telemedicine room,

except the telemedicine system itself. Examples

include table, chairs, telephone, fax machine, and

file cabinet.

■ Training. Enter the cost of training operations

and maintenance personnel as well as medical

staff. As a rule, the telemedicine system supplier

provides training on operating and maintaining

the equipment. Training may also be required

for medical personnel who present the patient

(inmate) to the physician during the telemedicine consultation. The training considered here

is the one-time initial training for starting the

telemedicine project; as such, it is a capital cost.

Training conducted in the future, as part of the

day-to-day operations, would be an operating cost.

Operating cost. The operating cost includes all

expenses associated with running the telemedicine

system.

■ Telemedicine system operation. Enter the cost

per month of maintaining the telemedicine room

(but not the telemedicine system). Note: The

hours per month of telemedicine system operation, which is not used in the calculations, will

be automatically computed and is the same as

the hours per month of communications.

OTHER TELEMEDICINE SYSTEM USES

TELEMEDICINE SYSTEM USE HOURS/MONTH COST/YEAR $ SAVED/YR

Inmate Counseling

Training of Inmates or Staff

Medical Training/Recertification

Arraignment of Inmates

Judicial Proceedings

Attorney–Inmate Conferences

Staff Video Conferences

Other

Total Cost of Other Uses of Telemedicine System

TELEMEDICINE COSTS AND BENEFITS

Total Cost/Year Incurred by Telemedicine Total Consultations/Year

Total Cost/Year Avoided by Telemedicine Cost/Consultation

Cost Adjustment for Other System Uses Cost Savings/Consultation

Total Cost Savings/Year Cost Savings/Year (After Payback)

Cost Payback Period (Months)

. . . continued from page 37
Appendix C: Telemedicine Cost-Benefit Model

39

■ Communications. Enter the cost of all communications unique to the telemedicine system. (Refer

to the telemedicine operating cost spreadsheet in

the detailed model for an example of the types

of costs to include.) The hours per month of

communications is calculated based on the minutes per consultation and the number of consultations entered in the medical personnel cost

section (see below). It is for information purposes only and is not used in calculating the communications cost.

■ Maintenance/support. Enter all costs associated

with maintaining the telemedicine system in

good working order. This includes labor for troubleshooting and repair, spare parts, and any

items needed for periodic maintenance. If you

purchase a maintenance contract, enter the cost

of the contract.

Medical personnel cost. The cost of the medical

staff involved with telemedicine is entered in this

section. The cost entered must be carefully considered to achieve an accurate comparison with the

cost of conventional care. For each medical specialty to be practiced using telemedicine, enter the

number of consultations per year and the cost per

consultation. Also, enter the time (in minutes) that

each consultation is expected to take.

Once you have entered all the information requested

above, the model will calculate the total cost per

year incurred by telemedicine.

Costs avoided by telemedicine 

Medical personnel cost. Enter the cost of medical

staff that would have been incurred in the absence

of telemedicine. This cost may be either for staff

salary or for payment of medical fees to contract

service providers. For each type of consultation

shown, enter the number of consultations per year

that telemedicine replaced and the cost of each

consultation. The cost per consultation includes

both the physician’s cost and the cost of any other

staff members needed to accompany or assist the

physician.

■ Internal consultations. Enter the cost of medical

consultations for which, in the absence of telemedicine, a physician would have provided

medical care within the institution.

■ External consultations. Enter the cost of treatments patients would have received at a nearby

medical facility in the absence of telemedicine.

■ Medical center consultations. Enter the cost of

treatments patients would have received at a

medical center located a considerable distance

from the institution. Remember that in such

cases, the patient usually remains at the medical

center, perhaps for an extended period of time.

Patient escort and transport cost. Enter the

cost that would have been incurred in escorting

and transporting a patient, either inside or outside

the institution, for medical care. The labor costs

include all institution staff involved in the escort or

transport. The transport costs include all nonlabor

costs that would have been incurred in the escort

or transport. Enter cost data for the internal, external, and medical center consultations. Note that

the information to be entered here is the number

of escorts or transports avoided, which is not the

same as the number of medical consultations.

Other telemedicine system uses 

If the telemedicine system is to be used for purposes

other than providing medical services, an appropriate credit should be made against the telemedicine

system capital and support cost. Based on the hours

per month of other uses, the model will calculate the

cost per year for the other uses and for the cost savings to be credited to telemedicine.

Telemedicine costs and benefits 

Once you have entered all the information requested above, the model will calculate the costs and
Implementing Telemedicine in Correctional Facilities

40

COSTS INCURRED BY TELEMEDICINE

CAPITAL COST LIFE (yr) TOTAL COST COST/YEAR

Installation

Telemedicine System

Network/Communications Equipment

Telemedicine Room Fixtures

Training

Total Capital Cost

OPERATING COST HRS/MO $/MONTH COST/YEAR

Telemedicine System Operation

Communications 

Maintenance/Support

Total Operating Cost

MEDICAL PERSONNEL COST MIN/CON (Avg) CONSULTS/YR $/CONSULT (Avg) COST/YEAR

Psychiatry

Dermatology

Orthopedics

Other Medical Cost

Total Medical Personnel Cost

Total Cost Incurred by Telemedicine

COSTS AVOIDED BY TELEMEDICINE

MEDICAL PERSONNEL COST CONSULTS/YR $/CONSULT(Avg) COST/YEAR

Internal Consultations

External Consultations

Medical Center Consultations

Total Medical Personnel Cost

PATIENT ESCORT/TRANSPORT COST ESCORTS/YR $/ESCORT COST/YEAR

Internal Consultation—Escort Labor/Other Cost

External Consultation—Escort Labor/Other Cost

External Consultation—Transport Cost

Medical Center—Escort Labor/Other Cost

Medical Center—Transport Cost

Total Patient Escort/Transport Cost

Total Cost Avoided by Telemedicine

Figure C–2a. Detailed Cost Estimation Model—Telemedicine Cost-Benefit Summary

continued . . .
Appendix C: Telemedicine Cost-Benefit Model

41

benefits, as well as other information that may be

useful when considering telemedicine acquisition.

Detailed Cost

Estimation Model 

The concept for the detailed cost estimation model

is the same as that for the simplified model. The

model is organized with the summary sheet listed

first and the more detailed sheets following, as

shown in figures C–2a through C–2h. Entry of data

proceeds from the last sheet forward. This format

was chosen to allow management to review the

results starting at the top and working toward the

more detailed information.

Telemedicine cost-benefit summary 

The Telemedicine Cost-Benefit Summary (figure

C–2a) is identical to that used for the simplified cost

estimation model. However, in this case, all information is calculated from data entered on the detail

sheets. Only the hours per month for other uses of

the telemedicine system (as described previously)

need to be entered.

Capital cost 

The Capital Costs sheet (figure C–2b) can be used

alone or in conjunction with the Telemedicine

Installation Worksheet (figure C–2g) or the Telemedicine Equipment Worksheet (figure C–2h) or

both. If you are using the electronic version, data

entered on either of these worksheets will automatically be transferred to the Capital Costs sheet. The

worksheet calculates the amortization (depreciation)

of all capital assets. Straight-line depreciation is

used; however, if another method is desired, Excel

offers several alternative means of calculating 

depreciation.

Telemedicine operating costs 

The Telemedicine Operating Costs sheet (figure

C–2c) is used to accumulate all costs to operate and

maintain the telemedicine system, except for the cost

of medical personnel.

OTHER TELEMEDICINE SYSTEM USES

TELEMEDICINE SYSTEM USE HOURS/MONTH COST/YEAR $ SAVED/YR

Inmate Counseling

Training of Inmates or Staff

Medical Training/Recertification

Arraignment of Inmates

Judicial Proceedings

Attorney–Inmate Conferences

Staff Video Conferences

Other

Total Cost of Other Uses of Telemedicine System

TELEMEDICINE COSTS AND BENEFITS 

Total Cost/Year Incurred by Telemedicine Total Consultations/Year

Total Cost/Year Avoided by Telemedicine Cost/Consultation

Cost Adjustment for Other System Uses Cost Savings/Consultation

Total Cost Savings/Year Cost Savings/Year (After Payback)

Capital Cost Recovery Period

. . . continued from page 40
Implementing Telemedicine in Correctional Facilities

42

LABOR EQUIP/MTRL AMORTIZATION

COST CATEGORY HOURS RATE COST COST SHIP COST COST LIFE SALVAGE COST/YR

INSTALLATION

From Telemed Install Worksheet

Total Installation Cost

TELEMEDICINE SYSTEM

From Telemed Equip Worksheet

Total Telemedicine System Cost

NETWORK/COMM EQUIP

From Telemed Equip Worksheet

Total Network/Comm Eq Cost

TELEMEDICINE ROOM FIXTURES

From Telemed Equip Worksheet

Total TM Room Fixtures Cost

Figure C–2b. Detailed Cost Estimation Model—Capital Costs

continued . . .

OTHER TOTAL
Appendix C: Telemedicine Cost-Benefit Model

43

LABOR EQUIP/MTRL AMORTIZATION

COST CATEGORY HOURS RATE COST COST SHIP COST COST LIFE SALVAGE COST/YR

TRAINING

Telemedicine Operation

Telemedicine Maintenance/Support

Medical Training

Develop Training Plan

Total Training Cost

Total of Capital Costs

. . . continued from page 42

OTHER TOTAL
LABOR EQUIP/MTRL/SUPPLIES OTHER TOTAL

TM SYSTEM OPERATING COST HOURS/MO RATE ($/hr) COST ($/yr) COST ($/yr) SHIP ($/yr) COST ($/yr) COST ($/yr) 

Personnel

Medical Supplies

Office Supplies

Total System Operating Cost

COST

MINUTES/ EQUIP/MTRL/SUPPLIES OTHER TOTAL

COMMUNICATIONS COST ($/Month) ($/Minute) MONTH COST ($/yr) SHIP ($/yr) COST ($/yr) COST ($/yr)

Data/Video Communications

Telephone

Modem

Fax

E-mail/Internet

Pager

Other

Total Communications Cost

Figure C–2c. Detailed Cost Estimation Model—Telemedicine Operating Costs

Implementing Telemedicine in Correctional Facilities

44

continued . . .
Appendix C: Telemedicine Cost-Benefit Model

45

LABOR EQUIP/MTRL/SUPPLIES OTHER TOTAL

MAINTENANCE/SUPPORT COSTS HOURS/MO RATE ($/hr) COST ($/yr) COST ($/yr) SHIP ($/yr) COST ($/yr) COST ($/yr) 

Support Subcontract

Maintenance/Support Labor

Spare Parts

Other Support Equip/Material

Total Maintenance Support Costs

Total Operating Cost/Year

. . . continued from page 44
Implementing Telemedicine in Correctional Facilities

46

MAINTENANCE/SUPPORT COSTS CONSULT

CONSULT-COST/HOUR CONSULT-COST/CONSULT

OTHER TOTAL

(List by Medical Specialty) (MINUTES) $/hr CONSULT/YR $/CONSULT CONSULT/YR COST ($/yr) COST ($/yr)

Psychiatry

Total Psychiatry Cost

Dermatology

Total Dermatology Cost

Orthopedics

Total Orthopedics Cost

Other Specialties

Total Other Specialties Cost

Total Medical Personnel Cost/Year

Figure C–2d. Detailed Cost Estimation Model—Medical Personnel Costs
Appendix C: Telemedicine Cost-Benefit Model

47

MEDICAL PERSONNEL CONSULT

CONSULT-COST/HOUR CONSULT-COST/CONSULT

OTHER TOTAL

(List by Medical Specialty) (MINUTES) $/hr CONSULT/YR $/CONSULT CONSULT/YR COST ($/yr) COST ($/yr)

Internal Consultations

Total Internal Consultations Cost

Local External Consultations

Total External Consultations Cost

Medical Center Consultations

Total Medical Center 

Consultations Cost

Total Medical Cost/Yr

Figure C–2e. Detailed Cost Estimation Model—Medical Costs Avoided by Telemedicine
Implementing Telemedicine in Correctional Facilities

48

LABOR COST/TRANSPORT or ESCORT

TRANSP $ OTHER $/ TRANSP TOTAL

COST CATEGORY HRS RATE OT HRS OT RATE LABOR COST ($/Trans) TRANSP-ESC ESCORT/YR COST ($/yr)

INTERNAL CONSULTATIONS

Administrative Personnel

Medical Personnel

Security Personnel

Other Personnel

Total Internal Consults Cost

LOCAL EXTERNAL CONSULTATIONS

Administrative Personnel

Medical Personnel

Security Personnel

Other Personnel

Escort Vehicle Cost

Transport Vehicle Cost

Ambulance Cost

Total External Consults Cost

MEDICAL CENTER CONSULTATIONS

Administrative Personnel

Medical Personnel

Security Personnel

Other Personnel

Escort Vehicle Cost

Ambulance Cost

Charter Airflight

Commercial Airline

Total Medical Center 

Consultations Cost

Total Escort/Transport Cost

Figure C–2f. Detailed Cost Estimation Model—Medical Escort and Transport Costs Avoided
Appendix C: Telemedicine Cost-Benefit Model

49

LABOR MATERIAL

OTHER TOTAL

COST CATEGORY HOURS RATE COST COST SHIP COST COST

System Integrator

General

Electronics

Electrical

Masonry/Plaster/Drywall

Plumbing

Painting

Other—Carpet

—Acoustic

—Lighting

Total Installation Cost

Figure C–2g. Detailed Cost Estimation Model—Telemedicine Installation Worksheet
Implementing Telemedicine in Correctional Facilities

50

UNIT ITEM SHIP TOTAL

ITEM DESCRIPTION MANUFACTURER PART NUMBER QTY COST COSTS COST COST

Telemedicine System

Computer

CODEC

Display

Cameras

Medical Devices

Consoles/Cabinets

Other

Total Telemedicine System Cost

Figure C–2h. Detailed Cost Estimation Model—Telemedicine Equipment Worksheet

continued . . .
Appendix C: Telemedicine Cost-Benefit Model

51

Telemedicine system operating cost. This is the

cost of the supplies and personnel services needed

to operate the telemedicine room. To maintain accurate cost information for calculating costs and

benefits, a consistent approach should be followed

for cost entry here and on the Medical Costs Avoided

by Telemedicine sheet (figure C–2e). Either one of

the following approaches is satisfactory:

■ Enter all costs for maintaining the telemedicine

room. On the Medical Costs Avoided by Telemedicine sheet, enter in the Other Cost column the

savings that accrue by replacing conventional

care with telemedicine.

■ Enter only those costs that are unique to

telemedicine.

Communications cost. Space is provided in figure

C–2c to enter all communications costs. However,

the comments made above for cost entry also apply

here. The data and video communications cost

should be calculated accurately because it will be

the largest operating cost item. Depending on the

communications protocol you are using and your

service provider, your data and video communications cost could be based on rate per minute per

line, rate per minute for your selected bandwidth,

rate per data packet (with or without a fixed

monthly cost), or some combination of these rates.

The model includes a contingency factor of 20 percent for estimating the cost of communications.

Maintenance and support costs. This is the cost

for maintaining the telemedicine and communications equipment. If you have a fixed-cost support

subcontract, enter the cost of that contract in the

Other Cost column (figure C–2c). If you are providing maintenance, enter your labor, parts, and other

support costs in the spaces provided.

Medical personnel costs 

The Medical Personnel Costs sheet (figure C–2d) is

used to calculate the cost for all personnel who

provide medical services. Medical personnel should

be listed by their specialty. Provisions are made for

entering cost data for consultations where the cost

UNIT ITEM SHIP TOTAL

ITEM DESCRIPTION MANUFACTURER PART NUMBER QTY COST COST COST COST

Network/Communications

Total Network/Comm Equip Cost

Telemedicine Room Fixtures

Total Telemedicine Room Fixtures Cost

Total Telemedicine Equipment Cost/Yr

. . . continued from page 50
Implementing Telemedicine in Correctional Facilities

52

is determined either on an hourly basis or on a

per-consultation basis. The Consult (Minutes) column must be filled in for both cost methods. Note

that the total consultation minutes per year are calculated for each physician on the basis of the

Consult (Minutes) column entry. The total consultation time for all physicians is used to calculate

communications costs.

Medical costs avoided by telemedicine

Theoretically, for each consultation performed

through telemedicine, the cost of a conventional consultation should be avoided. You should review medical records for the past year and determine which

patients could have been cared for through telemedicine. This will form the basis for establishing the

number of telemedicine consultations that would

have occurred over the same time period, as well as

the number of internal, local external, and medical

center consultations that could have been avoided

through telemedicine. The medical specialties involved and your cost to provide these specialty services should be entered in the appropriate locations.

One of the most difficult tasks will be to establish an

accurate count of external and medical center consultations avoided through telemedicine. If telemedicine provides better access to medical services or

access to medical specialties that were otherwise

not available, you may find that the more immediate

treatments enabled by telemedicine reduce the incidents requiring transport of a patient for outside

medical services. (Review the findings of the

telemedicine demonstration project at http://www.

ncjrs.org/telemedicine/toc.html for guidance.)

Medical escort and transport costs

avoided 

The Medical Escort and Transport Costs Avoided

sheet (figure C–2f) is used to calculate the cost

avoided because patients treated through telemedicine did not require escort or transport. The cost

categories list personnel normally involved in

escorting or transporting patients. For external and

medical center consultations, provisions are made

to enter the cost to provide the transportation.

For internal medical consultations, escort costs may

be avoided if the escort provided is part of the routine movement of inmates. For external and medical center consultations, enter the cost for planning,

preparing paperwork, coordinating with the outside

facility, and transporting the patient; travel time to

and from the destination, time spent at the destination, and time for closing the incident; and all transportation costs. 

Telemedicine installation worksheet 

The Telemedicine Installation Worksheet (figure

C–2g) provides additional space for entering cost

data for installing the telemedicine system. No

entries are required on this worksheet if all installation costs were entered on the Capital Costs sheet.

Cost information entered on the Telemedicine

Installation Worksheet will be automatically transferred to the Capital Costs sheet if you are using the

electronic version.

Telemedicine equipment worksheet 

The Telemedicine Equipment Worksheet (figure

C–2h) provides additional space for entering cost

data for procuring the telemedicine equipment. No

entries are required on this worksheet if all equipment costs were entered on the Capital Costs sheet.

Cost information entered on the Telemedicine

Equipment Worksheet will be automatically transferred to the Capital Costs sheet if you are using the

electronic version.
Appendix D

Medical Requirements Analysis Worksheet
Implementing Telemedicine in Correctional Facilities

54

Medical Requirements

Analysis 

Construct a form or worksheet to collect the information outlined below. Information should be gathered for external outpatient consultation, external

inpatient consultation, and internal consultation.

This information should be gathered for each

subspecialty, such as dermatology, orthopedics, or

cardiology. 

■ The number of routine consultations.

■ The number of emergency consultations.

■ Frequency of consultations (patients seen

per month).

■ Locations consultations are conducted.

■ Monthly costs.

■ Number of consultations appropriate for telemedicine (case examples).

■ Time required for consultations.

■ Total monthly time required for consultations.

■ Type of data used.

❏ Static or dynamic images, textual.

❏ Source of data (x-ray, EKG strip, etc.).

❏ How often will data be produced?

❏ How often will data be recalled for later use?

❏ How often will data be communicated to a

remote location?

❏ How many locations?

❏ Expectations of data (image quality, annotations).

❏ Format of data for presentation 

(color, printed, viewed).

❏ Response time for data 

(prison-telecom-hospital).

■ Equipment used for consultations.

■ Number of inmates on waiting list.

■ Factors causing wait list.

■ Current practices and procedures for medical

consultation.
Appendix E

Medical Requirements Analysis—

Clinic Survey Form
Medical Requirements Analysis—Clinic Survey Form 

For planning purposes, responses to the following questions should be gathered from the clinics.

A. What telemedicine clinics would you like to see scheduled at your facility? Please specify any other

clinics that are not listed below:

FREQUENCY OF CLINIC NO. OF PATIENTS WEEKDAY CHOICES

SPECIALTY REQUIRED (WEEKLY, MONTHLY, ETC.) PER CLINIC 1ST 2ND 3RD HOURS

1. Psychiatry

2. Dermatology

3. Orthopedics

4. Podiatry

5. Cardiology

6.

7.

8.

B. What specialty areas would you like to have available for nonclinic consultations (nonemergency)?

1.

2.

3.

4.

5.

6.

7.

8.

Implementing Telemedicine in Correctional Facilities

56
Appendix E: Medical Requirements Analysis—Clinic Survey Form

57

C. How quickly would you need to have the nonclinic consultations (nonemergency)?

All specialty areas have the same response time, ______business days.

or

The maximum response time varies by specialty area, as follows:

MAXIMUM RESPONSE TIME

SPECIALTY AREA FOR SCHEDULING CONSULTATIONS

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

D. What turnaround time is required for teleradiology consultations for plain films?

__________________ business days.

Initially, would a faxed consultation report meet your needs? ______ Yes ______ No

How soon should the hardcopy consultation report follow? ______ business days.

E. Is the number of plain films you indicated equal to the number of monthly teleradiology consultations,

or is the number of monthly consultations less than this number? In other words, how many monthly

teleradiology consultations do you project and how many monthly films do you project?

__________________ monthly teleradiology consultations. __________________ monthly films.

F. Other comments:
Appendix F

Position Description—

Telemedicine Coordinator
Implementing Telemedicine in Correctional Facilities

60

Introduction

The incumbent serves as the telemedicine coordinator at a prison remote telemedicine site. Services

are coordinated in collaboration with the off-site

telemedicine consultant and the prison staff. The

telemedicine coordinator is primarily responsible

for coordinating telemedicine operations and medical consultations and for providing training and

assistance for the prison medical staff.

Major Duties

■ Serves as the telemedicine coordinator at a

remote prison telemedicine site.

■ Coordinates and schedules subspecialty consultations (clinic and nonclinic) for inmate medical

care with the telemedicine consultants. Operates

telemedicine equipment during telemedicine consultations (as appropriate) and helps the presenter use the telemedicine equipment during

the telemedicine consultation.

■ Assembles patient consultation forms and medical records for faxing or mailing to telemedicine

consultant before the scheduled subspecialty

clinics. Reviews information in advance to

ensure completeness and legibility.

■ Collects and reports required patient evaluation

data on a timely basis.

■ Ensures telemedicine equipment is fully operational and maintained and is properly set up

and tested before scheduled consultations.

■ Maintains stock of supplies and ensures security

of the exam room and equipment.

■ Provides reports and status updates as required.

■ Provides input for developing telemedicine policy

and procedure.

■ Teaches other health care personnel to operate

and maintain the telemedicine equipment.

■ Works responsibly and cooperatively with entire

telemedicine team.

■ Ensures patients’ privacy and confidentiality.

■ Performs related duties as required, but accepts

only those duties that are commensurate with

educational preparation, training, experience,

and licensing laws.

■ Adheres to all infection-control policies and

procedures.

■ Is subject to prison security background check,

which is to include urinalysis drug screen.

Knowledge Required 

■ Working knowledge of medical theory, clinical

practice and patient care, and medical terminology.

■ Working knowledge of the use of computers,

associated software applications, office equipment,

and medical equipment (e.g., stethoscope).

■ Excellent interpersonal skills.

■ Ability to understand medical records and accurately extract and enter patient data from patient

encounters.

■ Familiarity with prison custody, safety, and security

regulations; health service policies and procedures;

and inmate behavior. 

■ Ability to train other health care staff to operate

and maintain the telemedicine equipment.

■ Knowledgeable in the legal and ethical aspects of

correctional medicine.
Appendix F: Position Description—Telemedicine Coordinator

61

Supervisory Controls

The position is supervised by the head of Health

Services. However, the incumbent performs effectively and independently. The incumbent will have

the ability to set priorities, to be organized, and to

determine when to seek appropriate assistance. The

prison warden will have ultimate authority and

responsibility for all telemedicine activities and

efforts at the prison remote site. The incumbent

will be guided by the needs of the prison in all

tasks performed.

Physical Demands 

This position may require long periods of standing

or sitting. The incumbent is required to lift and

move supplies and to use specific medical equipment. The incumbent must be able to function

under stressful circumstances and be capable of

coping with complex or rapidly changing situations.

Work Environment 

The incumbent works in a hazardous-duty environment in a correctional setting. In addition, this

individual is subject to all exposures common to

the health care setting, including infectious and

communicable diseases, irritant chemicals, and

electrical hazards. The incumbent does not provide

direct patient care.
Appendix G

Developing Telemedicine Procedures
Implementing Telemedicine in Correctional Facilities

64

A successful telemedicine consult requires the

consultant physician or other health care provider

to be thoroughly prepared. Before the consult, the

originating provider should review and collect

information relevant to the consultation. The

health care provider should have established

procedures for collecting information for

telemedicine consultations.

This publication does not identify and develop procedures for all specialty requirements. Rather it presents guidance on how to develop procedures that

can be used to conduct telemedicine consultations.

Any procedures developed must be consistent with

acceptable medical practices. Competent medical

personnel must review the procedures on a regular

basis.

Procedures should be developed for various medical specialties that require different information

and different preparation. A cardiology consult may

require information on recent stress tests, for

example, while a dermatology clinic may require

the results of specified lab tests. Procedures for

dermatology consults can be established by asking

the consulting dermatologist for the information

necessary to conduct a telemedicine consult. With

guidance from the consulting dermatologist, a written procedure can be designed to be used during a

dermatology consult. The same process can be used

to create procedures for other medical specialties.

Any information the provider would have available

for an in-office patient should be provided to the

telemedicine consultant. The patient’s medical

record and any relevant tests or laboratory results

must be available. In some cases, this information

must be transmitted to the consulting physician

before the consult.

State medical boards may be able to provide information on State laws and regulations pertaining to

telemedicine. The boards of specific medical specialties may also be helpful, as may other correctional agencies that have established telemedicine

programs. For example, the Federal prison system

has an established telemedicine program and procedures for conducting telemedicine consults. For

copies of its procedures, contact—

Assistant Director

Health Services Division

Federal Bureau of Prisons

320 First Street N.W.

Washington, DC 20534

http://www.bop.gov

Other contacts that may be helpful in developing

procedures for conducting a telemedicine consult

include—

National Commission on Correctional 

Health Care

1300 West Belmont Avenue

Chicago, IL 60651

http://www.ncchc.org

American Telemedicine Association

910 17th Street N.W.

Suite 314

Washington, DC 20006

http://www.atmeda.org
Appendix H

Glossary of Telemedicine Terms
Implementing Telemedicine in Correctional Facilities

66

ACR-NEMA. American College of Radiology and

National Equipment Manufacturers Association.

These organizations have jointly developed standards for teleradiology practice. For computed

tomography (CT), magnetic resonance imaging

(MRI), ultrasound, nuclear medicine, and digital

fluoroscopy, images must be scanned at a resolution of 500 pixels x 500 lines at a depth of 8 bits

(256 gray scale) or better; for diagnostic x-rays,

2,000 pixels x 2,000 lines (“2k by 2k”) at 12 bits

(4,096 gray scale).

ADSL. Asymmetric digital subscriber line. A system currently under trial in several metropolitan

areas. Uses existing copper phone lines. With

proper retooling by telephone companies, ADSL

can supply 6-Mbps downstream delivery of data. 

algorithm. A mathematical coding scheme. A

coding scheme can compress digitized broadband

video or audio signals so that the signals can be

transmitted over a lower (and less expensive)

bandwidth. Standards-based algorithms enable

communications with standards-based systems

from disparate manufacturers. Proprietary algorithms are unique to individual manufacturers and

enable communications only between equipment

from that manufacturer. Current practice strongly

encourages standards-based systems.

analog. Information (electronic or otherwise) that

is created and transmitted as a continuous stream.

Waveforms (e.g., on oscilloscopes) are analog.

Compare this to digital information generated by

computers. Modems are used to convert digital

computer data to analog form for sending over

standard (plain old telephone system, POTS) lines.

annotation. The capability to add comments or

highlights to captured or live video. Simultaneous

shared annotation of captured (or, less commonly,

live video) images allows conference participants to

clearly point out the areas in question on an image,

and may provide significant instructional value.

ATM. Asynchronous transfer mode. A telecommunications service that supports switched multimedia communications from T1(1.544 Mbps) to

very high data rates (155 Mbps and higher). Not

commonly available.

audio-only conference add-ins. The capability to

add another site into a videoconference using only

an audio connection. This feature uses a regular

phone line connected to the CODEC to connect

someone who is not near a video site but needs to

be part of the conversation.

bandwidth. The capacity of an electronic transmission medium to transmit data per unit of time. The

higher the bandwidth, the more data can be transmitted. Typically measured in kilobits or megabits

per second. Standard telephones are low-bandwidth

devices (a maximum bandwidth of 33.6 Kbps). Cable

television uses high bandwidth (up to 140 Mbps).

beam splitter. A device for tele-otoscopes or 

-ophthalmoscopes that allows the clinician to see

directly into the eye or ear and also routes a portion

of the image to the video camera. This capability

is usually preferred by the clinician, who is accustomed to looking directly through the device rather

than at a video monitor.

bit. Binary digit. The basic 0–1 unit of information

used by computers for information entry, storage,

and transmission. Data rates in telecommunications are often referred to in bits (b) per second.

See bandwidth, byte, Kbps, Mbps.

BRI. Basic rate interface.
or may not affect their ability to transmit diagnosticquality images.

chip. An integrated circuit. See CCD.

chrominance. Hue and saturation (color) on a

video monitor. 

CIF. Common intermediate format. An international

standard for video display formats developed by

the TSS (see ITU-T Standards). 

CODEC. Coder/decoder hardware or software used

with interactive video systems that converts an analog signal to digital, then compresses it so that lower

bandwidth telecommunications lines can be used.

The signal is decompressed and converted back to

analog output by a compatible CODEC at the receiving end. The compression method (algorithm) may

be proprietary or standards based.

CSU/DSU. Channel service unit/data service unit.

A hardware device that is needed to terminate a

high-speed telecommunications connection. It is

inserted between the telemedicine system (e.g.,

CODEC) and the communications line. The device

conditions and strengthens the signal and supports

the necessary link protocols for transmission of

data over leased or switched communications lines.

It also acts as a multiplexer.

DICOM. Digital imaging and communications in

medicine. An industry standard for connection of,

and communications among, medical imaging

devices. The most recent iteration is DICOM 3.

digital. Information coded in discrete numerical

values (bits). Digital data streams are less susceptible to interference than analog data streams. Also,

because they are made up of zeros and ones (bits),

they can be manipulated and integrated easily

with other data streams (voice, video, data).

bursty data. Short, intense transmissions of

grouped, related information. Sometimes called

“boluses of data” by medical clinicians. 

byte. The amount of computer memory needed to

store one character. Each data character, such as

the letter A, is composed of 8 bits, called a byte

(abbreviated B). Units of storage are often referred

to in terms of the number of bytes (e.g., “100-MB

hard drive”).

camera control. The capability to control the video

camera used in the consultation, either at the near

end (local control of local pan-tilt-zoom iris-focus)

or the far end (hub control of pan-tilt-zoom at the

remote site). This feature may be quite useful in

consultations if the examiner wants to control the

remote camera’s view without having to provide

verbal directions to the assistant at the remote site.

CCD. Charge-coupled device. An integrated circuit,

or “chip.” A 1-CCD (one-chip) camera contains a

single charge-coupled device with specialized semiconductors containing photosensitive cells that

generate voltage when struck by photons of light.

One photosensitive cell equates to one pixel in the

displayed image. The number of cells on a chip

determines the number of pixels of resolution that

the camera can display. The larger the chip, the

greater the image resolution. Increased resolution

is accomplished either by using larger chips or by

using more chips. Single-chip cameras do a good

job. Two-chip cameras use one chip for chrominance

and one for luminence. Three-chip cameras do an

even better job, because they have more total cells

and because they use one chip each to capture red,

green, and blue light. Three-chip cameras provide

images with higher resolution and better color representation, and can cost 10 times as much as

single-chip cameras. CCD scanners for teleradiology

are less expensive than laser scanners and may not

have the same ability to detect contrast. This may

Appendix H: Glossary of Telemedicine Terms

67
Implementing Telemedicine in Correctional Facilities

68

digital camera. A camera that captures images

(still or motion) digitally and does not require

analog-to-digital conversion before the image can

be transmitted or stored in a computer. The analogto-digital conversion process (which takes place in

a CODEC) usually causes some degradation of the

image and a time delay in transmission. Avoiding

this step theoretically provides a better, faster

image at the receiving end.

DS3. A leased line (nonswitched) running at

45 Mbps. Compare with OC3, T1, ISDN.

duplex audio. A communications mode that

enables simultaneous transmission and reception

of audio signals in both directions. Full-duplex

audio enables both ends of a conference to speak

and be heard simultaneously (like a regular telephone call). Half-duplex audio supports only one

site speaking at a time; other speakers will be cut off.

echo cancellation. A feature that prevents a system

from picking up the sound from its own speakers

and transmitting it back to other conference sites.

Highly desirable for acceptable audioconferencing. 

encryption. A security feature that ensures that

only the parties who are supposed to be participating in a video conference or data transfer are able

to do so. It is accomplished by mathematically

transposing a file or data stream so that it cannot

be deciphered at the receiving end without the

proper key.

Ethernet. A local area network datalink protocol

operating at 10 Mbps to 100 Mbps.

firewall. A computer connected to both the Internet

and the local hospital information network that

prevents the passing of Internet traffic to the internal hospital network. It provides an added layer of

protection against computer hackers.

fps. Frames per second. See frame rate.

frame rate. The number of frames per second

(fps) displayed on a video monitor. A frame rate of

25–30 fps is considered “full motion”; most broadcast video operates at this rate. A frame rate of 15

fps is noticeably “jerky.” Slower frame rates may

be inadequate for observing and analyzing gait

and motion.

frame relay. A service that supports data rates in the

range of 56 Kbps to 1.54 Mbps. The frame relay

circuit often comes in different levels of committed

information rates. Regional telephone companies

can offer frame relay cheaper because they can

oversubscribe these circuits to users and share the

bandwidth.

freeze-frame video. A video camera feature that

allows the consultant to get a well-framed and

focused still image of a lesion or other medical

condition for closer examination. Still images captured from a live video source are often of higher

resolution than the live video picture and, as a

result, may provide more diagnostic value. Also

referred to as image capture.

frequency response. A relative measure of audio

quality, expressed in cycles per second, or hertz

(Hz). Generally, the broader the frequency response,

the better the signal. To approximate a standard

acoustic stethoscope, an electronic stethoscope

should be able to send and receive sounds as low

as 30 Hz (for low-pitched heart murmurs) and as

high as 1,000 Hz (for squeaks, wheezes, and pops

heard in lung conditions). Many electronic stethoscopes can have their frequency response optimized

for either heart or lung sounds by flipping a switch.

full-motion video. Video that runs at 25 or 30

frames per second, down to a minimum of 10–15
Appendix H: Glossary of Telemedicine Terms

69

fps. Any frame rate less than about 10 fps is

approaching slow-scan video.

ghosting. A motion artifact in monitor displays

of compressed video images. As an image moves

quickly across the field of view (e.g., an arm waving), it leaves a trail of ghost images that resolve

as the movement stops.

graphic equalizer. A device that allows the user

to emphasize or deemphasize selected frequencies

within an audio sample. An example is the different settings for heart and lung sounds in electronic

stethoscopes. See frequency response.

graphics stand. A device that is typically used to

support a document so that images of graphics or

text can be captured and transmitted. Can be used

for skin lesions and the like.

gray scale. The levels (shades) of gray that a

screen or pixel within a screen can display. 

GUI. Graphical user interface. See interface.

H.230, H.242, H.256, H.263, H.324, . . . . See

ITU–T Standards, video format.

IATV. Interactive televideo. Also abbreviated ITV.

image capture. See freeze-frame video.

image management. The capability to sort, arrange,

and manipulate stored images into functional groups.

Systems without this feature allow the user to store

images only in the order in which they were saved;

once stored, they cannot be rearranged.

INMARSAT. An international global telecommunications satellite network, established by government

treaty in 1979, with 79 member countries. Land

Earth Stations (fixed or portable, even to size) provide links between rural sites and telecommunications

networks. INMARSAT can provide low-bandwidth

digital services anywhere on the Earth’s surface for

as little as $1 per minute.

integrator. A vendor that uses parts from other

manufacturers to produce a product that is optimal

for the particular user’s requirements.

interface. The means whereby a system enables

information to be accessed and modified. A graphical user interface with mouse-controlled, point-andclick on-screen icons is an example of an easy-to-use

interface device.

ISDN. Integrated services digital network. A lowto medium-speed technology for digital telephony.

Usually transmits at 64–128 Kbps, although higher

speeds are possible.

ISO. International Organization for Standardization.

The ISO, in conjunction with the International

Electrotechnical Commission, establishes and coordinates worldwide standards for, among other

things, electronic information exchange. 

ISP. Internet service provider. The local, regional,

or national company that provides dial-up connections to the Internet, as well as hosting of home pages.

ITU–T. International Telecommunications Union–

Telecommunications Standardization Sector (TSS).

An organization founded in 1865 as a telegraphy

standards body and now is a United Nations agency. 

ITU–T Standards. The H series refers to videoconferencing standards; the G series, to audioconferencing standards; and the T series, to data transfer

standards. The T.120 series, in particular, refers to

image capture, annotation, and transfer in videoconferences.

ITV. Interactive televideo. Also abbreviated IATV.
Implementing Telemedicine in Correctional Facilities

70

JPEG. Joint Photographic Experts Group. The international group that has developed standards for

still-image compression.

KB. Kilobyte. 1,024 bits of data.

Kbps. Kilobits (thousands of bits) per second.

A typical compressed-video clinical interaction is

transmitted at 385 Kbps.

LAN. Local area network. A computer network

linking computers, printers, servers, and other

equipment within an organization.

laser digitizer. A scanner that uses a laser device

to capture image information in digital form. Very

high resolution and wide gray-scale range are possible.

leased line. A point-to-point private line for the

sole use of the party who leases the circuit. Unlike

a switched line, the price of a leased line does not

vary as a function of usage.

leveling. A software manipulation technique, using

mathematical algorithms, to compensate for a teleradiology monitor’s inability to provide the same

contrast and bit depth as the original hardcopy x-ray.

This feature provides much more usable clinical

information.

low-pass filter. A filter for leveling out the borders

in the screen display of a radiology image.

luminence. Characteristics of brightness for a

video monitor.

MB. Megabytes (millions of bytes).

Mbps. Megabits (millions of bits) per second. A

typical uncompressed video signal requires 45 Mbps

(or more) to transmit.

modem. Modulator-demodulator. A device that

enables transmission of digital data (by transforming it to and from analog waveforms) over standard

analog phone lines and cable video systems.

MPEG. Moving Picture Experts Group. A group of

standards for compressing and storing motion video.

MRI. Magnetic resonance imaging.

multiplexer. A hardware device that combines two

or more subchannels of information for transmission as a single data stream.

MUX. Multiplexer.

network. An assortment of electronic devices

(computers, printers, scanners, etc.) connected

(by wires or wireless) for mutual exchange of

digital information. 

ocular tube adapter. A device that allows a camera to be mounted to any microscope. This feature

is needed to adapt a telepathology system to an

existing ocular microscope without a camera port.

Capturing images through an ocular tube has some

disadvantages that must be weighed against the

cost of a new scope.

OC3. A high-speed digital transmission capability

of 1.55 Mbps. Compare with DS3, T1, ISDN.

PBX. Private branch exchange. A telephone switch,

typically located at the customer site, connected to

the public telephone network but operated by the

customer. PBXs may be digital or analog.

peripheral device. An attachment to a videoconferencing system to augment its communications

or medical capabilities. Examples include electronic

stethoscopes, otoscopes, ophthalmoscopes, dermascopes, graphic stands, and scanners.
Appendix H: Glossary of Telemedicine Terms

71

PIP. Picture in picture. This feature allows both

ends of the videoconference to be viewed simultaneously on a single monitor. PIP swap allows the

user to switch the two video pictures so that the

local video fills the largest portion of the screen.

pixel. The smallest unit of a raster display; a picture

cell with specific color or brightness. The more pixels

an image has, the more detail, or resolution, it can

display.

POTS. Plain old telephone system. The analog,

public switched telephone network in common use

throughout the world. POTS enables voice phone

calls and data transmission of up to 56 Kbps, as

well as limited videoconferencing.

PRI. Primary rate interface.

primary user interface device. The device used to

control the videoconferencing system. Hardwired

and wireless, keyboard, mouse, and touchscreen

options each have advantages and disadvantages.

The user should seriously consider in what setting

and for what application the system will be used to

determine the preferred interface.

printer interface. A device that allows data and

images sent or received via the computer to be sent

to a printer. This enables reports, images, and data

shared in a videoconference to be rendered as

hardcopy for recordkeeping and teaching purposes.

raster. A pattern of scanning lines covering the

area upon which the image is projected in the

cathode ray tube of a television set.

real time. Transmission and reception of audio,

video, and data virtually simultaneously (without

more than a fraction of a second delay). Applications

that are transmitted within a few seconds are sometimes called “near” real time. Compare with storeand-forward, slow-scan video.

resolution. The level of detail that can be captured

or displayed. For video displays (teleradiology or

interactive video), resolution is measured in pixels

x lines x bit depth.

RGB. Red green blue. A coding language that controls the electron gun in cathode ray tube monitors.

The video signal that enters the monitor is separated into its component parts and converted to RGB;

the video images are then rendered on the monitor’s

screen.

rollabout unit. A portable teleconferencing or

telemedicine system in which the monitor, CODEC,

camera, etc., are placed in a cabinet with wheels

that can be rolled from room to room. “Rollabout”

can be a misleading term, because some units

weigh more than 500 pounds and are very cumbersome to move.

room unit. A stationary teleconferencing or telemedicine system, usually with two large monitors, that

is placed more or less permanently at a single site.

RS–232. An interface between data terminal equipment and data communications equipment, using

serial binary data exchange.

scan line. Raster.

slow-scan video. A slow progression of freezeframes (less than 1 or 2 per second). Also called

“still video.” Compare with full-motion video.

spooling. The capability to review one image or

data set, while receiving and storing additional

images for subsequent review without “locking up”

the computer.

store-and-forward. Captured audio clips, video

clips, still images, or data that are transmitted or

received at a later time (sometimes no more than

a minute later). Compare with real time.
Implementing Telemedicine in Correctional Facilities

72

switched line or network. A telecommunications

mode similar to a dial-up telephone line. There is

often a usage charge for switched services, particularly for long-distance connections, such as telephone lines. Compare with leased line, where the

connection is continuously open and charges are

usually levied at a flat, monthly rate.

Switched 56. A dial-up 56-Kbps digital line, billed

at a monthly rate plus a per-minute charge, as with

a POTS phone line. Costs for switched 56 service

vary from provider to provider, but generally are

about the same or somewhat more than those of a

voice call.

T1. A leased line providing 1.544-Mbps data. T1

is available almost everywhere and can be fractionated. Fractional T1 services are less expensive than

full T1. Typical interactive video telemedicine programs transmit video images at “1/4 T1” rates

(384 Kbps).

T.120. A standard for audio and graphics exchanges, supporting higher resolutions and pointing and

annotation (which the H.320 standard does not).

tariff. Telecommunications rates set by either a

Federal or State regulatory body.

TCP/IP. Transmission control protocol/Internet protocol. The most popular open-standard protocols

used in data networks today. The Internet protocol

is used to route packets of data on a network.

telemedicine. The provision of health care over a

distance using telecommunications technology.

teleradiology. The interpretation of diagnostic

images sent over a distance using leased or

switched transmission lines.

third-party equipment. Equipment added to an

existing system to expand the original system’s

capabilities. Some vendors modify videoconferencing systems with additional cameras to fabricate a

telemedicine capability. Third-party equipment may

not be covered by the vendor’s warranty, and its

performance may not be guaranteed.

transmission rate. The amount of information

per unit of time that a technology such as a conventional (POTS) or digital (ISDN or T1) telephone

line, satellite or wireless telecommunications, or

LAN can transmit. A typical POTS-based modem

can transmit 33.6 Kbps of information per second.

TSS. Telecommunications Standardization Sector

of the International Telecommunications Union.

See ITU-T.

twisted pair. A pair of copper wires that has

been twisted to minimize electronic interference.

Standard telephone wire.

URL. Universal resource locator. The World

Wide Web address (typically in the form:

http://www.name_of_site) of an Internet home

page or other document.

video format. The manner by which video

images are exchanged between the remote and

hub sites. Formats include National Television

System Committee (NTSC), phase alternation line

(PAL), high-definition television (HDTV), and

sequential color and memory (SECAM).

video on demand. The ability to provide instantaneous access to remotely stored sources of video.

video output. Composite, S-video.
Appendix H: Glossary of Telemedicine Terms

73

videophone. A small, standalone video appliance

with a small camera and circulation—not part of a

computer or larger videoconferencing system—that

enables interactive audio-video communications

over POTS and ISDN.

WAN. Wide area network. A computer network

wider in geographic scope than a LAN. Provides

digital communications (voice, video, data) over

switched (ISDN, switched 56) or unswitched

(fractional T1, T1) networks.
About the National Institute of Justice

NIJ is the research and development agency of the U.S. Department of Justice and is the only Federal agency solely dedicated

to researching crime control and justice issues. NIJ provides objective, independent, nonpartisan, evidence-based knowledge

and tools to meet the challenges of crime and justice, particularly at the State and local levels. NIJ’s principal authorities are

derived from the Omnibus Crime Control and Safe Streets Act of 1968, as amended (42 U.S.C. §§ 3721–3722).

NIJ’s Mission

In partnership with others, NIJ’s mission is to prevent and reduce crime, improve law enforcement and the administration of

justice, and promote public safety. By applying the disciplines of the social and physical sciences, NIJ—

• Researches the nature and impact of crime and delinquency.

• Develops applied technologies, standards, and tools for criminal justice practitioners.

• Evaluates existing programs and responses to crime.

• Tests innovative concepts and program models in the field.

• Assists policymakers, program partners, and justice agencies.

• Disseminates knowledge to many audiences.

NIJ’s Strategic Direction and Program Areas

NIJ is committed to five challenges as part of its strategic plan: 1) rethinking justice and the processes that create just communities; 2) understanding the nexus between social conditions and crime; 3) breaking the cycle of crime by testing researchbased interventions; 4) creating the tools and technologies that meet the needs of practitioners; and 5) expanding horizons

through interdisciplinary and international perspectives. In addressing these strategic challenges, the Institute is involved in the

following program areas: crime control and prevention, drugs and crime, justice systems and offender behavior, violence and

victimization, communications and information technologies, critical incident response, investigative and forensic sciences

(including DNA), less-than-lethal technologies, officer protection, education and training technologies, testing and standards,

technology assistance to law enforcement and corrections agencies, field testing of promising programs, and international crime

control. NIJ communicates its findings through conferences and print and electronic media.

NIJ’s Structure

The NIJ Director is appointed by the President and confirmed by the Senate. The NIJ Director establishes the Institute’s objectives, guided by the priorities of the Office of Justice Programs, the U.S. Department of Justice, and the needs of the field. NIJ

actively solicits the views of criminal justice and other professionals and researchers to inform its search for the knowledge and

tools to guide policy and practice.

NIJ has three operating units. The Office of Research and Evaluation manages social science research and evaluation and crime

mapping research. The Office of Science and Technology manages technology research and development, standards development, and technology assistance to State and local law enforcement and corrections agencies. The Office of Development and

Communications manages field tests of model programs, international research, and knowledge dissemination programs. NIJ is

a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice

Statistics, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. 

To find out more about the National Institute of Justice, please contact:

National Criminal Justice Reference Service

P.O. Box 6000

Rockville, MD 20849–6000

800–851–3420

e-mail: askncjrs@ncjrs.org

To obtain an electronic version of this document, access the NIJ Web site

(http://www.ojp.usdoj.gov/nij).

If you have questions, call or e-mail NCJRS.
U.S. Department of Justice

Office of Justice Programs

National Institute of Justice

Washington, DC 20531

NIJ Guide