A pilot linking the Duval County Jail to UF Health, run from a vendor presentation in May 2014 to a completed pilot in August 2015. Two populations the city had a duty to and limited means to reach: indigent residents for whom travel to a clinician was itself the barrier, and the incarcerated population in the Sheriff’s Office corrections system.
What made it a project rather than a demonstration was where it started. It opened with a return-on-investment analysis covering the corrections population and the employee clinic, not with equipment, and that business case is what turned a vendor conversation into a funded, numbered project. Tele-psychiatry was chosen as the first use case deliberately: it is the encounter where the clinician least needs to be in the room, so it tested the concept where the concept was strongest.
Multiple video systems integrated with diagnostic imaging modalities including ultrasound and X-ray, so a remote clinician could conduct the encounter and read live imaging in the same session rather than working from a description. The physician has to trust what they are seeing well enough to make a care decision on it, which sets the bar for fidelity, latency and synchronization far above an ordinary video call.
The corrections use case was designed around staff safety as well as access: examining injuries remotely protects the physician and attending staff and removes a transport movement that carries its own risk. Inmate medical records sit at the intersection of HIPAA and CJIS with different rules on the same record, which made the compliance boundary as much of the architecture as the video path.
Not the first time
This work was not approached cold. The teleradiology platform built at StorComm from 1997 had already solved the same proposition with the clinician moved instead of the patient — diagnostic imaging delivered to radiologists at home, over whatever the last mile at their address could carry, under Food and Drug Administration clearance.
Knowing beforehand that image fidelity and latency are the whole argument, and that a degraded read is worse than no read, is why this pilot opened with a business case and a use case chosen for where the concept was strongest rather than with a demonstration of equipment.
Outcome
A funded, numbered project rather than a demonstration, because it started from a return-on-investment analysis rather than from a vendor.