By Jomo Kenneth Starke

Telehealth is a proven factor in lowering health care costs while improving outcomes, but the medical establishment has a blind spot when it comes to telehealth in corrections. Despite billions invested in correctional health care, reports find that telehealth shows “mixed evidence” of success.

For instance, despite high hopes for Spain’s early-stage telemedicine program in prisons, the country’s prison system managed only 1,228 video consultations while conducting 47,295 prisoner transports.

Across the globe, correctional systems report similar struggles with virtual care implementation. These failures aren’t about bad technology or poor implementation. In reality, most correctional systems have access to the tools they need to address the growing challenges and costs associated with medical transports and improving health care for incarcerated patients.

The challenge comes when systems attempt to onboard telehealth the way a hospital would, which foundationally disregards the specific needs and circumstances of the incarcerated population. By shining a light on these needs, it becomes much easier to understand where telemedicine initiatives have failed in corrections—and the paths they can take to succeed.

The Square Peg, Round Hole Problem
Every major study on correctional telehealth makes the same assumption: telehealth means video visits. That seems logical. After all, video consultations work beautifully in hospitals, clinics, and homes. But jails and prisons aren’t hospitals.

Consider what happens when you try to implement video visits in a correctional facility. First, you encounter security protocols that prohibit internet access. Giving incarcerated people access to live internet connections poses obvious risks that no security director will accept. Then there’s the privacy problem: HIPAA requires confidential spaces for medical consultations, yet most patients live in shared cells or open dormitories. Creating private video consultation rooms in overcrowded facilities isn’t just expensive—it’s often physically impossible given space constraints.

These barriers don’t even consider the logistical nightmare associated with coordinating an incarcerated patient’s availability with a specialist’s schedule. Both must work around court appearances, lockdowns, work details, medical callouts, and existing appointments.

The CSG Justice Center identified these as “implementation barriers,” but what if they’re not barriers to overcome? What if they’re signals that we’re using the wrong approach entirely?

The Quiet Revolution in LA County Jails
While the debate about video telehealth continues, Los Angeles County’s jail system has been quietly transforming health care through a completely different approach: asynchronous electronic consultation.

At LA County Correctional Health Services, Chief Medical Officer Margarita Pereyda, MD, and her team started small with just 52 eConsults in 2014. As years went by, the program experienced dramatic growth; from January 2022 through June 2025 alone, the system processed 15,395 consultations across 15 correctional facilities, utilizing 90 different specialties.

Providers inside the prison submit secure messages and inquiries to specialists about a patient’s condition. Within 1-2 days, the specialist responds with clinical guidance, negating the need for in-person specialist visits in most cases. According to the latest data from June 2025, 25% of consultations are resolved without any transport needed, saving $1,500 in security and vehicle costs per each eliminated transport.

The Power of Asynchronous Care
Asynchronous eConsult, like the program in LA County, succeeds where video fails because it aligns with correctional realities rather than fighting against them. The security benefits are immediate and obvious: there are no live connections to monitor, no real-time communication channels to exploit, and no internet access required for the patients.

The operational efficiency transforms how specialists and correctional physicians collaborate. Correctional physicians can submit questions between rounds or during administrative time. Specialists can batch-review consultations during downtime, between surgeries, or at the end of clinic days; one specialist can effectively serve multiple facilities across a region without traveling or sacrificing clinic time, giving rural jails the same access to expertise as urban facilities.

More importantly, these benefits have been replicated outside of LA county. An asynchronous eConsult program at the Inland Empire Health Plan for San Bernardino and Riverside County jails generated similar results.

From January 2022 through June 2025, the Inland Empire correctional facilities processed 7,390 eConsults across 31 specialties, with 91% of consultations resulting in scheduled visits and 9% resolved through specialist guidance alone. The San Bernardino County Sheriff’s Department became particularly active, submitting 7,348 consultations during this period. Overall, the program achieved a 57% reduction in unnecessary off-site specialist visits, generating annual savings between $70,000 and $262,000 per facility.

Embracing the Real Telemedicine Revolution
The struggle with video telehealth in corrections isn’t a technology problem; it’s a fit problem.

The question isn’t whether telehealth can work in corrections—LA County and others have proven it can. The question is whether we’re willing to let go of our preconceptions about what telehealth should look like and embrace what it could look like. Instead of asking, “How can we make video work in jails?” we must ask “What actually works in jails?”

This reframe allows us to understand how to identify the appropriate solutions that work within the unique constraints of correctional facilities, avoiding the pitfalls of trying to force a solution, and instead making way for more successful—and cost-effective—implementations.

Jomo Kenneth Starke is the founder of Celerius Labs and an expert in ROI optimization, digital health strategy, and AI implementation for safety-net health care systems.