Telemedicine

Built out a telemedicine programme with local hospital partners, piloted over multiple years, serving 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 to care, and the incarcerated population in the Sheriff’s Office corrections system.

Multiple video systems were 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 design problem was clinical rather than technical at heart: the physician has to trust what they are seeing well enough to make a care decision on it, which sets the bar for image fidelity, latency and synchronisation far above an ordinary video call.

The corrections use case was designed around staff safety as well as access to care. Examining injuries on incarcerated people 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 access, retention and disclosure rules on the same record, which made the compliance boundary as much of the architecture as the video path.