Telemedicine Goes to School

Telehealth is a wonderfully adaptive technology. It’s being used in orthopedic practices and for sports medicine, as a remote monitoring tool for elderly patients, and in prisons. The Veteran’s Administration (VA) has long been an advocate for telehealth and is one of our nation’s strongest adopters of the technology, and the majority of hospitals in the U.S. currently make use of some form of telemedicine.

Telemedicine has widespread application in a variety of settings, and all signs point to increasing use of these tools in the future. One telehealth application that is making an impact these days is use of the technology in our nation’s schools, particularly educational facilities in rural areas.

A recent case study from the American Public Health Association (APHA) sheds new light on telemedicine as a tool to help stretch medical treatment to rural educational systems. This article will look at how telemedicine can help bridge gaps in care for school-aged children.

The Center for Rural Health Innovation is a non-profit organization in North Carolina whose goals are to apply innovative technology to improve access to healthcare in rural communities in the region. To meet their goal, they use high-definition virtual visits to extend healthcare into schools. The program currently operates successfully in four rural North Carolina counties.

Why is this important? The problem in these rural communities is that primary care, dental, and behavioral healthcare are often difficult to access. Rural communities typically have a difficult time filling these employment positions with medical talent. This means that rural residents typically travel long distances to receive treatment. Many of these rural areas even lack enough pharmacies to fill prescriptions.

To counteract these challenges the Center for Rural Health Innovations developed a telemedicine application to bring clinical providers to the community. The non-profit developed the Health-e-Schools Program, which provides nursing care to rural students via telemedicine. The organization works closely with schools and physicians, nurses, and midlevels to provide telemedicine services.

The benefits are outlined in the Center’s Health-e-Schools case study:

The overall goal of Health-e-Schools is to improve health and keep students in school. Although accessing health care can be difficult for students in any location,
it can be especially challenging in rural areas with few providers. Through telemedicine, Health-e-Schools is able to provide primary care and behavioral health services to students in schools, where they spend most of their time.

The telemedicine application in the Health-e-Schools project works in exactly the same way as an on-location in-school health clinic. The majority of the illnesses treated by medical professionals are routine bumps, headaches or cramps, cuts, flu, or other minor illnesses. Illnesses such as an upper respiratory infection or conjunctivitis can easily be diagnosed and treated in a virtual visit.

Having a medical practitioner on call with a virtual visit can bridge gaps in treatment, bringing at-risk patients together with clinical care. The Center even has a small amount of funding that can help low-income students with prescription medications.

Health-e-Schools also offers behavioral health services via a virtual visit. This is particularly important because the Kaiser Family Foundation suggests that the state only has approximately 38% of the providers needed to fill current demand. They are also expanding an asthma management treatment program based on the success of the behavioral health initiative. In 2017 the organization partnered with Mission Children’s Hospital in Asheville to connect their pediatric pulmonologist and asthma educator with students and their parents. The goal was to reduce inpatient admissions by intervening with rescue inhalers.

Any student enrolled in public schools in the four-counties served can use the service and parents can sign up their children for free. Generally, the consent form is sent home to the parents at the beginning of the year. Once the consent form is filed a parent, teacher, or the student can schedule an appointment with the service.

If they feel ill at school, the school nurse can use video conferencing to consult a doctor. Appointments are scheduled via a centralized scheduler that fields the requests of the nurses.

In addition to video conferencing equipment, the Health-e-Schools flyer states the technology includes using “specially equipped stethoscopes and cameras so that a centrally located healthcare provider can examine students at multiple schools without traveling.” The technology has been successfully used to treat:

· Earaches

· Sore throats

· Colds and allergies

· Asthma

It has also been used for chronic disease and medication management, sports physicals, consultations, care coordination, behavioral health, and so much more. The program accepts Medicaid and private insurance and offers a sliding fee scale for uninsured students. The program doesn’t turn away anyone based on his or her ability to pay. More serious conditions or if lab work or other tests are required, the student is referred to a local doctor or hospital.

Interestingly, in an interview in Healthcare Informatics, the founder of the program, Dr. Steve North, suggested that it was the school nurses themselves that playing an important ambassador-like role in launching these successful telehealth initiatives. When the program launched in 2011, no one in the region had even heard of telehealth. Today, it’s an accepted best practice for the organizations in the region. In 2014, the program won the American Telemedicine Association’s President’s Award for Health Delivery Quality and Innovation.

Currently, the program is offered in nearly 40-schools in the poorest and most rural areas of the state and has been an award-winning innovator in providing care for the past six years. Each year, more than 8,000 students are treated in the program.

The benefits of telehealth for schoolchildren are the same as for any telemedicine visit: improved access, lowered costs, and improved healthcare outcomes. Keeping kids healthier and in school improves their chances to learn and eventually graduate.

OrthoLive is an advocate for telehealth technology. We offer our clients an easy-to-use application for providing orthopedic care in a variety of clinical settings from on-site worker’s compensation to orthopedic ER on-call to virtual visits in the medical practice or hospital. Contact our team to find out more about how telehealth can expand access to your target populations.