Telehealth in Schools

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Nurses facilitate real-time treatment options

A student complains of a sore throat. She goes to see the school nurse who determines it would be best if a physician checked her out, as she may need medication. The girl’s parents are called, one must leave work to pick her up at the school and drive to the pediatrician, where she must wait with other sick kids, exposing herself to more germs. And she will miss the lessons at school that day.

What if there was an easier way to get sick school kids access to healthcare? Telehealth partners school nurses with area healthcare facilities, offering real-time virtual doctor’s appointments for students. Two rural school districts in different states have adapted this technology to the benefit of their local communities. Myra Elaine Mauter, BSN, Sevier County school system, Tennessee, said, “If you don’t take care of child’s physical needs, they don’t have the ability to learn.”

The American Telehealth Association identified criteria for model school-based telehealth:

  • Inclusive definitions of technology with little to no restrictions on the types of technology approved for use in a clinical service
  • Geographic area served
  • Applicable health services and conditions
  • Provider eligibility
  • Reimbursement methodology
  • Level of coverage and affected health care plans 1

The association called out several states for their highly-ranked telehealth programs and chief among them was Georgia, home of Coffee County school district.

Treating Vulnerable Populations

“The need was here and children were not receiving the care we thought they could,” said Kathy Cole, RN, nurse manager, Coffee County school district, Douglas, Ga. The rural county has 12 schools spread out over a wide area, with some being 15 miles from the closest doctor. Children would come to school sick, be sent home, and then return to school sick the next day. “It was a vicious cycle,” remarked Cole. Sometimes, they would go to the local emergency department for treatment, but would never fill prescriptions, setting up poor continuity of care.

After visiting a neighboring county and seeing their program, the district’s medical director introduced the idea of telemedicine.  Three years ago, the district received a Capitol Equipment Grant.  They have updated existing clinics and added telemedicine.  March 2014 marked the official kickoff of telehealth in Coffee County.

Mauter’s school district in Sevierville, Tenn. started its telemedicine program in the fall of 2009. The district is also in a large county, geographically-speaking, with long distances to cover to get to doctors. Often, when students were sick, parents couldn’t leave work to get them. “Kids needed the opportunity to receive healthcare in school,” said Mauter.

Multiple Moving Parts

“It was a big investment,” said Mauter. Sevier County school system partnered with Cherokee Health, a large non-profit healthcare system in eastern Tennessee. Cherokee covered one-third of the cost of the equipment and the district, through grant funding, covered the remaining two-thirds.

Each year, in both school districts, parents fill out packets with children’s medical history, HIPPA information, copies of insurance card, etc., which are kept on file at the school.  Cherokee Health offers a sliding fee scale for Sevier county parents without insurance.  “Before I put them in front of telehealth, each time, I call the parent,” Mauter explained.

“They are so amazed,” said Cole, of her district’s parents. “It’s a whole new concept.” Live demonstrations have been the most effective in getting parents on board with telemedicine.  She continued, “People are still learning about it. We take any opportunity to tell people about it.”

Partners in Care

Coffee County school district collaborates with Coffee Regional Medical Center, Asthma Allergy Clinics of Georgia, Georgia Asthma Coalition, and several pharmaceutical organizations.  They also offer specialty visits, such as psychiatric consultations in partnership with Children’s Healthcare of Atlanta. Certain physicians have set times to be available and others are on call. “In acute situations, we get student’s vitals and contact the parent, then the physician,” explained Cole. So far, the maximum turn-around time from a child presenting with an ailment to when they are seen by the doctor has been three hours.

Sevier County connects students and school nurses to either a pediatric nurse practitioner or a family health nurse practitioner at Cherokee Health. They are available by appointment Monday thru Friday from eight-to-three. Their telehealth program is growing. In the 2014-15 school year, over 1500 cases were seen.

Mauter also noted that telemedicine has been a good access point to get children into a healthcare system.  Students who did not have a pediatrician or family doctor before will build those relationships with the physicians at Cherokee Health.

Some common complaints in the schools include colds, flu, earaches, fevers, rashes and strep throat.  Cole added, “Asthma is very prevalent in this area.  We want to have cutting edge asthma treatment.”

With the telemedicine equipment, school nurses can see everything the physician or nurse practitioner sees, like inside the child’s throat if they complain of a sore throat.

And it’s not just the students who benefit from telehealth, as faculty and staff can also take advantage and see a doctor when they are unwell. Teachers also like the services because, if a child is found not to be contagious, they can return to the classroom, missing less instructional time then if they had gone to a traditional doctor’s office.

Starting a Program

Cole cautioned, “You have to have nurses on board. If they don’t want to do it, your program will fail.” Administrations considering adding telemedicine services need to prepare school nurses and get them involved from the planning stage. Cole admitted some of her nursing staff were more eager than others to use the services, however, once they saw how easy it is, they came around.

This year, Mauter and some other school nurses presented on telehealth at the National School Nurses Association annual convention. She explained, “It’s a new resource not everyone is aware of. The more we promote it, the more schools can use it.” She and her colleagues offered case studies of how their districts approach telemedicine. She hoped the audience got different perspectives on how it can help their schools.  “It’s a wonderful tool for children to get the help they need,” Mauter remarked.

Arguing in support of school-based telehealth, Cole added, “You’ll feel like you’re making a difference in a child’s life.”


Reference

  1. American Telemedicine  Association.  “State Medicaid Best Practice School-Based Telehealth. ” July 2013. http://www.americantelemed.org/docs/default-source/policy/state-medicaid-best-practice—school-based-telehealth.pdf  Accessibility verified June 11, 2015.
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