Technology lets the nurse tap into outside experts, often getting students back to class more quickly

This article was published on May 25, 2018 on The Wall Street Journal, written by Emily Holland. Photo source: Mike Bradley for the Wall Street Journal.

Telemedicine has grown rapidly in recent years. Now hundreds of schools are bringing it to the nurse’s office.

School nurses say telemedicine helps them treat students faster right at school, reducing risk of infection, getting the students back to class faster and relieving a big burden on the students’ families.

At Abraham Lincoln School No. 22, in Rochester, N.Y., when nurse Amy Dickason thinks a student needs a doctor’s attention, she calls Health-E-Access, a program that sends mobile telemedicine units to schools and child-care sites in her area. Equipped with high-resolution cameras, electronic diagnostic and videoconference equipment, each technician can set up a tele-health consultation with a doctor.

For a student with an earache, say, the technician can first assess the eardrum in person, take video and photos of the ear canal, and connect the student to a doctor for a real-time consultation.

Ken McConnochie, developer of Health-E-Access, says most cases are completed within 90 minutes from the moment a student reports to the nurse to when the doctor signs off. During that time, Mr. McConnochie says, in addition to tending to the student, the service also will have spoken with a parent, a written report will have been filed, and any prescriptions, if needed, will have been called in to the patient’s preferred pharmacy.

Formerly, Ms. Dickason couldn’t be sure a student would see a doctor just because she recommended it. Parents’ work schedules, lack of money or lack of transportation often interfered, she says. Telemedicine has helped to address many of these barriers.

“Telemedicine has opened another door to providing health care to students that are often unable to be evaluated and treated via the traditional avenues,” she says.

In Dallas, there is a school-based tele-health network serving more than 90 schools in the area. Each school nurse’s office has a telemedicine cart with stethoscopes, otoscopes and other devices that can stream video and data to doctors and nurses. From special consultation rooms at Children’s Health, a major pediatric hospital in the Dallas region, Stormee Williams, medical director of school telemedicine, and her staff have diagnosed and treated sinusitis, colds and flu, ear infections, pinkeye, head lice, rashes, asthma, insect bites and other common conditions.

The system has its limitations, Dr. Williams admits. “For example, I am not able to do a full abdominal exam, which involves touching the belly,” she says. “Telemedicine is not the answer to every medical issue,” she adds. But for many patients, it can be a necessary first step. “We have definitely seen patients and later referred them to be seen in person either through a primary-care doctor, emergency-room staff or other specialist,” Dr. Williams says.

At a time when school shootings and other acts of violence are fueling a call for more mental-health services, experts also see telemedicine as a way to efficiently connect students with psychiatric care.

For instance, if a student is showing significant symptoms of depression and anxiety, a school counselor or school psychologist may seek an evaluation from a child psychiatrist, either through video or in person, says Sharon Hoover, co-director at the Center for School Mental Health at the University of Maryland School of Medicine. Parental consent is often required before a psychiatric consultation can be given. The rules vary from state to state, but tele-psychiatrists typically try to involve parents.

Using telemedicine as an early-intervention strategy hopefully can help “avoid some negative and very serious outcomes,” says Loren Nix, director of school-based telehealth for the Global Partnership for Telehealth, an organization that helps schools in Georgia, Tennessee and Florida.

The funding question

One of the biggest barriers to establishing telemedicine in schools is funding. Many current programs are funded by state or federal grants or by local hospitals or nonprofits. But programs will bill the parents’ insurance for the service when they can—and many telemedicine programs are targeting areas where students aren’t covered by private insurance.

In North Carolina, the Health-E-Schools program, developed by Steve North, is used in 55 schools in four rural counties and doesn’t turn away those who can’t afford care. In 2017, 13% of children treated through the program didn’t have any insurance, says Dr. North, who is also founder and medical director of the Center for Rural Health Innovation.

Each state’s rules differ on how consulting doctors are reimbursed—and whether they pay the school as well, says John Schlitt, president of the School-Based Health Alliance, an advocacy group based in Washington, D.C.

Almost every state allows Medicaid reimbursement for some telemedicine services, but many limit where it can be used and the types of service that are covered. Only 16 state Medicaid programs recognize schools as an eligible site for telehealth treatment.

Action in the legislatures

Some 167 bills related to telehealth are active in state legislatures this year, according to the Center for Connected Health Policy.

Legislation to provide federal support for school-based health services, including tele-health technology, was proposed in Congress in 2016 and again in 2017, but is still in early stages of the legislative process.

Individual schools that want to adopt telemedicine can face a number of obstacles as well. Lack of office space is often one, which sometimes leads to the second: protecting the students’ privacy.

In Rochester, Ms. Dickason says, “Many of the school health offices are cramped for space and lack a designated area that can be used for telemedicine visits.” Under these conditions, she says, “a private conversation or protecting patient confidentiality becomes a concern.”

Nevertheless, she adds, “Every effort to maintain privacy and confidentiality is made.”

Telemedicine in schools is still relatively new, and obtaining parental consent can be difficult at times, Ms. Dickason says. But she has found parents to be mostly supportive.

“Once parents have used telemedicine,” she says, “they come to realize how helpful it is to them.”