Telemedicine, in which a remote doctor or physician’s assistant provides health care via the internet, has caught on in the business world and is now making its way into public schools.
Five of the Title 1 buildings in Maryland’s Howard County Public Schools offer telemedicine for students, says Sharon Hobson, a registered nurse who coordinates the district’s telemedicine program for the Howard County Health Department. “The goal of the program is to keep children in school so they aren’t being sent home for minor illnesses” says Hobson.
The setup varies from school to school. Howard County’s nurses use a cart with a high-resolution computer screen. A physician is contacted to examine student patients through a video-chat application.
The setup includes stethoscopes, otoscopes and cameras that nurses use to take pictures of a child’s ears, nose and throat, and instantly deliver the images to the doctor.
Hobson recalls a case of a child—from a refugee family with few resources—who had an ear infection. Rather than sending the child home, the principal’s office called the mother, who walked about a mile to the school, signed papers allowing treatment and watched the doctor’s exam over the school’s monitor.
The child was given an over-the counter pain reliever, and a prescription was called in to a nearby pharmacy where the mother was able to pick it up. The child immediately returned to class, missing little instruction time.
Telemedicine has also diagnosed ailments such as pinkeye, strep throat, frequent headaches, rashes and acute asthma attacks. Telemedicine cannot diagnose stomach aches or anything that requires a physician to physically touch the patient.
Tips to start your own telemedicine program
Find a provider and/or hospital to partner with
Decide the mechanics of operation over the course of the day: Who does the scheduling? Where will the students be assessed?
Educate yourself on the implications of the Health Insurance Portability and Accountability Act and the Family Education Rights and Privacy Act. For example, can you tell a teacher about a student’s ailment?
Source: Dr. Steve North, founder of Center for Rural Health Innovation in North Carolina
(Continued.)
Partners and providers
Howard County schools partner with two medical practices and the Howard County Hospital Emergency Pediatrics Department. If a child’s family has insurance, the visits are billed to the insurance company. If not, Howard County Hospital volunteers its services. No child is turned away due to inability to pay.
Part of the challenge is finding providers to partner with, says Dr. Steve North, founder of the Center for Rural Health Innovation in North Carolina. “We weren’t really successful until we had a provider all day, every school day” says North, who launched his nonprofit health center in 2007 and has expanded telemedicine to 33 schools in four counties. Treatment is available to students and faculty, and North says 89 percent of the students who are seen return to class immediately after appointments.
Los Angeles USD is in the process of launching a pilot program in five schools, says Dr. Kimberly Uyeda, director of medical services for the district. The pilot program, which starts this spring, will address the needs of acute infections, simple conditions that are conducive to diagnosis and treatment using telemedicine, Uyeda says. If the pilot is successful, Uyeda hopes to expand it to more schools.
The LAUSD medical services department constitutes a small team of physicians, optometrists and medical support staff who provide care to those who have no access to a regular doctor.
Tips to start your own telemedicine program (cont.)
Follow economies of scale. The more schools using telemedicine, the less expensive it will be per school.
Involve your IT departments from the beginning. Information will need to flow through safety firewalls to the health providers and back.
Become informed about the various telemedicine reimbursement rules in your state.
Source: Dr. Steve North, founder of Center for Rural Health Innovation in North Carolina
Insurance and costs
The costs of the necessary technology are dropping, North says. In Howard County, the first year was most expensive due to buying the equipment, including telemedicine carts, nebulizer machines, clinical supplies and medications, as well as copies of enrollment forms, Hobson says.
Now that startup costs are covered, Howard County pays $11,400 for an annual licensing fee, a portion of Hobson’s salary and the administrative assistant’s salary. Another $200 to $300 covers medications every year.
Federal grants are available, such as through the Distance Learning and Telemedicine program of the U.S. Department of Agriculture.
Every state’s Medicaid covers some telemedicine services, and 31 states require that private insurers cover telehealth the same way as in-person doctor visits, says Gary Capistrant, chief policy officer at the American Telemedicine Association.
Hobson says she would like to see telemedicine expand to also cover mental health service and wellness programs for students.
“I think it is well accepted throughout the country that children who are healthy are more ready to learn” Hobson says. “Telemedicine is a cost-effective way of keeping children in school and healthy.”
Shawna De La Rosa is a freelance writer in Seattle.
