Digital diagnosis: telemedicine puts doctors in schools

    Diego Montealvo is in the nurse's office at school

    Diego Montealvo is in the nurse's office at school

    When children get sick at school, it can be a big disruption. For the kids – they have to miss class – and for mom or dad, they have to leave work, try and schedule a last minute doctor’s appointment, maybe even go to the emergency room. So, what if kids could see a pediatrician without having to leave school?

    That’s the idea behind a telemedicine initiative run by Children’s Health in Texas. The program has gone from reaching several hundred kids to thousands of kids. 

    While most second graders at Gilbert Elementary are sitting at lunch tables, sticking slices of cheese pizza in their mouths, Diego Montealvo is standing in the nurse’s office, opening wide for a piece of metal.

    “Ahhhh,” he says, as the school nurse aims a digital otoscope at his tongue. He’s staring up at a doctor who appears on a big screen above a rolling cart. This doctor isn’t at the school in Irving — she’s at an office building in Dallas. But she’s looking at Diego from the screen, and like a conductor, she directs the school nurse to examine him with the medical instruments.  

    Diego isn’t sick today, but when he came in to see the school nurse last November, he had pain in his ear. With telemedicine, Diego can now connect remotely to a doctor through Children’s Health from school. Back in November, he was diagnosed with an ear infection and prescribed an antibiotic in between classes. His mom, Isabel Montealvo, said that saved her time and money.

    “After I left work, all I had to do was pick up the prescription from the pharmacy because they sent it over,” she says.

    Children’s started a telemedicine program at a pair of preschools in 2013. Today, there are screens and carts in 57 urban and rural campuses across North Texas. It’s one of the largest school-based telemedicine programs for kids in the country. Dr. Stormee Williams – the one peering into Diego’s throat and nose – explains each school is selected based on need. 

    “We look at the map of where kids are going to the ER for non-emergent issues and where we can step in to fill that gap for the family and for the kids,” she says.

    The number of kids who are uninsured in Texas is high: one out of nine children doesn’t have health insurance. For these kids, Williams says it’s not easy to see a doctor for the flu, pink eye, or a stomach ache. Of course, she admits not everything can be diagnosed via telemedicine. Rashes, for example, can be tricky.

    “Sometimes, I can look at a rash and say that’s ringworm,” Williams says. “Other times, I need to see what it feels like, so we will send [the student] to their primary care doctor.”

    Research shows parents can save time and money with school-based telemedicine. The focus now is on whether telemedicine is improving kids’ health. Only a few studies have been done so far. Dr. Quianta Moore, a Baker Institute Scholar in Health Policy, points to research showing telemedicine visits were similar in quality and outcomes as face to face encounters, and in some instances, kids preferred the digital encounter.

    “In that study it showed that the adolescents prefer to engage in these visits [rather] than in person consultations,” she says.

    Another study in the journal Pediatrics found that children with type 1 diabetes who used telemedicine at school had better blood-sugar control and fewer visits to the ER.

    The challenge with school-based telemedicine, Moore says, isn’t technology, its cost effectiveness. There’s the cost of equipment – tens of thousands of dollars – and the risk of not getting reimbursed by insurers. Representatives of Children’s Health actually had to work with Texas state representatives to change the law so that doctors could get reimbursed by Medicaid.

    Although Children’s isn’t billing patients directly at this point, they plan to in the future. The hospital has shared best practices with Arkansas Children’s Hospital and the University of Texas Medical Branch. In the meantime, dozens of schools across the country are experimenting with telemedicine – from Kansas to Arizona and Georgia. Most are collecting data to see if the programs help kids like Diego miss fewer days of school while helping parents save time and money.

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