School-Based TeleHealth Care: The Intersection of Health, Tech, and Education

 
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February is School-Based Health Care Awareness Month and here at TeleQuality, we thought it’d be the perfect opportunity to showcase how telehealth is revolutionizing school-based health care programs across our nation. Combining the power of school clinics, quality health care, and powerful 21st century technologies, telehealth in schools is changing the way health care is delivered to our newest generation of Americans.

Let’s break down how school-based health programs work, incorporating telehealth into the process, the benefits these programs provide to their students, and so much more in our 2nd blog post of 2018.


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Health Equity for Students

Everyone remembers visiting the school nurse office growing up. You were either miserably sick you couldn’t focus and were desperate to go home, or you took a chance and “faked” a sickness in the hopes of getting out of school for the day. While we can’t stop kids from being kids, school-based health clinics (SBHCs) are becoming a powerful tool for achieving health equity among children and adolescents. School-based health programs believe all kids, no matter their location, should have access to the same safe, convenient health care in their districts and an equal opportunity to learn and grow in their studies.

For many families and students in rural and underserved areas across the country, healthcare is not readily available because of healthcare professional shortages, rural hospitals shutting down, etc.; therefore, the opening of an on-site SBHC is not a matter of convenience but can mean the difference between having medical care or none at all.

The introduction of telemedicine into SBHCs truly allows schools to provide the quality health care to their students, no matter where they are. Telemedicine programs connect students with a health provider via telemedicine technologies, usually through a mixture of live video conferencing and health IT medical tools. Additionally, public policy advances in a majority of states now make it possible for prescriptions to be dispensed remotely and for physician-patient relationships to be established without an in-office visit.

 

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Setting Up a School-Based Clinic Program

Unlike for-profit or stand-alone health centers and clinics, SBHCs rely heavily on community partnerships to become successful and financially sustainable. Schools districts, local health systems, medical schools, foundations and local organizations become integral pieces all playing a part in their success. On the financial side, SBHCs often have 3-5 different revenue sources combined with a mixture of state grant funding.

The healthcare professionals school districts are able to employ also depends on available community resources. For example, sometimes a school district simply cannot afford to hire a full-time nurse for its staff. One school district in rural southern Indiana circumvented that problem by partnering with their local medical school, the Marian University College of Osteopathic Medicine, whose 4th year medical students serve as the school nurses for their on-site clinic all day every day. This beneficial partnership allows the medical students to gain valuable medical experience while students have access to a physician via telemedicine.

SBHCs can provide a variety of services for students, especially at the high-school level. The range of services will also depend on healthcare professional resources. Here’s just a small list of services SBHCs can provide in –person or via telemedicine:

  • Primary care, mental health care, and oral health care screening and treatment
  • Offer physical exams and sports physicals
  • Prescribe and dispense medication
  • Bill public and private insurance for reimbursable services
  • Conduct clinical and lab tests
  • Treat chronic illnesses

 

The Rise of School-Based Health & Funding 

School-based health clinics have seen tremendous growth in the past few decades, rising from a total of 1,135 in 1998-99 to 2,315 in 2013-14 according to census data from the School-Based Health Alliance. Another study conducted by Mathmatica Policy Research found a significant increase in health care access by students who used school-based health centers: 71 percent of students reported having a health care visit in past year compared to 59 percent of students who did not have access to an SBHC.

Available funding for SBHCs has also grown the past few decades. On the federal level, the Health Resources and Services Administration houses the School-Based Health Center Capital (SBHCC) Program and just recently announced availability of up to $10 million in grant funding for FY2019 on capital investments for currently operational school-based health centers. Several states have their own grant funding for SBHCs and many state healthcare associations assist SBHCs find funding resources to kick-start or sustain their services.

 

Setting up Telehealth for SBHCs

If a SBHC decides to incorporate telemedicine to expand its reach to medical providers, there are key steps the SBHC must shore up to achieve success:

  • Technical specifications: bandwidth, WAN and LAN networking requirements, broadband infrastructure
    • Telemedicine relies on its underlying Internet connection for high-resolution video and audio transmission. Your telemedicine sessions will severely suffer if the telecom infrastructure can’t support the amount of streaming and high-capacity data services your program will run. Make sure your current telecom service provider upgrades your services accordingly, or you can find dedicated service providers who exclusively build networks for schools such as Education Networks of America.
  • Technology selection: HIPAA compliance, encryption
    • You’ll need to ensure all your health data records are complying with HIPAA regulations, and that your data is protected. Health care data is one of the most sought-after information on the dark market. Proactive monitoring, support and management of your IT environment can help prevent and mitigate cyber-attacks.
  • Hardware: camera (zooming, panning, tilting), sound (microphones/headsets), lighting, etc.
    • There are a variety of companies that supply the telemedicine equipment needed for e-visits. Depending on the type of services you’re providing via telemedicine, the typical set-up will need a web cam, a telemedicine kit or cart and telemedicine software.

 

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Telehealth Workflow

One of the toughest challenges to implementing telehealth into a SBHC is integrating and training on your new telemedicine workflow. All stakeholders (medical providers, clinic, on-site healthcare professionals, students, teachers, administrators) need to be educated on the proper process and workflow before implementation. A typical, simplified process for a SBHC telemedicine session can flow like this:

  1. A student is showing symptoms and determines that he or she needs to be seen at the school’s clinic.
  2. The on-site healthcare professional gathers info on the condition and will either give a quick diagnosis or determine if a virtual telehealth visit is needed.
  3. The telehealth visit is scheduled and the student’s parents are contacted to see if they would like to join the session.
  4. Under the doctor’s orders, the school health workers will use the web-connected camera to examine the student’s eyes, ears, throat and skin. Special web-connected medical tools such as stethoscopes allow the doctor to hear the heart and lung sounds as well.
  5. The doctor will then determine if the student can stay in school, needs to be sent home or needs an additional follow-up appointment with the doctor. Should the student need medication prescribed, the physician can call in a prescription to the family’s preferred pharmacy.

The benefits of administering healthcare in the telehealth setting are numerous, including:

  • Convenience of the school-based setting, which equals less time away from class
  • Ease of referral between parents, schools and health center provider
  • Increased compliance with appointments (no traveling necessary)
  • Coordination with teachers and school staff
  • Increased continuity of care between health center and medical providers

 

In conclusion, SBHCs are a fantastic way to expand access to primary and specialized health care for students. Although tricky to initially get off the ground, SBHCs truly showcase the impact that can occur through the combination and alliances between our schools, healthcare providers and the newest health technologies.

 

Additional Reading & Resources:

  • The School-Based Health Alliance is holding a Congressional hearing on children’s mental health needs amidst the opioid epidemic. Register here: http://www.sbh4all.org/briefing/
  • School-Based Health Alliance Info:
    • Core Competencies: Veteran practitioners have outlined seven core school health care competencies—the knowledge, expertise, policies, practices, and attributes—that are essential to supporting student wellness.
      • Census: Learn about the geographic distribution of models, staffing profiles, student demographics, and community partnerships from the only national school-based health care database
    • Performance Measures: Discover the five leading quality indicators that constitute the national school-based health care performance dataset
    • Literature Database: Explore school-based health care’s well established evidence base in our virtual library.
    • School-Based Health Care State Policy Survey: Check out the most recent state-level public policies and activities that promote the growth and sustainability of SBHCs.

What do you think? Does your local school district have a telehealth system for the school clinic? What best practices have you seen out there for school-based health programs? Tell us in the comments below!