Health-e-Schools

Description

Health-e-Schools was created by the Center for Rural Health Innovation (CRHI) to enhance the way healthcare is delivered to students in rural schools in western North Carolina. Healthcare professional shortages pose many challenges for parents and their children. Often, parents are forced to miss multiple hours of work to drive their child to a healthcare facility for a basic examination or consultation when answers could have been given much more efficiently by staying in the school setting. Students also miss more school as a result of the long commute and time taken to receive health services. Many rural children do not receive adequate care due to time or money constraints.

Health-e-Schools was created in 2011 to address these efficiency, financial, and transportation concerns. A 2005 University of Rochester study on inner-city childcare centers found a 63% decrease in illness-related absences through the use of telehealth. This concept of using telehealth to treat students was extended to the rural school setting through Health-e-Schools.

This program has been successful because of the community support it has received since its conception. The Center for Rural Health Innovation is non-profit with a community-based board of directors. Additionally, each county's Health-e-Schools program has a coordinator in the local area who both promotes the program and keeps it on track to meet the needs and preferences of the community.

Health-e-Schools has received support from:

• BlueCross BlueShield North Carolina Foundation
• Kate B. Reynolds Charitable Trust (NC)
• USDA Rural Utility Service Distance Learning & Telemedicine equipment grants
• HRSA School-based Health Center equipment grants

Funds from the The Duke Endowment through Mission Health has supported the expansion of Health-e-Schools to additional sites. Local grants have allowed for even further expansion in Burke County, with portable equipment that takes school nurses with in between schools as they travel.

Services offered

Schools participating in Health-e-Schools offer services to all students, regardless of insurance plan or ability to pay. The sliding fee scale is used for those who are uninsured, but no patient is turned away due to type or lack of insurance. Parental or guardian written permission must be given to use these services. School faculty and staff are also eligible to utilize these services.

On-site school nurses are able to connect sick students with healthcare providers through this program. Health-e-Schools employs a full-time, off-site family nurse practitioner who uses telehealth as a means to evaluate and diagnose patients.

Technology operated in this telehealth program includes high-definition cameras and specially-equipped stethoscopes and otoscopes. The following health issues are commonly addressed or diagnosed by various healthcare providers via teleconferencing:

• Earaches, sore throats, colds
• Upper respiratory complaints, allergies
• Rashes
• Chronic disease management
• Medication management
• Sports physicals
• Pre-participation physicals
• Adolescent medicine consultations
• Behavioral health

Results

What began as a telehealth program that only 3 schools implemented in 2011 has grown to be a part of more than 115 schools serving more than 50,000 students.

The Duke Endowment grant allowed for twice as many students to be reached by Health-e-Schools in 2014, totaling 22 rural schools. In 2016, telehealth equipment became smaller, portable and more affordable, contributing to the Health-e-Schools rapid expansion.

One of the most notable successes is that Health-e-Schools has helped to increase classroom attendance and decrease the amount of time that parents or guardians must take off of work to bring their child to appointments.

The successful establishment of the Health-e-Schools network led to CRHI being the recipient of the President's Institute Award for Health Delivery, Quality, and Innovation from the American Telemedicine Association in 2014.

In 2019, Health-e-Schools collaborated to create the PATH Expansion program, designed to make telehealth available for the rest of Pender County Schools. This earned them an honorable mention for the 2019 Mid-Atlantic Telehealth Resource Center (MATRC) Breaking Barriers Through Telehealth award, in the small, rural, nonprofit organization category.

The article School-based Telehealth: A New Approach to Improved Outcomes in Rural NC Counties, published in the North Carolina Health News, shares more about the program's impact on a local level.

Challenges

Funding can be challenging, as many of the federal grants are specifically designated for equipment. By itself, equipment doesn't provide care—quality people are needed for that. Health-e-Schools staff work hard to provide high-quality, appropriate care, but finding funding for operations is an ongoing challenge. Fortunately, North Carolina can bill insurance carriers for services provided via telemedicine at the same rate as if they were provided in-person. This varies by state and could greatly impact another organization's sustainability plans if they wanted to replicate this model.

This model relies heavily on the school nurses, employed within each school district, to be the primary tele-presenter. Across the country as well as in North Carolina, school nurse funding has been cut sharply. The lack of school nurse availability to be a tele-presenter can lead to new barriers to care.

Replication

The School-Based Telemedicine Webinar Q&A Summary gives insight and information on how to successful implement a similar telehealth program.

Contact Information

Amanda K. North, MHA, Executive Director
Center for Rural Health Innovation
828.467.8815
amanda.north@crhi.org