Telemedicine has come to schools, now what standards are needed?

By Laura Lovett
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Correction: A former version of this article incorrectly stated that "Telemedicine School-Based Health Centers" is an organzation. This has since been removed along with any guidlines listed as part of it. 

When it’s the flu season, the line at the school nurse’s office is usually backed up to the door. As telemedicine continues to reduce the burden on clinics and other healthcare settings, more schools are now looking to the technology for help. 

“If we are looking for where can I reach kids where they are, and how can we provide access to care where kids are the majority of the time — we go to schools. It just makes more sense to reach kids where they are instead of [them] coming to us,” Dr. Stormee Williams, medical director of School Telemedicine at Children’s Health Dallas, said during a session at the American Telemedicine Association's annual conference in Chicago. 

Telemedicine programs are cropping up in schools around the country, but there is no unified measure of care or standards. Different organizations like the American Telemedicine Association and Telehealth School-Based Health Centers (tSBHCs) have laid out their own recommendations for practitioners. But now some clinicians are talking about moving towards more concrete guidelines. 

At ATA18, leaders in school-based telemedicine sat down to talk about standards of care in this growing care setting. 

When telemedicine started entering the school health arena and there were a lot of questions about how it would look. 

“We wanted to move beyond the idea that schools are a place for urgent care to be provided,” Dr. Steve North, medical director for Mission Virtual Care and a physician at Mission Center for Telehalth, said at the conference. “We want to shift the model of thinking to creating healthier students with virtual care.”

North said it is important to provide preventative care, such as oral health services. While telehealth in schools aims to target an unmet need, the goals isn’t to replace primary care pediatricians.

“What we are really talking about is 'How does school become part of healthcare?'” North said. 

Both North and Williams have been growing their services to include more and more students. And while the doctors' focus area is very different (North works with rural populations and Williams works in Dallas Texas), both agree that there needs to be some kind of standard of care. 

“One of the questions that always comes up is, why standards? Why would we want to create something that said, 'what you do in Oklahoma is what we do in North Carolina' … they should line up somehow,” North said. “Really, it is around moving the conversation forward so that we can look at sustainability, [so that] we can look at integration and acceptance by the education community so that when a new program is coming, the health insurance entities and the hospitals know what the quality is going to be in that program.”

In the past, educational and health institutions have teamed up on initiatives for student health. In the 1980s the CDC and the Association for Supervision and Curriculum Development started to work together to focus on how children can be healthy in the community. The result was a collaborative approach called Whole School, Whole Community, Whole Child, which focuses on holistic health for kids.  

“We saw this coordinated effort and everyone agreed there is a benefit by not just focusing on healthcare and not just focusing on academics, but brining them together for a community-wide benefit,” Williams said. 

Right now both healthcare-focused organizations and school-focused organizations are starting the conversation around guidelines for telemedicine.

The ATA’s guidelines include a lot of pieces that are typical in pediatric medicine. The guidelines state that patients will have confidentiality, the services should be provided in a private setting, and that collaborations are needed within the community and at schools. The ATA also said that parents and guardians should sign all consent forms, that medical history and medical home information should be obtained at this time, that the presenter (often the school nurse) should attempt to obtain verbal consent before any encounter, that parents should be allowed to participate, and that written parental consent should be outlined and shared between the entities. 

The School-Based Health Alliance has also been talking to early adopters about best practices when it comes to telehealth in schools. 

But it isn’t just the care that is being standardized, as some are looking to extend these efforts to research as well. An organization called Sprout, for example, is now looking to standardize pediatric research and outcomes in utilization of telehealth. 

But in the meantime, the presenters said the path to more standards regulations and measures is plenty more discussions, meetings, and careful planning.