From the mHealthNews archive

Telehealth gives schools a new tool for student healthcare

By Robert Bergamini, MD

Roosevelt High School in St. Louis, Mo., is like many urban schools around America: Many students lack consistent access to healthcare for a variety of factors, including financial constraints or a shortage of providers.

Mercy is a 32-hospital integrated healthcare system with 300 outpatient facilities spread over four states, including Missouri. At one of the health system’s regular community roundtable meetings, members of the Roosevelt neighborhood expressed concern about potentially underserved students. The health system realized that this situation was having a severe impact on education, parents’ jobs and the health of the students.

In less than two years, what started as a simple discussion had evolved into a six-room, school-based health clinic open five days a week. Today, it’s staffed and managed by Kathy Woods, a full-time family nurse practitioner (FNP) employed by Mercy.

Woods has emerged as more than just a caregiver; she has become an integral part of the Roosevelt community. By helping students access Mercy’s web-based telehealth technology in the clinic, she connects them with much-needed physician specialists and mental health professionals.

Lack of access drives telehealth solution
Telehealth technologies have been used by Mercy since 2006 to connect rural facilities in Missouri, Kansas, Oklahoma and Arkansas to specialists in larger cities. Although Roosevelt is in a major city, accessing care even for routine screenings, tests and checkups can be a challenge.

That all changed for Roosevelt students when Woods arrived. She provides students with routine and sports physicals, as well as care for acute illnesses such as upper respiratory infections, pneumonia, ear infections, sore throats and asthma. Furthermore, she offers immunizations and medical care for any children of currently enrolled students.

Woods also connects students with pediatric and adolescent mental health professionals – a much-needed service at Roosevelt. Approximately 45 percent of students have struggled with depression at some point, but few had visited a mental health professional before Woods’ arrival.

Woods, supervised by nearby Mercy Clinic family physician Sarah Cole, DO, treats students regardless of their ability to pay and offers parents on-site assistance for enrolling in Medicaid. Cole regularly visits Roosevelt as well, and also consults with Woods through the telehealth program.

This level of attention has greatly expanded healthcare access to hundreds of students, reducing school absences and keeping parents from missing work. In the coming years, Mercy and Woods look forward to offering electronic encounters for additional specialties such as pulmonology and neurology.

Overcoming language differences
Caring for Roosevelt’s student population is somewhat unique in that there are 21 languages spoken at the school. In fact, more than 20 percent of students don’t speak English as their primary language. This posed a logistical and staffing challenge.

Now, when a student in need of an interpreter arrives for an appointment, Woods logs in to a secure, dedicated website on a computer in one of the clinic’s exam rooms. She requests a translator via a partnership that Mercy has with an outside translation service, and within a few minutes a gender-specific telehealth clinician fluent in one of seven designated languages is available to help with the consult. A clinician fluent in other languages can be available within 20 minutes.

The students are highly engaged in these encounters. Helping hold the students’ attention is the application’s picture-in-picture feature, a standard with any telehealth encounter, which allows them to see themselves in the monitor and communicate directly with the physician, making the sessions more interactive.

Detecting visual cues
These web-based telehealth encounters also enable providers to detect subtle cultural cues that may not be recognizable to a clinician unfamiliar with the student’s native country. In one such case, a clinician interpreter was able to help Woods diagnose pneumonia simply because she noticed unique gestures the student was making after certain questions.

Occasionally, Woods uses the telehealth program to consult with Cole on a student’s condition. During one such consultation, the technology allowed Woods and Cole to discern that a skin rash, which would have dictated a three- to four-day absence per school policy, was non-contagious, enabling the student to remain with her classmates.

Benefits to students, parents and the community
In the first year of the telehealth program, more than 80 percent of parents signed consent forms allowing their children to be seen at the Mercy Clinic at Roosevelt. The clinic cared for an average of 30 students a week, double the number initially anticipated.

Students and parents have told Mercy and Roosevelt administrators they're grateful to have the clinic. Some students have received a physical exam for the first time in their lives. One parent even wept as she filled out the medical consent forms because having the clinic in the school meant she would not have to miss work for a doctor’s office appointment and risk losing one of her jobs.

Benefits and reactions like these make practicing at the Mercy Clinic at Roosevelt meaningful to providers. Mercy is considering expanding the in-school clinic concept to other schools throughout its region, although no plans are yet in the works. By leveraging technology to bring needed healthcare providers to underserved areas, Mercy can truly practice preventive care, addressing health issues before they turn into more serious events.

Robert Bergamini, MD, is a pediatric hematology-oncologist and medical director of Mercy’s Center for Innovative Care.

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