Telemedicine’s Greatest Benefits May Come Through School-Based Programs

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School-based telehealth programs keep parents at work and kids in the classroom, a win-win for families and the community.  

Imagine waking up in the middle of the night. Your child is sick, and you are afraid for their well-being. An emergency room is not available, and there are no paramedics around. You need medical advice and your child needs attention, so you call your child’s pediatrician. They listen to your child breathe and cough over the phone, quickly diagnosing your child based on what they can hear. They then reassure you that the problem is of little concern, that everyone can go back to sleep, and that the physician will see you in the morning. Your fears and concerns are relieved, and it was all due to technology.

This may sound like a familiar situation in how we leverage technology to quickly meet our medical needs with minimal disruption to our lives. Telemedicine has the ability for rapid assessment, treatment, and referral all at the patient’s convenience. But the scenario above is likely the first documented use of telemedicine where a physician was able to allay a parent’s fear that their child did not have the croup. The year was 1879; thee years after Alexander Graham Bell transmitted his famous words to his assistant, ushering in the telephone era.

While technology has drastically improved over the next near century and a half, the key tenets of why people use telehealth have not: speed, efficacy, and convenience. While that first instance of telehealth was limited to auditory assessments, today’s technology includes audio, video, and peripherals capable of transmitting blood pressure, temperature, heart rate, and blood oxygen to a distant physician capable of writing and delivering a prescription in a matter of minutes. Technological advances have allowed telehealth to move from triage to treatment, and with that advance came rapid deployment across a number of environments, including schools.

One of the most significant benefits to telehealth programs is the ability to provide care for non-emergent medical issues with minimal inconvenience to the patient. That increased convenience may be through a kiosk down the road, one in the child’s school, or even an application on a mobile device. Regardless of how people virtually connect to a physician, they are connecting for the single purpose of receiving near-immediate care with minimal disruption to their personal life. While virtual physicians have limitations to a physical physician (such as equipment, visuals, and connectivity), the speed and convenience of care remains a primary advantage of virtual health over in-person physicians.

“I was scrambling to find someone to pick up my daughter and take her to the doctor until I remembered we had signed up for this [program]. My daughter missed a minimal amount of class and I was able to pick up meds on my lunch break and bring them to her.”

This comment came from a parent of a student who utilized the Children’s Health System of Texas’ (CHST) school-based telehealth program. Similar to that first use case in 1879, it illustrates the ideal scenario for school-based telehealth: A working caregiver with an inflexible schedule, a child with a medical need, an effective medical solution, and a child who is able to be treated in school and returned to class.

Beyond the reason for using telehealth lies the outcome of the interaction. Did the patient get their medical needs met? Was their care accurate or did they need additional care from their primary physician? Where else would they have gone without it? Did we save them money? What was the total benefit of the service? These questions are key components to the effectiveness of telehealth: accurate diagnoses and comparable treatment to standard medical practice. These are simple questions; however, several challenges exist prohibiting the direct assessment of these questions. Many telemedicine services aren’t structured for direct follow-up, and some services are contracted to a different party so that outcomes cannot be objectively captured.  These elements make the direct assessment of virtual health outcomes very difficult. In the case of the school telehealth program at Children’s Health System of Texas, surveys were deployed to both school nurses and caregivers to assess multiple perspectives on both outcomes and satisfaction. These topics covered the areas of needing additional care, preventing absenteeism, and averting emergency and urgent care centers in addition to overall satisfaction and willingness to recommend telemedicine services to others.

Along with telehealth’s convenience is the ability to be seen by a physician without having to leave work. In the case of school telehealth, it saves a parent or caregiver the need to leave work, pick up the child, and take them to see a physician. In cases of hourly workers who have no paid time off benefits, this can result in significant income losses. Further, in cases where the child could have returned to school, these situations result in unnecessary losses in income. All caregivers were asked if they would have missed work without the school-based telehealth program, and 74% of respondents reported that they would have had to miss work. In addition, over 70% of the caregivers report saving up to four hours with the school telehealth program, and 67% report that it saved up 25 miles of travel, resulting in additional $13.75 directly back in the caregiver’s pocket when factoring in a rate of $0.55 per mile for travel costs.

In conjunction with keeping caregivers at work is the ability to also keep children in school for minor medical problems. When asked if the student would have missed school without the school telehealth program, 69% of nurses responded that the child would have left school. Further, 51% of caregivers report that their child would have missed up to a full day of school. At a projected reimbursement rate of $53 per day over a 180-day school year, our programs may have saved over $350,000 to schools on reduced absenteeism alone since the program’s inception.

Another benefit of telemedicine programs is the ability to provide care for low-acuity visits. In many cases, time, as opposed to either insurance status or the presence of a primary care physician, is a more significant indicator of where care will be received. A patient may have primary care, but when that fact is coupled either with potential loss of income or extended wait times for the next available physician appointment, places such as emergency rooms and urgent care centers become viable options not for emergency care, but for immediate care. One challenge with this approach is that low-acuity visits in the emergency room not only take up valuable resources for emergency needs, but may also lack the interventions required to generate income. Further, the cost burden to the patient and the insurer is significant when comparing costs of care.

When asked if patients would have gone to emergency or urgent care centers, more than two-thirds of the school nurses agreed that the child would have gone to one of these two centers. Almost one-quarter of caregivers provided the same response. Given the cost differences between urgent care, emergency care, and school-based telehealth, we estimate that nearly $1 million has been saved to payors in cost avoidance since the program’s inception.

A critical component of any effective service is user satisfaction. Previous conversations with patients on primary care physicians have found that patients will stay with a provider they like despite some inconveniences (such as long wait times or limited availability). At the same time, a highly effective program will see limited use if the customers are not satisfied with the service. To that end, the school telehealth program has three different customers: the parent, the child, and the school nurse.

Based on survey responses, 91% of the caregivers report positive satisfaction levels with the program, including 85% who are “very satisfied,” and 6% who are “somewhat satisfied.” In fact, only 5% of the respondents were dissatisfied with the service.

Where parents have an array of responses to satisfaction levels, nurse satisfaction is more heavily-weighted toward positive satisfaction. In our findings, 95% of the nurses report positive satisfaction (74% were very satisfied) and there were no dissatisfied responses. The remaining 5% in the sample reported neither positive nor negative satisfaction.

Another key indicator of a program’s ability to provide quality services is to examine the willingness to recommend services. On a scale of 0-10 with 10 being “highly likely to recommend services,” the average rating for caregivers was 7.69 out of 10. This is somewhat misleading in that 78% reported being “very willing to recommend” school telehealth, and only 4% responded that were not likely to recommend services. Nurses report more favorable responses with an average score of 9.39 out of 10, and only 3% not likely to recommend services.

At the heart of the school-based telehealth program is effectively treating the child’s medical needs. The impact of this program, however, reaches far beyond the delivery of clinical care. It is a convenient, patient-centered solution that impacts the child, the nurse, the school, and the caregiver. The ability to provide effective care in a convenient location, at a convenient time, while saving the caregiver time (and a little money), is a welcomed service in a time where most budgets are being tightened.

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