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Access to Care

Thousands Of Texas Kids Can Now Visit The Doctor, From School, With Telemedicine

Diegoandteledoc.jpg
Lauren Silverman
/
KERA News

When children get sick at school, it can be a big disruption. For the kids – they have to miss class –and for mom or dad, who have to leave work, try and schedule a last minute doctor’s appointment, maybe even go to the emergency room. So, what if kids could see a pediatrician without having to leave school? 

That’s the idea behind a telemedicine initiative run by Children’s Health. The program has gone from reaching several hundred kids to in Texas to thousands. While most second graders at Gilbert Elementary are sitting at lunch tables, sticking slices of cheese pizza in their mouths, Diego Montealvo is standing in the nurses office, opening wide for a piece of metal.

This story was produced by KERA News.

“Ahhhh,” he says, as the school nurse aims a digital otoscope at his tongue. He’s staring up at Dr. Stormee Williams. This doctor isn’t at the school in Irving — she’s at an office building in Dallas. But she’s looking at Diego through the screen, and like a conductor, she directs the school nurse to examine him with the medical instruments.

Diego isn’t sick today, but when he came in to see the school nurse last November, he had pain in his ear. At this point, most school nurses would call a parent to pick up their kid. Then the parent would have to call the doctor for an appointment, maybe visit an urgent care center or the ER. The kid misses school, the parent misses work.

With telemedicine, Diego can now connect remotely to a doctor at through Children’s Health from school. Back in November, he was diagnosed with an ear infection and prescribed an antibiotic in between classes. His mom, Isabel Montealvo, says telemedicine saved her time and money.

“After I left work, all I had to do was pick up the prescription from the pharmacy because they sent it over,” she says.

Children’s Health started a telemedicine program at a pair of preschools in 2013. Today, there are screens and carts in 57 urban and rural campuses across North Texas. It’s one of the largest school-based telemedicine programs for kids in the country. Dr. Williams explains each school is selected based on need.

Second grader Diego Montealvo visits the school nurse’s office for a virtual checkup with Dr. Stormee Williams, a pediatrician with Children’s Medical Center of Dallas.
Credit Lauren Silverman / KERA news
Second grader Diego Montealvo visits the school nurse’s office for a virtual checkup with Dr. Stormee Williams, a pediatrician with Children’s Medical Center of Dallas.

The number of kids who are uninsured in Texas is high: one out of nine children doesn’t have health insurance, compared to the national average of one out of six. For these kids, Williams says it’s not easy to see a doctor for the flu, pink eye, or a stomach ache. 

“We look at the map of where kids are going to the ER for non-emergent issues and where can we step in to fill that gap for the family and for the kids,” she says.

Of course, she admits not everything can be diagnosed via telemedicine. Rashes, for example, can be tricky.

“Sometimes, I can look at a rash and say that’s a ringworm,” Williams says. “Other times, I need to see what it feels like, so we will send [the kid] to their primary care doctor.”

Research shows parents can save time and money with school-based telemedicine. The focus now is on whether telemedicine is improving kids’ health. Only a few studies have been done so far. Dr. Quianta Moore, a Baker Institute Scholar in Health Policy, points to research showing kids who accessed psychiatrists via telemedicine did even better than those who completed in-person visits.

“In that study it showed that the adolescents prefer to engage in these visits [rather] than in-person consultations,” she says.

Another study in the journal Pediatrics found that children with type 1 diabetes who used telemedicine at school had better blood-sugar control and fewer visits to the ER.

The challenge with school based telemedicine, Moore says, isn’t technology, its cost effectiveness. There’s the cost of equipment – tens of thousands of dollars – and the risk of not getting reimbursed by insurers. People from Children’s Health actually worked with Texas state representatives to change the law so that doctors can get reimbursed by Medicaid.

[See The Doctor Could See You Now At School]

Although Children’s Health isn’t billing patients directly at this point, there are plans to create payment models for both insured and uninsured kids.

In the meantime, Children’s Health will be collecting data from their program to see if it can help kids like Diego miss fewer days of school, and help parents save money and time. By 2016, the telemedicine program could be in 80 school campuses across North Texas.