For the past eight years, Sevier County in East Tennessee has partnered with a federally qualified health center to provide remote access to basic acute- and primary-care services for more than 14,000 students in the county's public school system.
The promise of telemedicine is delivering now in East Tennessee.
For the past eight years, the public schools of Sevier County, located just east of Knoxville, have relied on Cherokee Health Systems to provide more than 11,000 acute and primary care episodes and screenings for the system's 14,000 students.
In the 2015–16 school year alone, there were 1,631 visits across 23 schools in Sevier County, the largest rural school district in the Volunteer State,
It's a program that measures its return on investment with metrics such as reduced absenteeism and improved access to care. Before the affiliation, it was not uncommon for as many as 20% of the students and educators at Sevier County schools to be stricken during flu season, forcing school-wide closures.
In the past five years, however, there have been no school closings in the county due to the flu, and program organizers at the federally qualified health clinic and the school system credit the partnership.
Deb Murph, RN, COO at Knoxville-based Cherokee Health Systems, says the main emphasis of the telemedicine program is to keep children in school by addressing health issues early and pre-emptively inside the school walls and eliminating travel time to clinicians' offices.
"If they were having to leave and get checked for an acute illness they would have to leave school and that usually means a half-day missed or more than that," Murph says. "The ideal was to place the services where the children are located and address their acute healthcare needs on the spot instead of having them leave."
Providing access to care inside the school also means that a parent or another relative in the more isolated areas of Sevier County (with a median family income of $40,000, about $4,000 below the state average) may not have to take time away from work to either bring a student to a clinician's office, or stay with them at home.
Tallying the Cost
Murph says the cost of the telemedicine visits are about 15% to 20% higher than an office visit, but that does not account for the saved travel time, avoided absenteeism on students and teachers, and time away from work for their parents.
Under the program, which requires parental consent, students are screened for acute and potentially contagious health issues such as strep throat and flu by a school district nurse, who decides if an uplinked telemedicine visit over a secure site for the students with a Cherokee Health nurse practitioner is needed for a more comprehensive exam.
The Cherokee Health nurse practitioner can provide real-time diagnoses and treatment plans, or refer students for more complex care, all of which is coordinated with the school nurse, the students and their families.
In addition, the telemedicine visits are used to monitor chronic conditions for some students, such as high blood pressure and diabetes, and to promote sound preventive medicine, and proper nutrition. As part of routine exams, students are often examined for lice, bed bugs, and other skin irritation issues during the tele-conferences.
When we talk about the potential of telemedicine to improve access to care for isolated patients in rural America; to provide pre-emptive primary care that addresses health issues early and before they become more problematic; and to engage patients in their own health, that is exactly what is happening in this relationship between Sevier County's public schools and Cherokee Health.
John Commins is the news editor for HealthLeaders.