7 Considerations When Launching School-based Telehealth

The ability for a student to be seen by a provider not physically located at the school has been around for at least 20 years. Even before the pandemic, the use of telehealth in School-Based Health Centers (SBHC) grew almost threefold from 7% in the 2007/2008 school year to 19% in 2016/2017.

As a well-defined and oftentimes well-run care delivery model in schools that involves teaming up with a local clinic, SBHCs are, however, only available in 2% of all schools. It stands to reason that therefore the percentage of telehealth visits is not representative of access to telehealth in all schools.

Yet it shows the potential for adoption and the potential for growth, especially after the widespread experience with telehealth across the health system during the Covid-19 health crisis

It is therefore not surprising that more and more school-based telehealth services are emerging in many of the approx. 100,000 public schools all across the US.

As superintendents, principals, school nurses, health centers, or health systems are considering to expand access to care for students, here are 7 aspects to consider when launching school-based telehealth services:

1. Leadership
2. Space
3. Technology
4. Privacy
5. School Staff
6. Workflow
7. Paperwork

1. Leadership Engagement is Key

As with any change effort, the engagement of leadership is key. Who exactly is a leader, however, is not a clear cut as in other change efforts. Telehealth well done requires effective coordination and collaboration between the school administration, the school nurse, the student, the student’s parent, the clinician, and the clinic staff.

At best, a telehealth offering involves at least two organizations (the school and the clinic), and the situation gets more complex when parents become involved.

For a smooth design, launch, and ongoing support of a well-performing telehealth service the involvement of key leaders is necessary. That includes the school’s principal and superintendent; the school nurse; the clinical leader; and the clinic’s administrative leaders.

Prior to even considering a school-based telehealth service, getting these key stakeholders together is key.

2. Space Constraints

Depending on the type of school (elementary vs. high school) and the types of services (primary care vs. behavioral health), telehealth requires a dedicated space that affords privacy — space that is often difficult to come by in the school nursing environment.

Not all telehealth services need that separate level of privacy, though. Especially in primary care, the visit with a telehealth provider can be thought of as an extension of the nurse visit — and whatever privacy measures are already in place can still be used.

Fortunately today’s telehealth technology does not require a large footprint, even with exam tools or a system on a mobile cart.

When a private space is needed, though, measures such as sound insulation or white noise can be explored for consideration.

3. Ultimately, Telehealth is not about the Technology

Except when the technology does not work.

In essence, video visit only telehealth services only need (ideally) a computer or laptop with proper HD webcam, a speaker, and/or a headset (or a connector for personal headsets). The ability to conduct exams adds additional expenses for an otoscope, dermascope, or remote ECG, depending on the nature of the clinical services provided.

But even assuming that the technology works, there are key additional peripheral technical considerations including a reliable internet connection, electrical outlets, proper lighting, on-premises tech support, etc.

4. Privacy Can Pose Challenges

In healthcare, maintaining privacy is paramount. This can be extra challenging to ensure when the school becomes an extension of a clinic, giving students access to clinical specialty services (e.g., a pediatric endocrinologist) or behavioral health services.

When students are seeing clinicians with little to no involvement of the school nurse, extra measures must be taken to ensure the privacy of the visit. This includes making it non-obvious to non-involved individuals that a student is using the the telehealth unit (e.g., for a counseling session). Other challenges include protecting the students’ privacy regarding inquiries from parents, especially in states with a low age of consent.

Finally, technical considerations (such as white noise) and workflow considerations (such as sign-in sheets) must be carefully reviewed from the perspective of privacy.

5. Involving School Nurses and other Staff

To make telehealth a smooth experience for the student, the school nurse, and the clinician, the support of many people is needed — staff need to obtain signed consent forms from parents, staff must be educated on how to protect students’ privacy, the telehealth workflow cannot disrupt the school nurse’s daily operations, etc.

Getting the key staff involved early to design the workflows and think through the various processes is therefore paramount for success.

6. Designing Effective Workflows

The smooth delivery of healthcare services is first and foremost an exercise in following a well-defined, proven workflow. While in traditional in-person care delivery these workflows have evolved “naturally” over many years, the complexities of telehealth must be conquered with a conscious “pre-design” of the various workflows.

This includes scheduling visits (including ad hoc), informing or involving a parent, rooming a student, conducting the telehealth visit and/or exam, handling prescriptions and follow up visits, and billing. All workflows involve many people as referenced in the previous section.

For telehealth to work well, these workflows must be documented, reviewed, and trained on, especially if telehealth is used only sporadically in the beginning. Cheat sheets or other visuals are great tools to ensure that all of the proper workflow steps are followed every time.

7. Conquering the Paper Tiger

Healthcare and educational services are two highly regulated services that oftentimes require an inordinate amount of paperwork including for example consent forms for parents, billing considerations, and HIPAA-protection arrangements between the two entities, etc.

Obviously for any paperwork to be completed by the parents, it is a good practice to integrate those forms with the annual school enrollment process. The contractual arrangements between the school and the clinic depend on the nature of existing relationship (e.g., whether the clinic also already provides the school nurse, etc.).

Designing and Launching School-Based Telehealth Services

Launching a school-based telehealth service is not as simple as a webcam, a zoom license. Many considerations (at least 7!) must be taken into account and it first starts with the engagement of leadership. While a grass-roots effort by the school nurse or a clinician may get you started, the various hurdles to success are too manifold to overcome without a properly planned approach.

If you have already successfully launched a school-based telehealth service, let me know what other aspects you would recommend to others getting started.

And if you’re just getting started, reach out to me for a conversation about how those 7 considerations apply to your unique situation.