The ability for students to be seen by a provider not physically located at the school has been around for at least 20 years. Even before the Covid 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.
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.
With so few school-based health centers and many schools, especially smaller ones in rural areas, not even having a full-time school nurse available, there are great opportunities for a more wide-spread adoption and growth of telehealth.
But in most schools, students’ access to appropriate care during the school day is limited, and even minor ailments require a parent to take time off from work to pick up their kid. 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 as well as leaders in health centers and health systems are considering to expand access to care for students, here are 7 aspects to consider when launching school-based telehealth services:
- Leadership
- Space
- Technology
- Privacy
- School Staff
- Workflow
- 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 to secure their full support of a school-based telehealth service 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 for a school nurse office should still suffice.
Fortunately today’s telehealth technology does not require a large footprint — even a cart with exam tools fits comfortably even in a room that may formerly have served as a closet.
When a private space is needed (e.g., for behavioral health consults), measures such as sound insulation or white noise should be explored.
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, dermoscope, 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 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 in the design of the workflows and to 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 mastered through a conscious “pre-design” of the various workflows.
This includes the scheduling of visits (including ad hoc visits), informing or involving a parent, rooming a student, conducting the telehealth visit (with or without an exam), handling prescriptions and follow up visits, and billing. Each of the various workflows may involve many of the people 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 the 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.
Have you already successfully launched a school-based telehealth service? Please let me know what you learned or other aspects you would recommend to others getting started.
Or are you just getting started? Then reach out to me for a free consultation about how you could apply those 7 considerations to your unique situation.
Special Tip: The theme of our monthly Telehealth T-Time event on August 15, 2024 is school-based telehealth and you can get your free ticket to attend (or view the recordings about a week after the event here): Telehealth T-Time: A Community for Telehealth Enthusiasts, August 15, 2024
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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.
Contact Christian by phone or text at 657-464-3648, via email, or video chat.
