School Nurses Connect Through Telemedicine

Community Health Telehealth partnership with Slate Valley School District opens a new chapter on access to health care

West of Rutland along the New York border “where the Taconic Mountains give way to the historic Champlain Valley” at Fair Haven Grade School, a video monitor and remote monitoring stethoscope and camera sit on the telemedicine cart in the office of the school nurse Heather Hollister. Twenty miles away at Community Health Pediatrics in Rutland, Dr. David Schneider checks the equipment on his telemedicine cart and flips on the video connection.

A grade school child complained of ear pain, so Hollister scheduled a virtual appointment with Schneider with full approval from the child’s parent.

The school nurse uses digital tools to help Schneider remotely hear the child’s heartbeat and see inside the child’s ear. Tiny cameras allow the doctor to examine the child and make a diagnosis. The ears were clear, Schneider said, and the child was sent back to class, but not before expressing fascination with how the inside of his ear looked on the video monitor in Hollister’s office. The result? The child stays in school; the parent stays at work; and the school retains student continuity in education.

“Last spring I met with Dr. Schneider and the team from Community Health and we started talking about getting telemedicine up and running in our schools. We started with Fair Haven Grade School,” said Slate Valley Unified School District Superintendent Brooke Olsen-Farrell. The school was struggling with student attendance, she said, and has “a population that has high social emotional needs and access to health care.”

“If we could bring those resources into the school versus parents having to take off from work  and come and get their child from school or the child not even attending school that day,” Olsen-Farrell said, “it would cut down on absenteeism and we could also address the health needs of students.”

The Community Health-Fair Haven Grade School telemedicine partnership was serendipitous, and according to Schneider, the perfect timing was the result of the immediate and total buy-in on both sides. Community Health’s mission to make health care available to the underserved community of young children in the area melded with the educators’ goal to keep children healthy and in school and learning. Schneider and two provider colleagues at Community Health Pediatrics, Dr. Indra Lovko and Nurse Practitioner Amy Pfenning, were committed to the program and were as excited about it as the school nurses.

Parents were also thrilled Olsen-Farrell said. The proof of that was when almost 100 percent of the parental consent forms were returned giving the ok to involve them and their children in the telemedicine program at Fair Haven Grade School for the 2019-2020 school year.

Hollister and RN Mary Winn are fluent in the workflow and relationship with Community Health Pediatrics which can also include flu and strep testing on site. The outcome of most telemedicine visits is a diagnosis, treatment and possibly ordering a prescription, and the child is sent back to class, home or to the doctor. Hollister said it is important to demonstrate the value and convenience of the program and how it actually helps families stay healthy.

Schneider was introduced to telemedicine in 2018 when Community Health’s board of directors and leadership team gave their support to this innovative plan to test school-based telemedicine as a must-have option to delivery of Community Health’s services. The system worked so well at Fair Haven Grade School, that the school district made plans to eventually include all six schools and 1,300 students in the entire school district.

“We started in the grade school,” said Olsen-Farrell, “and then expanded to the high school and then Castleton Elementary School. It’s opened up a whole other conversation about community-based health and how we can partner with the health centers in our community in our school district.”

Those studying telehealth and telemedicine will tell you that the possibilities are endless and  cost effectiveness apparent. They will also tell you about resistance within the insurance industry to recognize that telemedicine as a viable and effective way to deliver health care.

Although some students at Fair Haven are covered by private insurance, there is a high Medicaid population in pediatrics in general in Vermont, Schneider said, making Medicaid a much more accessible option for children. “So we were able to get reimbursement for telemedicine and that broke down one of the barriers for the organization.”

The program at Fair Haven Grade School served as a roadmap for how to see patients when the governor’s “stay home, stay safe” order went into effect during the coronavirus health crisis.

Community Health was planning to integrate the Telehealth service into all seven of the practices within the Community Health network when the federal government recognized the value of telemedicine and passed regulations that made telemedicine a reimbursable service for Medicare patients.

“Once we were in the pandemic, everyone immediately recognized the role telemedicine could play for seeing patients who needed to be seen while keeping patients and staff safe,” said Dr. Jennifer Hanson, associate medical director at Community Health’s Express Care centers. “There was an immediate ‘ah-ha’ moment when everyone realized this was something we needed to do.”

By mid-March Hanson had gathered a team of experts in clinical practices, quality assurance, technology, administrative, financial and legal services to develop a workflow and training program for clinical and nonclinical staff. The forethought and strategic planning by Community Health’s board of directors once again proved valuable when the expensive but highly efficient electronic medical records (EMR) system put in place over the past five years became a vital element in rolling out telemedicine to the whole network – there was a telemedicine platform built into the EMR that was ready to access.

“Community Health Pediatrics was at an advantage because three of us were already trained in telemedicine,” Schneider said. “We worked out some protocols before the whole organization got a sense of what was coming.”

Regardless of the outcome of the pandemic, Hanson said there are multiple scenarios under which telemedicine is a fantastic service for patients. “One of the things we are looking into is remote monitoring for some of our patients with chronic disease,”  Hanson said, to understand how patients are doing thru monitoring vital signs and video check-ins to determine if an office visit is needed. Community Health CEO Don Reuther said other telemedicine services being considered include urgent care consultations from home, evaluations in nursing homes during off hours and access to specialty care at university medical centers in New England. Patients will have more timely access to health care, detect the onset of disease earlier, benefit from continuous care, and see lower cost of care by avoiding costly emergency room visits and fewer hospital readmissions.

At Community Health, telemedicine brings health and wellness to thousands of Vermonters who need affordable health care but are faced with transportation and other obstacles. In the Slate Valley Unified School District, school nurses connect with a doctor or nurse practitioner so they can better determine the next course of action for students and their parents in a timely and convenient way.

“The nurses love it. The parents love it. The children take to it naturally,” Schneider said about the program at Fair Haven Grade School. “They are used to the equipment. It’s the same as in the doctor’s office so it’s nothing scary, it’s just with a video camera attached. With the stethoscope I can hear thru a headset on my end but otherwise they are basically cameras that go in the ears, and throat or on the skin.”

Telehealth isn’t just about the technology. It’s also about lowering the cost of care, improving outcomes, timely monitoring, patient continuity, as well as provider access to patients with mobility or chronic illness obstacles.

Community Health uses the same familiar staff to deliver a new service offering that provides a different process where a patient’s location isn’t a barrier to getting high quality consultations and care.

For more information about Community Health and the Telehealth program check our website at https://www.chcrr.org/.

Dr. David Schneider is a pediatrician at Community Health Pediatrics. A graduate of New York College of Osteopathic Medicine, Dr. Schneider did his residency at Schneider Children’s Hospital, Long Island Jewish Medical Center in New Hyde Park, N.Y. He joined a private practice in Vermont in 1993 and then joined Community Health in October 2011.

Dr. Jennifer Hanson, the associate medical director of Community Health Express Care, is a graduate of University of Vermont College of Medicine. Dr. Hanson joined Community Health in 2019. A native of Middletown Springs, Vermont, Dr. Hanson says the best way to serve her community is through family medicine.