It could be a scene straight out of a movie.
A child with asthma has difficulty breathing while at school, so his
teacher sends him down the hallway, where he sits in front of a video
screen. Using a special stethoscope, a doctor who is miles away examines
the boy's chest, sends a prescription to his local pharmacy and instructs
the student to go back to class.
But rather than just a dream of the future, this scene could be taking
place in Yancey and Mitchell counties as early as this year with the
implementation of a school-based telemedicine network.
Dr. Steve North, a family physician at the Bakersville Community Medical
Clinic, is exploring using the advanced videoconferencing technology to
expand school-based health centers that provide health care, mental health
and other services to more schools in the two rural counties where
accessing health care can be difficult.
The project is being supported by the Graham Children's Health Services of
Toe River and is being funded through The Kate B. Reynolds Charitable
Trust, the American Academy of Pediatrics and the Community Foundation of
Western North Carolina.
"It's about providing improved coverage for acute issues and better
management of chronic issues," said North, who is exploring the idea
through a N.C. Foundation for Advanced Health Programs fellowship.
"The overall hope is that by improving kids' health we will in turn
improve their attendance at school and their academic performance."
School-based health centers at the two middle schools in Yancey County
have been providing health care, mental health and nutrition counseling
for the past 15 years, said Paulina Etzold, director of the health
centers.
She said the clinics are a huge benefit to the rural area, where access to
health care and other services is limited and transportation difficulties
compound the problem.
In 2007, Yancey County had seven physicians per 10,000 people and Mitchell
County had 17.6 physicians per 10,000 people, compared with 20.9
physicians per 10,000 people statewide, according to data from the UNC
Sheps Center for Health Services Research.
"It really impacts on the health care for children who can't access health
care," Etzold said.
Remote schools suffer
While the clinics help increase access to health care, North said they are
not an option for some smaller schools in even more remote parts of the
region.
"While it's a great idea, it isn't financially viable to a school of 60
kids," he said. "The question is: How can we use a centralized nurse
practitioner to provide services these kids need, and telemedicine is a
potential way to do that."
Under North's model, the existing school-based health centers in Yancey
County would serve as hubs, as would a new clinic at a school in Mitchell
County.
Specialized Internet-based videoconferencing technology outfitted with
cameras and scopes would enable nurse practitioners or doctors at these
hubs to communicate and examine children at the other, more remote schools
in the counties. Psychologists at East Tennessee State University would
also provide mental health counseling as part of the network.
North expects the project to be up and running some time this year, with
full implementation of the program over the next two-three years.
Teledentistry possible
"In addition there is also the potential to do nutrition counseling and
education and also to do teledentistry," he said. "If we could provide
those services, you could really have a functioning school-based health
center at a little, tiny school."
North's idea of a school-based telemedicine network is unique, said Jodi
Polaha, an assistant professor of psychology at ETSU. She said while
telemedicine is being used in some areas of the country, it is usually
based in a medical center or university, not in a community.
She said having the technology based in the school will make it easier for
meetings to be set up with everyone involved in a child's life, including
parents, teachers and health care practitioners. She said this could help
resolve issues quickly or be useful in dealing with complex problems like
obesity.
Polaha said if successful, the telemedicine network could form the basis
for similar networks in other areas of the country.
"There are so many other rural areas where this would be an awesome model
but no one has seen a rural area pull something like this together," she
said.
