Posted by: Francis Koster Published: January 10, 2012

The Possibilities of Telemedicine

The Possibilities of Telemedicine

by Francis P. Koster, Ed.D.

About one in nine American school children has asthma. In 2008, children with asthma were absent some 13 million school days — and many of these students could have been in school, if they had access to better disease management. These numbers are higher in school districts with many low-income students.

Imagine yourself as a school principal with 1,000 kids — and a school nurse who visits one day a week.

Many of the asthmatic students could go into life-threatening status at any time, and your school-based "first responder" school nurse is 15 miles away at a neighboring school today. So you call an ambulance and call the child's mom and dad. Then, you try to settle the rest of the kids down to focus on their lessons as the ambulance screams into the driveway. Everybody loses.

Children with asthma often have some meter to help monitor their condition. Asthmatics may blow into a tube with a ball in it that tells them how well or poorly their lungs are working — the higher the ball rises, the better the child's lung function. Still, in many schools there is no one to monitor the child’s disease status and, most importantly, assess it to know if trouble is looming.

But a trained healthcare worker, using Skype or similar video call programs, can monitor the child remotely by watching the child use the meter. This also helps the parents deal with a well-documented behavior of children with chronic disease — use of the disease as a tool to manipulate their parents. The presence of the tele-nurse makes that sort of action less likely to succeed.

In the absence of a trained health professional, when a child with asthma starts to go downhill, the school folks on the scene know that death is among the many outcomes possible. As a consequence, such children are often sent directly to hospital emergency rooms, where the examination and treatment are very expensive. Take a rising number of school kids with this kind of disease, and you can see why the annual spending for asthma and diabetes in emergency rooms is rising. Telemedicine can help to reverse this trend.

Several school systems have taken major steps to get their arms around this issue by installing Internet-based school nurse telemedicine systems. These systems allow a specially trained school nurse, or a nurse from a nearby hospital or doctor’s office, to view the child remotely, watching as the various meters and test equipment are used on a daily or frequent basis.  They then record the data electronically for sharing with the parents and others via email and/or electronic health records.

In Rochester, N.Y., a study of the effectiveness of telemedicine in schools involving 22 schools and daycare centers showed a 22 percent reduction in ER visits when the telemedicine system was in place. The study also found that most of those visits were replaced by visits to the doctor's office, which cost only one-seventh as much as the emergency room.

In rural Arkansas, three schools were connected to health care workers more than 100 miles away to help their students with asthma. The monitored children had fewer ER visits and decreased school absences, and their parents missed fewer days of work when their children were in the program. Another impact was that both children and their parents came to understand the disease better, and were able to manage it better after the children left the program, resulting in better health for those children and lower costs to society.

Finally, in 2009, the well-respected Journal of Pediatrics reported on a controlled research study involving children ages 5-14 with diabetes who participated in a telemedicine project, measured alongside children who had the same disease but did not participate in the project. The study found that the telemedicine participants had fewer symptoms of out-of-control disease over time, while the non-participants had more. Further, “there were fewer hospitalizations and emergency department visits” among the children who participated in telemedicine.

In my research on this topic I found many other examples of such success stories, including stories dealing with diabetes and hyperactivity, both of which stress school administrators, children and their parents. You can find more information on these programs at

The interesting thing about this new opportunity is that it is far cheaper than the old way of managing chronic disease in schoolkids. As our country copes with rising healthcare costs and rising rates of asthma, any school system with access to broadband can create an arrangement with a neighboring doctor’s office, public health department, or hospital which will improve the health of the children, help the teachers focus on teaching, help parents remain at work, and lower costs all around.

As a nation, we do not lack the tools to tackle our problems — we just need to imitate the success others have had. It will make a better future for us all.

Copyright 2011. All rights reserved.

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Francis P. Koster Ed.D.

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