Another use for digital video.
Telemedicine could have healthy future
By Art Nadler <nadler@lasvegassun.com>
LAS VEGAS SUN
Your child is sick and has what looks like an ear infection. Unfortunately, there's no way to tell unless you leave work, drive to school and take him to the family doctor.
The Kansas City School District may have come up with an alternative plan.
In February, four elementary schools in the Kansas City area began using telemedicine to pre-diagnose ill students' medical conditions.
The pilot program, called Tele-KidCare, is the first in the nation to use telemedicine techniques. It's the brainchild of Julie Taylor, a school nurse in Kansas City, Kan., who talked University of Kansas Medical Center physicians into sharing their telemedicine system with the school district.
Doctors nationwide have for years been communicating with each other and diagnosing patients' illnesses via closed-circuit television cameras between offices.
A patient simply goes to a site and, through the use of electronic instruments at one location such as an otoscope to look into the ear and throat, a specialist at another site can conduct a visual examination.
A small hand-held camera also is used to zoom in on any part of the body -- the skin, eyes, scalp, etc. -- which is then viewed instantly at another site.
Nevada physicians are using a telemedicine system, but it is still in its infancy. The University of Nevada School of Medicine began the program 18 months ago so that large urban cities such as Las Vegas could service remote rural communities.
"It's very feasible to use this in schools in Nevada," said Gerald Ackerman, director of the Northeast Area Health Education Center with the University of Nevada School of Medicine. "It's probably not being used in schools here because no one sat down with us to talk about it. The system is very primary-care physician orientated."
Dr. Charles Bernick, associate professor of neurology at the School of Medicine, agrees. He thinks schools in rural areas would be helped greatly because they are not well served by physicians. He believes the technology is advancing so quickly that telemedicine will become a common staple in medicine in the near future.
Telemedicine is currently operating from 10 sites around the state, Ackerman said. Systems are located at University Medical Center; South Lyon Medical Center, Yerington; Mount Grant General Hospital, Hawthorne; William Bee Ririe Hospital, Ely; Elko General Hospital, Elko; Humboldt General Hospital, Winnemucca; Pershing General Hospital, Lovelock; the School of Medicine at the University of Nevada, Reno; a multi-speciality clinic in Reno; and Washoe Medical Center, Washoe.
Taylor said it's too early to tell whether telemedicine has reduced absenteeism in the four Kansas City elementary schools. Nurses noticed that children who were examined are returning to school more quickly than those who were not. They normally would have been out three to four days, she said.
"We caught four children with heart murmurs that needed cardiac examination," Taylor said. "A lot of times kids that have rashes are sent home, but now we can see if it is serious enough. In Hispanic communities, we are seeing parents take their children to schools because they feel more comfortable going there."
Dr. Gary Doolittle, director of the telemedicine service at Kansas University, said he has found it especially helpful for parents who both work. They don't have to take off during the day to drive their children to their doctor.
Doolittle emphasized that before a telemedicine physician sees a child, the parents are called and given the option of being in the school nurse's office during the examination. And though the pilot program isn't charging families who participate, it does require them to sign a waiver, and eventually parents' insurance companies will be billed for a normal office visit.
Dr. Brian Cram, superintendent of the Clark County School District, thinks Kansas City's telemedicine program is interesting, but he feels Nevada might be too conservative for such a program. Nevada parents might not want to relinquish control to physicians they don't know.
"We prefer a more personal contact with the student," Cram said. "We want to refer them to a family doctor and keep the parents involved."
Sally Jost, assistant director of CCSD's Health Services, thinks telemedicine initially sounds as if it would work, but she wants physicians to examine students in person.
"In terms of an assessment tool, it would be helpful," Jost said. The problem in Clark County is that not all schools have nurses on the premises during school hours. Each nurse rotates between two assigned schools.
School Board member Judy Witt said she thinks telemedicine is worth investigating, but she also agreed with Cram that Nevada's conservative population might not be supportive.
Witt feels health-care issues are important, and if a new delivery system is available, it would be foolish not to explore it, she said.
Meanwhile, Kansas City is going all out to integrate telemedicine into its school system. The district plans to add a fifth school in the near future.
Taylor said she was able to pay for the telemedicine equipment, which costs from $15,000 to $18,000 per computer, monitor and accessories, through Medicaid. Doctors need only spend $3,000 to $5,000, she said, because they don't need examination equipment.
Taylor said the federal government mandates that schools must provide services for students with special needs. As a result, the Health Care Financing Administration said Medicaid must pay for the telemedicine equipment.
Subsequently, Taylor said, all children in the school district can use the telemedicine program.
Assemblywoman Vivian Freeman, D-Washoe, who is vice chairwoman of the Legislative Committee on Health Care, said she thinks using Medicaid matching dollars would be a feasible way to fund a similar program in Nevada. She said a school-based telemedicine program could be very helpful for low-income parents who don't have access to medical care.
Freeman said she would discuss the possibility of a school-based telemedicine program with the state Division of Health.
"You cannot teach kids if they are not well," Dr. Gary Doolittle said of KU's support of the school-based system. "It just made sense for us to become involved. If there is a way for parents to have their children see a doctor without making a call or taking off work, then this will be especially helpful."
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