Nancy Berardi, R.N., an elementary-school nurse in Rochester, New York, has Ben in her office. The towheaded fifth-grader has arrived with a fever, a cough, and a sore throat. "I just saw your sister yesterday--she has strep, right?" Berardi asks. Ben nods.
Seconds later, Berardi's on the phone with Ben's mom, who's at work. "We'll take a strep culture and have the doctor examine him," she explains, jotting down Ben's health-insurance information. She calls a telemedicine tech, who arrives at the school soon after to swab Ben's throat for a rapid strep test. Five minutes later, the results come back positive. The tech logs Ben's details on a secure server.
"Ready to see the doctor now?" Berardi asks. With a click of the tech's mouse, a physician appears on a monitor.
"So, Ben, I hear you aren't feeling so great," says the doctor.
"Yeah," Ben replies, enthralled by the image on the screen.
The pediatrician goes over the symptoms with Berardi.
"Let's check his ears and lungs," he says, and the tech fastens an electronic otoscope to Ben's ear. An image of his eardrum pops up on the screen. "Looks fine," the doctor says. "Let's check the other ear."
After he determines that neither ear is infected, Berardi places a digital stethoscope on Ben's chest so the doctor can listen to his heart and lungs. The doctor asks Ben to open his mouth so he can see his throat and tonsils. "Purplish-red throat," he says. "It's definitely strep. I'll phone in a prescription." Berardi thanks him and then calls Ben's mom, who will leave work and take her son home.
Thanks to the use of telemedicine, technology that brings the doctor's office to child-care centers and schools, this was another typical day in the nurse's office at Abraham Lincoln School No. 22. "We can often get a child seen by a doctor and treated within an hour," says Berardi. Telemedicine has evolved from chiefly being a way to bring medical care to rural areas with a shortage of primary-care doctors and specialists. Now it's an increasingly popular way to offer care in urban and suburban areas too.
Berardi's school is part of a telemedicine program designed by the University of Rochester Medical Center. Sometimes a provider from the child's own primary-care practice is available to see the child; either way, a report goes out to the child's own pediatrician after the visit. This program, called Health-e-Access, began in 2001 in three child-care centers and is now in all 37 of Rochester's city elementary schools, says director Kenneth McConnochie, M.D., M.P.H., professor of pediatrics. Since the program started, there have been more than 13,000 telemedicine visits and there are at least 24 similar programs across the country, including The Georgia Partnership for TeleHealth and the Arizona Telemedicine Program at the University of Arizona in Tucson.
One big advantage of telemedicine is that kids can be seen right away at school, rather than at an after-hours pediatric clinic or a local E.R. "In one analysis of pediatric emergency-department visits, we found that 40 percent were for nonemergencies such as rashes and other problems that can be diagnosed with telemedicine," says Dr. McConnochie. When telemedicine was offered in child-care facilities and in elementary schools, E.R. visits for these kids dropped by 22 percent.
VaLeesa Rush, of Kansas City, Kansas, used her school's service when her then 6-year-old daughter, MacKayla, developed an ear infection. Within an hour of hearing from the nurse, she was videoconferencing with the doctor at school. "MacKayla gets stressed in doctor's offices," says Rush. "Since she knew the school nurse, she was much more relaxed. It was also a relief not to have to sit in a doctor's office worrying about germs." Windy Garrett, R.N., the nurse at MacKayla's school, says having the trusted figure of a school nurse in the comfort of a familiar setting nearby may also ease parent anxiety. "I can tell by the look on a parent's face when she doesn't understand something," she says. "I'll ask the physician to repeat it, or I'll say to the parent, 'That sounds confusing. Does that make sense to you?' so she can speak up."
Increasingly, schools are also using telemedicine as a way to diagnose and treat mental-health issues like ADHD and autism, says Ryan Spaulding, Ph.D., director of the Center for Telemedicine & Telehealth at the University of Kansas Medical Center, in Kansas City, home of the country's longest-running school program. This is largely because there's a shortage of child psychiatrists, psychologists, and autism-spectrum experts in the United States. "It can be hard for parents to find an expert close enough to them. Often they have to take a day off for psychological testing," explains Dr. Spaulding.