More on Telehealth

School-based telehealth program reduces ED visits by pediatric asthma patients

There's a potentially large impact school-based telehealth programs can have on children with chronic illnesses.

Jeff Lagasse, Associate Editor

Reducing emergency department visits is one way to lower the overall cost of care, and telehealth can help in this regard -- even for children, based on the results of a new school-based program.

Researchers at the Medical University of South Carolina report in JAMA Pediatrics an association between a school-based telehealth program and reduced emergency department visits for children with asthma living in a rural and underserved region of South Carolina.

This shows the potential impact that school-based telehealth programs can have on children with chronic illnesses, especially those living in communities lacking access to healthcare -- though the role of the school nurse is an important part of the process.

The MUSC team, led by pediatrician Dr. Kathryn King Cristaldi, analyzed Medicaid claims for children ages 3-17 in Williamsburg County with access to a school-based telehealth program. They then compared them to those for children in four surrounding counties without school-based telehealth. Cristaldi co-directs the Telehealth Center of Excellence at MUSC, one of only two such centers in the nation.

Children with access to school-based telehealth were 21% less likely to visit the ED for their asthma than those without such access, the report found. However, the three-year study found no association between school-based telehealth and all-cause ED visits.


Asthma is one of the most common and costly diseases in childhood. The authors attribute the success of the program to engaging the school nurse to ensure children are getting their medications daily, as well as increasing the overall awareness of asthma management.

Williamsburg County is a rural and medically underserved area of South Carolina situated along the I-95 "corridor of shame," so dubbed for its high rates of poverty. MUSC developed this program to address disparities in access to care, linking children to pediatric experts via telemedicine -- but it was the school nurses who ultimately helped to ensure the program's success by actively engaging the community.

School nurses go out of their way to help students on a daily basis, the authors said. So it was no surprise that they would be the ones to use the telehealth cart to connect sick children with expert providers at remote locations, helping to examine the children with special electronic stethoscopes and other peripherals.

This special equipment enabled providers at remote locations to assess the children's conditions, almost as though they were in the room. It was also the school nurses who helped to obtain feedback from parents, kept them informed and made sure they had the resources they needed.

Next, the team will analyze the program's ability to help to implement asthma best practices, as well as continue to explore the cost-effectiveness of school-based telehealth.


Telehealth usage is on the rise. From 2016 to 2017, private insurance claim lines for services rendered via telehealth -- as a percentage of all medical claim lines -- grew 53% nationally, more than any other venue of care, according to a white paper published in April by FH Health Indicators.

By comparison, national usage of urgent care centers increased 14%, that of retail clinics 7% and of ASCs 6%. The usage of ERs decreased 2%.

Focus on Patient Experience

This month, our coverage will continue a special focus on the patient experience. We'll talk to the thought leaders and first-movers reimagining the how and where of patient-friendly tech, and report on ways to activate, if not delight, the people they treat.