ELKRIDGE, Md. — In late November, on the first cold morning of the season, a second-grader at Ducketts Lane Elementary School had trouble breathing during recess.

When the school nurse, Veronica DeSimone, examined the girl, she heard wheezing in her chest and noted her low oxygen levels. DeSimone determined that the child was having an asthma attack.

The nurse would have administered medication, but the girl’s parents hadn’t yet signed a permission form or delivered their daughter’s medicine to the school. The girl’s father, the only parent available, was at work at least an hour away. There was not time to wait for him to come get his daughter.

Not long ago, DeSimone would have had to call an ambulance to take the child to the hospital.

Audio link

Instead, DeSimone set up an online video and audio link to an emergency room pediatrician at Howard County General Hospital. With earlier permission from the girl’s parents to participate in the school’s telemedicine program, DeSimone examined her with a digital stethoscope, which allowed the pediatrician to listen to the girl’s lungs remotely.

The doctor confirmed DeSimone’s diagnosis and directed her to administer the necessary medicine. Within 10 minutes, the child was back in class.

Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools. According to the American Telemedicine Association, at least 18 states authorize Medicaid reimbursement for telemedicine services provided in schools and 28 states plus Washington, D.C., require private insurers to cover telemedicine appointments as they would face-to-face doctor visits.

Can’t replace

Telemedicine can’t always replace an in-person examination — a doctor often has to touch a patient, for example, to diagnose the cause of abdominal pain — but it does make it less likely that a child will have to miss class for a visit to the doctor’s office.

“The piece for me that is so exciting is how many more kids are able to stay in school,” said Heidi Balter, principal of Ducketts Lane, which was outfitted with telemedicine equipment a year ago.

Lawmakers and educators around the country echo that enthusiasm. “School telehealth will be a game changer in terms of children’s health, keeping them in school and improving educational outcomes,” said Democratic state Rep. Kip Kendrick, who helped pass a new Missouri law that allows Medicaid payments for telemedicine in the schools.

Many states still limit Medicaid reimbursement for telemedicine, and, according to the American Telemedicine Association, 24 states specify settings, such as a doctor’s office, where a patient must be in order to participate in a telemedicine appointment.

In Texas, the state Medical Board is involved in a legal dispute over its insistence that “a doctor-patient relationship” be established before telemedicine can be used. The dispute, however, doesn’t apply to school telemedicine as long as a school nurse is present.

But as state policymakers become more accustomed to telemedicine and familiar with its benefits, “we’re seeing many of the restrictions falling to the wayside,” said Latoya Thomas, the director of state policy for the American Telemedicine Association.

Health disparities

The impetus for school telemedicine in Howard County, where Ducketts Lane is located, came from former County Executive Ken Ulman. Ulman believed that health disparities in lower-income areas of the county were depressing student achievement, and that telemedicine might help.

In 2015, the county chose Ducketts Lane and five other elementary schools to be the first to offer telemedicine services. All of the schools drew students from economically disadvantaged areas and all had full-time nurses.

The county found a willing partner in Howard County General, which was looking for ways to expand access to its services. The hospital agreed to pick up the costs of making its emergency room pediatricians available for telemedicine calls.

The county picked up the tab for the $27,000 in telemedicine technology that each school required. The equipment included a video monitor, a camera, and digital stethoscopes and Otoscopes, to check ears, noses and throats and transmit the images.