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Seeing the doctor – on a video screen – at the school nurse's office

Sue Andelora feels like she has seen it all in her 20 years as a nurse at Frontier Central Middle School, from asthma attacks and broken arms, to headaches, stomach aches and earaches.

And she's good at knowing what to do, but as a registered nurse, she can't make a diagnosis or initiate treatment.

That is about to change. She'll be able to help a doctor or nurse practitioner evaluate a student in her office remotely through telemedicine, and they can prescribe treatment.

She'll use her otoscope to look in the student's ears, and stethoscope to check the lungs and heart, like she usually does. But the medical professional on the other end will be seeing what she sees, and hearing what she hears, then talking to her and the student.

"As I’m looking in the ear, it’s going up on the screen and going right up to that provider so they're seeing it actually at the same time," Andelora said. "Being able to have the provider be able to listen at the same time, that will be a huge help."

The telemedicine is a pilot program at Frontier Middle School with Mobile Healthcare Partners of Buffalo. Once parents give permission for the program, students who go to the nurse's office could be seen by a doctor, nurse practitioner or physician's assistant who could send a prescription to the pharmacy.

The idea is to help students get treatment as fast as possible, to cut down on sick days and to get students back to school as soon as possible. Parents can sit in on the evaluation or follow it on their cell phone from work. They don't have to take time off to take the child to the pediatrician or urgent or emergency care.

"We find that’s a problem for a lot of parents – being able to leave work, or take time at night trying to take them to an urgent care because they can’t get to their primary provider during the day," Andelora said.

There also are students who don't have primary care providers, and this is another way to access health care for them, she said.

"Not every visit warrants a medical evaluation, but for those who do, it will be so nice to get the process started right away," Andelora said.

The program is not taking the place of the primary physician, said family physician Dr. James S. Collins, chief medical officer of Mobile Healthcare Partners.

"We’re not ever trying to interfere with the ongoing continuity of care that people have," Collins said.

Frontier Middle school has about 1,200 students. Every day, 90 to 100 of them make their way to the nurse's office, which is staffed with two nurses, Andelora said. Eleven children with diabetes are seen at least twice a day, she said, and daily medications are given to other students with chronic conditions.

Last year, 13.5 percent of students at the school were deemed chronically absent, which means they missed 10 percent or more of school.

It's not just academics that concerns Principal Ryan Sikorski, but the soft skills they learn by social interaction with their peers.

"When they’re home and isolated, they’re missing out on that key component that really is essential as they get into high school,"  he said.

Mobile Healthcare Partners is hiring a pediatric psychiatrist to address mental health issues with students, Collins said. He said the psychiatrist would meet face to face with parents and the child to establish a relationship, and then would treat them through the telemedicine equipment.

"The anxiety and mental health component of our students is growing significantly," Sikorski said. "For our kids, it gets compounded when they’re not in school, because they have that much more to do when they finally come back."

Since this is a pilot program, the district wants to start slowly and tackle issues and concerns as they emerge. One is insurance. Local health insurance firms generally will cover the telemed visit, but out-of-town companies have not been as open, Collins said. For that reason, all children will be covered under the pilot program this year regardless of insurance, he said.

Superintendent Richard Hughes said he believes insurance eventually will include telemed coverage "because it makes sense."

The district eventually would like to add staff members to the plan, and the company would like to have the ability for nurses to test for strep throat and the flu.

The program is expected to start Dec. 1.



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