The nurse’s offices at two elementary schools in South Georgia are on the cutting edge of innovation when it comes to delivering health care in rural areas of America.
This fall, the students, faculty and staff returning to school in the small town of Nashville in Berrien County have access to a full range of pediatric, family practice and other medical experts from around the state. These may be the most advanced school-based telemedicine clinics in the country.
Early next year, all the public schools in Berrien should be equipped with specialized computers capable of transmitting high-resolution images of everything from blocked ear canals to the earliest signs of skin cancer.
Federal health officials are watching the experience at the schools as part of a $200 million initiative in the Affordable Care Act to promote school-based medical care in underserved areas. The Berrien County telemed clinics, which went into operation a year ago, are getting about $400,000 of that money.
The school clinics are the latest telemedicine development in Georgia, which is setting the pace nationally for promoting telemedicine as a way to deliver medical care in regions where the nearest doctors are often hours away from their patients.
“Georgia is definitely a model for other states,” said Sherilyn Pruitt, director of the Office for the Advancement of Telehealth, part of the division of rural health in the U.S. Health Resources Services Administration.
The nonprofit group that has pushed the Peach State to the forefront – a position it rarely occupies on issues of health care services for the disadvantaged – is the Georgia Partnership for TeleHealth, headquartered in Waycross. The partnership is one of nine “resource centers” designated by the feds to help promote the concept around the country.
“We’ve come a long way,” said Paula Guy, executive director of the partnership, who as a public health worker remembers the earliest efforts 20 years ago to organize telemedicine services through a handful of clinics connected to the Medical College of Georgia in Augusta.
Now, through the work of the partnership, there are nearly 250 places in the state –- hospitals, nursing homes, doctor’s offices, clinics — where telemedicine care is delivered. It’s done through what she describes as a “network of networks” of more than 175 physicians.
The two clinics in the schools in Berrien typify the kinds of services now available around the state. The school-based clinics are also supported by grants from the Emory Urban Health program and the Governor’s Office for Children and Families.
Each clinic is equipped with a $30,000 computer and specialized scopes that send images of the inner ear, eyes, skin and other body parts –- as well as heart sounds, blood pressure readings and other monitors –- to doctors as near as the next county or as far away as Atlanta or Macon.
A nurses usually conducts the physical exam and stays with the patient while the physician oversees the encounter, seeing and talking with the patient and monitoring the readings on a laptop.
Sometimes better than a conventional visit
For diagnosing common ailments — ear and sinus infections, bronchitis, skin abrasions and basal cell cancers — telemedicine sometimes proves better than hands-on treatment, because the cameras used to illuminate problem areas and transmit them to the physician often provide clearer pictures than can be seen through the scope alone, nurses and physicians say.
The real booster shot for telemedicine in Georgia came in 2005, when the state insurance commissioner at the time, John Oxendine, negotiated an agreement with WellPoint, Inc. for a $126.5 million donation for rural health programs as a condition for approving the merger of insurance giants Anthem and WellPoint in the state. (WellPoint is the parent company of Blue Cross and Blue Shield of Georgia.)
Most of that money was earmarked for rural hospital improvements, but $11.5 million was set aside to establish the current telemedicine network. That paved the way for the state’s other medical schools and academic health centers to start participating, according to Jimmy Lewis, chief executive officer of HomeTown Health, a coalition of about 50 rural hospitals and medical centers around the state.
“What happened is that it was built outside the government and it was built right,” said Lewis, who is also on the board of the telemedicine partnership. “That freed us from making political decisions about how to proceed and it expanded interest in participation. It exploded after that.”
Around the same time, the Georgia General Assembly passed legislation requiring insurance companies writing health insurance plans in the state to cover telemedicine visits the same way they would pay for ordinary visits to a doctor’s office.
The insurance mandate made physicians in the state – particularly specialists – take notice. Since then, more and more of them have joined telemedicine networks, 50 in the last six months alone, according to Guy.
One inducement to join the program is that the telemed partnership often makes all the arrangements for appointments for both doctor and patient. The physician can block out a period of time to be available, and the partnership staff will schedule the appointments and make sure each patient’s medical history and other paperwork are in order before the patient is linked to the telemed clinic.
New federal rules make it easier to credential and grant privileges to doctors who are telemedicine providers and are miles away from patients, said Sidney Welch, a health care attorney at Atlanta law firm Arnall Golden Gregory.
Telemedicine has also moved the state in other directions, especially in the area of children’s services.
Dr. Jordan Greenbaum, a forensic pathologist and medical director of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, uses telemedicine to improve investigation and treatment of victims of childhood abuse and neglect. She and colleagues had “real time” consults via telemedicine in 100 cases of suspected child abuse last year.
By the end of 2011, Dr. Greenbaum hopes there will be a network of 21 child advocacy centers, walk-in clinics and physician offices capable of using telemedicine to conduct forensic physical exams and psychological counseling for children in need of help. (There are five such centers running now.)
“The ability to provide real-time assistance with medical exams of these kids is essential,” she said. “Telemedicine allows that. I can interact with the child and the examiner as if they were sitting in my office with me.”
Because of the shortage of medical providers trained in child abuse evaluations in the state, many victims many not get the appropriate services they need, she said. “Telemedicine helps us deal with the shortage. It isn’t the whole answer, but it is a major step forward.”
New weapon against learning disabilities
Similarly, telemedicine has come to the forefront in the treatment of common behavioral and mental health issues for children in underserved areas of Georgia, said Sherrie Williams, a licensed clinical social worker who directs the Berrien County school clinics. Perhaps the greatest advancement is using it to diagnose and treat autism and autism-related disorders, thanks to a partnership with the Marcus Autism Center in Atlanta, Williams said.
When a student is falling behind in school because of attention deficit disorder or some other common problem, it’s no longer necessary to send the child to a psychiatrist 50 miles away, Instead the student, accompanied by his or her parents, can go to the school clinic, take the necessary battery of tests, and consult via computer with a specialist. “The fact that we can do that all right here makes a big difference for the kids and their parents,” Williams said.
Lewis, of HomeTown Health, said that even though the state has accelerated telemedicine availability in recent years, it still is just scratching the surface. He envisions telemedicine links in state prisons and county jails, nursing homes and a lot more schools around the state in the next five years.
Williams points out that in the Berrien school district there are more than 250 students who report having problems with childhood asthma. Not only can they get a full range of services at the clinic, but the computer there has programs available to help them learn how to use inhalers, limit their exposure to things that trigger attacks, and otherwise control the risks involved with the disease.
“It’s amazing what this technology has the potential to do,” she said. “We see new adaptations all the time.”