The Role of School Nursing in Telehealth
It is the position of the National Association of School Nurses (NASN) that utilization of telehealth technology may be a valuable tool to assist registered professional school nurses (herein referred to as a school nurse) to provide school health services. The health of many students is impacted by lack of access to primary care and specialty services due to health disparities caused by poverty and other social determinants of health. Technology and telehealth can assist the school nurse in addressing these issues. The school nurse is on the frontlines of school health services and has the expertise to provide the critical link and oversight to successfully implement and utilize telehealth/telemedicine technology in the school setting.
The terms telehealth and telemedicine are often used interchangeably although telehealth is considered a broader term that includes not just clinical services but education and training (Institute of Medicine [IOM], 2012). The U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) (2015) defines telehealth as:
The use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
The use of telehealth often focuses on populations who have barriers to access health care such as those in rural communities, those living in poverty, or those who are homebound (IOM, 2012). Telehealth provides a potential strategy to remove barriers by:
- Providing extended health and mental health care,
- Providing timely access to meet urgent and emergent healthcare needs,
- Promoting collaboration between regional health centers and healthcare providers in remote areas,
- Decreasing absenteeism and time out of class, and
- Decreasing lost work time for parents/caregivers (Children’s Health Fund, 2016; Ollove, 2017; Reynolds & Maughan, 2015).
Telehealth in schools has mainly focused on primary care services. The Centers for Disease Control and Prevention (CDC) and ASCD recommend a broader, coordinated, collaborative approach to student health. School nurses are well positioned to integrate telehealth into the Whole School, Whole Community, Whole Child model of care (ASCD & CDC, 2014). According to the American Academy of Pediatrics (2015), telehealth should be utilized as part of a coordinated system to decrease fragmentation and piecemeal approaches to care.
Challenges exist related to telehealth technology such as sustainability, cost to implement and maintain equipment, privacy, liability, and provider reimbursement (IOM, 2012). When creating budgets for implementing and sustaining a telehealth program, developers and providers should include funding for schools and school nurses. New funding reimbursement models which include team approaches to reimbursements that include school nurse services should be considered. In states which do not currently have provision for Medicaid reimbursement for telehealth services, school nurses and stakeholders should advocate for establishing this provision.
School nurses collaborate with other school health services team members to address the health needs of the entire school population (NASN, 2016). Telehealth can be used for health education and health promotion. As a primary care partner, telehealth can assist the school nurse in decreasing communicable disease outbreaks through availability of providers to quickly diagnose and treat illness (Ollove, 2017) and improve student attendance by assisting school nurses in the management of chronic conditions (Reynolds & Maughan, 2015). The use of telehealth to address physical or mental/emotional health can improve student attendance and may enhance parents’ and caregivers’ work productivity (Ollove, 2017). Researchers have found that collaboration between healthcare providers/specialists and school nurses and others via telehealth was efficient, decreased miscommunications between parties, improved student health, and increased parent resources and connections (Mackert & Whitten, 2007; Young & Ireson, 2003; Reynolds & Maughan, 2015).
School nurses are responsible for student health and health issues arising in school and understand the priorities of both health and education in the school setting (NASN, 2016). Advances in technology and the availability of telehealth services can assist school nurses to improve both healthcare access and health in student populations, particularly those who are underserved. School nurses should be involved with other health and education leaders in the development of telehealth policies, standards, and guidelines related to:
- Enrolling students in telehealth programs,
- Ensuring proper consent and parent/caregiver involvement,
- Triaging and coordinating students who would benefit from a consultation via telehealth (including decision tree protocols),
- Sharing of confidential information that meets both HIPAA and FERPA requirements,
- Monitoring appropriate outcomes and evaluation,
- Following up telehealth visit/consultation, and
- Coordinating school nursing services with other healthcare services.
Telehealth may also facilitate communication and consultation between school nursing colleagues regarding complex cases (Mackert & Whitten, 2007). Telehealth in the school can be used as a conduit for individual and population-based education for students, families, and staff as part of a larger coordinated school health services effort (Reynolds & Maughan, 2015). Telehealth has the potential for future use in areas such as remote connections for school nurses to help students access dental and eye exams, voice disorder treatments, nutritional and obesity counseling and behavioral/mental health counseling and assessment (Kelchner et al., 2014). The use of telehealth services is expected to grow from 250,000 persons in 2013 to 3.2 million persons in 2018 (National Conference of State Legislators Partnership Project on Telehealth, 2015). Technology continues to advance and school nurses must stay current and embrace innovative technologies as they explore new ways to keep students healthy, safe, and ready to learn.
Students will continue to have complex social, emotional, and physical health needs which must be addressed to ensure their success in school. Functioning as the bridge between health and education, school nurses address a wide range of student needs and are uniquely qualified to focus on the needs of students at greatest risk of health disparities. School nurses are the vanguard of individual and population-based student health care and have the expertise to utilize telehealth technology. While neither telehealth nor any other technology replaces the registered professional school nurse, the availability of telehealth provides a valuable tool to assist the school nurse in providing a more complete, coordinated approach to student health services in school.
American Academy of Pediatrics, Committee on Pediatric Workforce. (2015). The use of telemedicine to address access and physician workforce shortages [positon statement]. Pediatrics, 136(7), 202-209. doi: 10.1542/peds.2015-1253
ASCD & Centers for Disease Control and Prevention. (2014). Whole school whole community whole child: A collaborative approach to learning and health. Retrieved from http://www.ascd.org/ASCD/pdf/siteASCD/publications/wholechild/wscc-a-collaborative-approach.pd
Children’s Health Fund. (2016). 15 million kids in health care deserts: Can telehealth make a difference? Retrieved from https://ms01.childrenshealthfund.org/wp/wp-content/uploads/2016/04/White-Paper-4.4.2016.pdf
Institute of Medicine. (2012). The role of telehealth in an evolving healthcare environment: Workshop summary. Retrieved from https://www.nap.edu/catalog/13466/the-role-of-telehealth-in-an-evolving-health-care-environment
Kelchner, L.N., Deliyski, D., de Alarcon, A., Zacharias, S., Beckmeyer, J., Tabangin, M., & Doarn, C. (2014). Access to pediatric voice care: A telehealth solution? Final report. Retrieved from https://healthit.ahrq.gov/sites/default/files/docs/citation/r21hs021781-kelchner-final-report-2014.pdf
Mackert, M., & Whitten, P. (2007). Successful adoption of a school-based telemedicine system. Journal of School Health, 77(6), 327-330. doi: 10.1111/j.1746-1561.2007.00214.x
National Association of School Nurses. (2016). Framework for 21st century school nursing practice: National Association of School Nurses. NASN School Nurse, 31(1), 45-53. doi: 10.1177/1942602X15618644
National Conference of State Legislators, Partnership Project on Telehealth. (2015). Telehealth policy trends and considerations. Retrieved from http://www.ncsl.org/documents/health/telehealth2015.pdf
Ollove, M. (2017). Telemedicine in schools helps keep kids in the classroom. The PEW charitable trusts. Retrieved from http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/01/04/telemedicine-in-schools-helps-keep-kids-in-the-classroom
Reynolds, C. A., & Maughan, E. (2015). Telehealth in the school setting: An integrative review. The Journal of School Nursing, 31(1), 44-53. doi: 10.1177/105984051454053
U.S. Department of Health and Human Services, Health Resources Services Administration. (2015). Telehealth programs. Retrieved from https://www.hrsa.gov/ruralhealth/telehealth/
Young, T. L., & Ireson, C. (2003). Effectiveness of school-based telehealth care in urban and rural elementary schools. Pediatrics, 112(5), 1088-1094.
Acknowledgement of Authors:
Kathey M. Haynie, MSN, RN Elaine Mauter, BSN, RN
Brenda Lindahl, RN
Keisha Simons-Major, MSN, RN
Lynne Meadows, MSN, RN
Erin D. Maughan, PhD, MS, RN, APHN-BC, FNASN, FAAN
Adopted: June 2017
This position statement replaces the position statement titled The Use of Telehealth in Schools.
Suggested citation: National Association of School Nurses. (2017). The role of school nursing in telehealth (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.