School-based telehealth saves money – and anxiety

September 19, 2019
Nurse with mouth open showing student patient what she wants her to do
Stephanie Merrell, an MUSC Health school-based telehealth nurse, gives a checkup to Mitchell Elementary School student Shai'mae Watson as MUSC Health pediatrician Dr. William S Randazzo looks on. Photos by Sarah Pack.

Stephanie Merrell’s voice catches as she thinks about the 8-year-old girl.

The third-grader had a history of knee pain. In fact, she’d already had two surgeries on it in the past year. So when she walked into the school nurse’s office with her father that morning, the crutches made sense. 

Her dad told Merrell his daughter had a flare-up over the weekend, so they took her to a free-standing urgent care facility. Their diagnosis: bursitis. Alarms bells went off immediately in Merrell’s mind.

As a member of the MUSC Health’s school-based telehealth team, the licensed practical nurse has seen her share of kids’ ailments, but she had to admit, this was a new one to her.

“You don’t usually see many 8-year-olds with bursitis,” Merrell said. 

Just to be safe, Merrell took the child’s temperature, which was elevated. A routine exam by a school-based health provider on a particularly angry, swollen part of her knee was enough for them to know this diagnosis was off. So they made a call and sent the girl and her father to the MUSC Children’s Hospital Emergency Department. Once there, a few basic tests confirmed the team's instincts: It wasn’t bursitis. It was way worse. It was sepsis. 

“The doctors said if she had gone, maybe, another day without getting seen, she could have died,” Merrell said.

Telehealth in Schools Program


Number of schools Telehealth in Schools program has a presence


Parents happy with program and think it helps overcome barriers to care


Reduction of child asthma-related ED visits in Williamsburg County


Percentage of sick visits that could be done thru telehealth vs in-office

Merrell has been a nurse for nearly 20 years – half of that time has been spent working in schools. In 2017, she joined MUSC Health’s telehealth team, rotating between elementary and middle schools around the Lowcountry. She is convinced if it weren’t for MUSC Health’s presence, many kids wouldn’t get the basic care they need. School-based health links children to care as parents identify the school as a safe place to go for pediatric care.

This year, MUSC Health’s School-Based telehealth program, now in its fifth year, has a presence in more than 100 schools across the state, providing many children with the only consistent health care they will receive. Kathryn King Cristaldi, M.D., medical director of the program, gets emotional when talking about its success.

“One student who was having a really tough time in school was referred to me through the program. He was having behavioral issues and really needed help. But for his family, access to care was an issue and he was at risk for school failure. We were able to initiate an evaluation, make a diagnosis of ADHD and get him the treatment he needed,” she said. “Just the other day, he insisted his school nurse call me, so he could tell me he made the honor roll.”

“School nurses are the front line of public health.  


They know all of their students. So for us to be able to plug into that is huge.”


Kathryn King Cristaldi, M.D.

School-based telehealth provides access to high-quality health care in a school setting. With the aid of a state-of-the-art medical cart equipped with a high-resolution camera, a video screen and all the basics necessary to perform a telemedicine exam, an MUSC Health nurse practitioner or physician is able to examine the student remotely – or sometimes on-site, depending on the day or school – with the assistance of the school nurse. If a prescription medication is needed, it will be sent to a local pharmacy, and a note will be sent to the student’s primary care provider.

Two photos stacked vertically, the top shows a nurse using a stethoscope on a student patient and the bottom shows the nurse and student patient speaking with a doctor via a Telehealth cart 
Merrell uses a stethoscope to listen to Watson's heartbeat. In real time, Dr. Randazzo is able to hear the same things as Merrell, see all Watson's vitals and then they all have a discussion -- in much the same way a patient would in a doctor's office.

The program treats common childhood illnesses such as sore throats and rashes and chronic diseases such as asthma. If the student’s condition is not able to be diagnosed via telemedicine, the provider will work with the family to connect them to a provider who can see the student in person.

This year, program manager Elana Wells said they’ve now implemented electronic consent to make it even easier for kids to enroll in the program. Instead of sending a child home with a form, they can text parents a link – while their child is still sitting in the school nurse’s office – and get consent on the spot. 

“You never know if that consent form will even make it out of the book bag to the parent,” Wells said. “This is something we’re really excited about.”

A recent study showed that the best place to address access barriers for children’s health care is through the school system. In fact, school-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved students in more than 2,500 schools across the United States. SBHCs have also been shown to decrease emergency department use; reduce absences; and improve academic outcomes, chronic disease control access to mental health services, and the utilization of adolescent health services.

“School nurses are the front line of public health,” Cristaldi said. “They know all of their students. So for us to be able to plug into that is huge.”

Lorraine Smart, another of MUSC Health’s school-based LPNs, serves several schools in Sumter and Williamsburg counties. She realizes how important that trust is.

“These kids see us every day. They know our faces and know we care about them. There’s a comfort level there. So when we need to use a cart to connect them with a primary care provider, that anxiety they might have otherwise had is almost completely gone,” she said.