I first got a glimpse of technology’s potential back in 2010. As a pediatrician at Miami Children’s Health System, I flew to Haiti in the aftermath of the devastating 2010 earthquake to help treat children. Many suffered trauma, but I found myself caring for little ones with chronic conditions, as well. Along with my stethoscope, my computer and smartphone quickly became essential tools in my medical bag, as I sent emails and images to colleagues in Miami for consultations.
Back home, I became acutely aware of how we lagged behind in using technology in pediatric settings. I’m a doctor to the iGeneration. I have patients as young as two who seem instinctively adept at manipulating an iPad, yet their school remains largely stuck in a sepia-tone world.
There’s no excuse. The 2009 HITECH Act brought electronic health records to hospitals and doctors’ practices and the 2010 Affordable Care Act jumpstarted innovation across the healthcare spectrum. Funding in digital health startups continues at a record-breaking pace, with venture capitalists investing $8.1 billion last year, according to Rock Health. The money targeted healthcare providers, pharmaceutical companies and consumers. By comparison, only a tiny fraction — just under $60 million — went to pediatric-related technology in 2018. Young companies and their backers have largely overlooked what I consider the front line of health: our public schools.
Yet legislation on that front should help, as well. Poor health is one of the leading causes of school absenteeism, and the latter is linked to low academic performance. To hold schools accountable, most states have selected absenteeism as a measure of performance under the Every Student Succeeds Act of 2015. That can translate into millions of dollars in reduced state funding for school districts, which should motivate officials to address the reason one in six students misses class repeatedly.
Our children spend an average of 14 percent of their time in school from kindergarten through 12th grade. Any public school parent knows the drill: fill out the same paper forms at the beginning of each year authorizing the school nurse to administer medications with the approval of the child’s pediatrician. Vaccinations, of course, need to be up to date. The nurse, who typically oversees multiple schools, gets overwhelmed trying to screen children who suffer from serious chronic illnesses, such as asthma, diabetes and seizures, from a pool of hundreds of students.
Technology is advancing in everyday life, but schools are being left behind because health programs still rank at the bottom of budget priorities.
Inevitably, some fall through the cracks. More than six million children under the age of 18 suffer from asthma; it is the third leading cause of hospitalization among children under 15 and a major reason for school absenteeism. I’ve had children with asthma under my care where the school nurse is unaware of their condition. Those who suffer acute attacks are on oral steroids and need their medications more frequently — a situation schools often don’t properly monitor. As a result, some students end up in the intensive care unit requiring more aggressive therapy. It’s very frustrating for pediatricians, and devastating for families.
That is a prime example of why we need technology in schools. Lack of data-sharing among schools, pediatricians and families is especially exacerbated, because charts are often paper-based or locked in the school’s system. An electronic medical record can facilitate quicker access to information for monitoring and care coordination. It could prevent potential tragedies, absenteeism and unnecessary costs.
Telehealth can also play a role. Students, especially from low-income households, often don’t have a pediatrician, and so the school becomes by default their clinic. In my former role as medical director of telehealth Florida at Nemours Children’s Health System, we were encouraged by the results of an analysis we did on 1,000 telehealth visits. Sixty-seven percent of parents said they would have taken their child to an emergency room, urgent care center or retail clinic if they didn’t have access to remote consultation. This was outside of the school setting, but the study points to an opportunity for deployment in schools.
Technology is advancing in everyday life, but schools are being left behind because health programs still rank at the bottom of budget priorities. The American Academy of Pediatrics has for years advocated for a full-time nurse on campus, but that’s not always the reality. As the father of a four-year-old boy who’s prone to seizures, I worry.
Schools need to realize they’re not only in the business of education, they’re also in the healthcare business. The two go hand in hand.