Need: Rural school children lack proper healthcare resources within the school setting.
Intervention: Health-e-Schools provides health services to students via telehealth using video conferencing and special equipment.
Results: Health-e-Schools increases access to primary healthcare, increases attendance in the classroom, and decreases the amount of time that parents or guardians must take off of work to bring their child to health-related appointments.
Health-e-Schools was created by the Center for Rural Health
Innovation (CRHI) to enhance the way healthcare is
delivered to students in rural schools in western North
Carolina. Healthcare professional shortages pose many
challenges for parents and their children. Often, parents
are forced to miss multiple hours of work to drive their
child to a healthcare facility for a basic examination or
consultation when answers could have been given much more
efficiently by staying in the school setting. Students
also miss more school as a result of the long commute and
time taken to receive health services. Many rural
children do not receive adequate care due to time or
Health-e-Schools was created in 2011 to address these
efficiency, financial, and transportation concerns. A
2005 University of Rochester study
on inner-city childcare centers found a 63% decrease in
illness-related absences through the use of telehealth.
This concept of using telehealth to treat students was
extended to the rural school setting through
This program has been successful because of the community
support it has received since its conception. The Center
for Rural Health Innovation is non-profit with a
community-based board of directors. Additionally, each
county's Health-e-Schools program has a coordinator in
the local area who both promotes the program and keeps it
on track to meet the needs and preferences of the
Funds from the The Duke Endowment
Health has supported the expansion of
Health-e-Schools to additional sites. Local grants have
allowed for even further expansion in Burke County, with
portable equipment that takes school nurses with in
between schools as they travel.
Schools participating in Health-e-Schools offer services
to all students, regardless of insurance plan or ability
to pay. The sliding fee scale is used for those who are
uninsured, but no patient is turned away due to type or
lack of insurance. Parental or guardian written
permission must be given to use these services. School
faculty and staff are also eligible to utilize these
On-site school nurses are able to connect sick students
with healthcare providers through this program.
Health-e-Schools employs a full-time, off-site family
nurse practitioner who uses telehealth as a means to
evaluate and diagnose patients.
Technology operated in this telehealth program includes
high-definition cameras and specially-equipped
stethoscopes and otoscopes. The following health issues
are commonly addressed or diagnosed by various healthcare
providers via teleconferencing:
Earaches, sore throats, colds
Upper respiratory complaints, allergies
Chronic disease management
Adolescent medicine consultations
What began as a telehealth program that only 3 schools
implemented in 2011 has grown to be a part of more than
80 schools serving more than 25,000 students.
The Duke Endowment grant allowed for twice as many
students to be reached by Health-e-Schools in 2014,
totaling 22 rural schools. In 2016, telehealth equipment
became smaller, portable and more affordable,
contributing to the Health-e-Schools rapid expansion.
One of the most notable successes is that
Health-e-Schools has helped to increase classroom
attendance and decrease the amount of time that parents
or guardians must take off of work to bring their child
The successful establishment of the Health-e-Schools
network led to CRHI being the recipient of the
President's Institute Award for Health Delivery, Quality,
and Innovation from the American Telemedicine
Association in 2014.
In 2019, Health-e-Schools collaborated to create the PATH Expansion program, designed to make telehealth available for the rest of Pender County Schools. This earned them an honorable mention for the 2019 Mid-Atlantic Telehealth Resource Center (MATRC) Breaking Barriers Through Telehealth award, in the small, rural, nonprofit organization category.
Funding can be challenging, as many of the federal grants
are specifically designated for equipment. By itself,
equipment doesn't provide care—quality people are needed
for that. Health-e-Schools staff work hard to provide
high-quality, appropriate care, but finding funding for
operations is an ongoing challenge. Fortunately, North
Carolina can bill insurance carriers for services
provided via telemedicine at the same rate as if they
were provided in-person. This varies by state and could
greatly impact another organization's sustainability
plans if they wanted to replicate this model.
This model relies heavily on the school nurses, employed
within each school district, to be the primary
tele-presenter. Across the country as well as in North
Carolina, school nurse funding has been cut sharply. The
lack of school nurse availability to be a tele-presenter
can lead to new barriers to care.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.