By: Francis P. Koster, Ed.D.

About one in nine America school children have asthma. A decade ago, that number used to be one in 10. In 2008 children with Asthma missed 4 days of school due to the disease, for a total of around 13 million school days. i One in 400 school aged children have been diagnosed as having diabetes - and 6 times more have been statistically proven to either be undiagnosed or pre-diabetic. ii These numbers are higher in poorer school districts.

We already know that these conditions are fertilized by environmental toxins and poor diet, but much work still remains to be done to fully identify the enemy to children's health and longevity. The cost in both dollar terms and human suffering is rising annually. We also know that much of the cost could be avoided if we changed the way we manage patients with the disease.

Imagine yourself a school principle with 1000 kids - and a school nurse who visits one day a week. Any of the diabetic or asthmatic kids could go into life threatening status at any time, and your school based "first responder" school nurse is 15 miles away at a neighboring school today. So you call an ambulance.

Several school systems have taken major steps to get their arms around this issue by installing internet based school nurse telehealth systems. These systems allow a specially trained school nurse or nurse from a nearby hospital or doctors office to view the child remotely, watch as the various meters and test equipment as they are used on a daily or frequent basis, and if necessary adjust medications, or alert the parents or the doctor (or the ambulance).

The child often has some to help monitor their condition. in the case of Diabetes, a blood sugar monitor about as big as a deck of cards analysis the child's blood instantly, and reports on the need of more or less medicine. Asthmatics blow into a tube with a ball in it that tells them how well or badly their lungs are working. but, in many schools, there is no one to monitor their status, and trend it to know if trouble is looming. but, a trained healthcare worker using Skype or similar programs can do it remotely.

When a child with one of these conditions starts to go downhill, the folks on the scene know that among the many outcomes possible is death. As a consquence, such children are often sent directly to Emergency Rooms, where the examination and treatment are very expensive. Take a rising number of school kids with this kind of disease, and you can see why the annual spending in Emergency rooms is rising.

In Rochester, New York, a study involving 22 schools and daycares showed that 22% reduction in ER visits when Telemedicine was in place. they also found that most of those visits were replaced by visits to the doctor's office which cost only 1/7 as much as the Emergency Room.iii

In Rural Arkansas, three schools were connected to health care workers over 100 miles away to help the children with Asthma. The had fewer ER visits, decreased school absences, and lots less missed work days by parents. Another impact was that both children and their parents came to understand the disease better, and were able to manage it better after they child left the program iv

And the well respected Journal of Pediatrics reported in 2009 that a controlled research study for children ages 5-14 with Diabetes who participated in a telemedicine project along side children with the same disease but did not participate in the telemedicine found that the telemedicine participants had less disease over time, but the non-participants had more. Further, "there were fewer hospitalizations and emergency department visits."v

The interesting thing about this new opportunity is that it is far cheaper than the old way of managing chronic disease in school kids. As our country copes with rising health care costs, and rising rates of Asthma and Diabetes, any school system with access to broadband who can negotiate an arrangement with a neighboring doctors office, public health department, or hospital will improve the health of the children, help the teachers focus on teaching, help parents remain at work, and lower cost.

As a nation we do not lack the tools to tackle our problems - we just need to imitate the success others have had - it will make a better future for us all. 

i American Academy of Allergy, Asthma and Immunology, http://www.aaaai.org search "asthma statistics".

iii Telemedicine in Schools found to reduce unnecessary ED use by Children http://www.homehealthnews.org/2010/01

iv www.Childrenspartnership.org search "school based telehealth" see page 6-7 in the PDF

v Journal of Pediatrics Volume 155 Issue 3, Pages 374-379 September 2009