March 10, 2003: Lincoln Journal Star

NEBRASKA COMPANY HELPS PROVIDE NURSING SERVICES

High-resolution cameras and speedy Internet connections to a doctor's clinic in Norfolk are helping some cash-strapped schools provide nursing services.

"It is a good way to level the playing field for rural areas in getting good health care,'' Dr. Keith Vrbicky said of his American Educational Telecommunications LLC.

Through Internet broadcasts to schools, Vrbicky's company provides advice from nurses -- and doctors, if necessary -- on hard-to-diagnose cases. It also offers information on asthma, diabetes, adolescent development and other topics.

Vrbicky, an obstetrician-gynecologist, started the company in 1997 to focus on international telemedicine and distance education. He opened an office in Egypt, but business slowed after the Sept. 11 terrorist attacks.

So he turned to helping schools in his own state, providing Internet nursing services for free last year to schools in Leigh, West Point and Pleasanton. He now charges for the service and is starting a pilot program for businesses.

"It's very beneficial to schools that don't have a nurse, and our experiences with them were very good,'' said Larry Ferguson, superintendent of Leigh Community Schools.

Vrbicky hopes to help alleviate problems caused by a nationwide nursing shortage and school budget cuts.

His company may be the only one providing this kind of service to schools, although some universities and medical colleges have undertaken similar projects, said Jonathan Linkous, executive director of the American Telemedicine Association. Vrbicky declined to release his company's financial details, but said he hoped to turn a profit this year.

Westside Community Schools in Omaha signed up its 10 elementary schools this school year after Douglas County cut funding for a visiting nurses program. At Westside's Swanson Elementary School, health assistant Nancy Yount can activate a videoconference in less than a minute when she links with Vrbicky's clinic 90 miles away.

Yount's computer screen fills with a hallway and doors in Vrbicky's office, and shortly afterward a nurse enters the picture. In the right-hand corner is a smaller square, showing Yount in her own office with a student at her side.

Yount picks up a high-resolution video camera connected to the computer and trains it on the student's injury. A nurse on the other end gets a close look while talking through the computer to Yount and the student.

"It's a nice tool to have,'' said Yount, who has used it several times this school year, including to help verify that a student had shingles and choose the best course of action.

Outside Nebraska, 21 schools in southeast Kansas are getting the service, and Vrbicky's company recently signed a contract with the Universidad Autonoma de Guadalajara's School of Medicine in Guadalajara, Mexico. The university will use the network to help provide clinical care in Mexico and elsewhere.

Vrbicky's company has faced challenges. Macintosh computers that lacked the software to support American Educational's platform were widely used at Westside and the Kansas schools. The company has provided computers while it works on the problem.

The schools' costs for the program are based on the number of students served and other factors. Westside is paying $60,000 for the 2,800 students in its elementary schools.

At $25,000 to $40,000 a position, putting nurses into each of Westside's 10 elementary schools was not feasible, and Vrbicky's company was a viable alternative, said Ken Baldwin, director of building services at Westside.

American Educational also is compiling medical records for all the schools' students and sending three to five nurses to Westside schools when necessary to help with health exams. The Southeast Kansas Education Service Center, known as Greenbush, used a grant this year to have American Educational put cameras in 21 rural school buildings.

Some of the schools had been doing without a nurse, while others shared one among six buildings, said the service center's Kristy McKechnie. The service is better than a telephone consultation and it can be applied to special needs students who might require daily monitoring, medication or other consistent medical help, McKechnie said.

"The benefit is the nurse actually seeing the child,'' she said. "If there is a cut or an abrasion, the nurse can see the problem. Or if the student is having trouble breathing, the nurse can watch the chest and hear the wheezing.''

It's also more personal, McKechnie said.

"If I'm a child, I can actually see an adult who is looking at me,'' she said.

Greenbush paid $52,986 for its services this year. The contract will run through next year because some schools had technical difficulties that delayed hooking up to the system, McKechnie said.

Westside has not decided whether to renew its one-year contract with the company. Baldwin said the district's other options included hiring two nurses to serve the 10 schools or contracting with another health group.

American Educational is based in St. Louis to take advantage of that city's Internet infrastructure. The company also includes Vrbicky's Norfolk clinic -- Midwest Health Partners -- and telecommunications facilities in Omaha and Cairo, Egypt.

Expansion could include hooking up more than the four computers in Norfolk to answer calls and contracting with nurses in other states to provide services, Vrbicky said.

McKechnie believes the concept has promise.