By Mary Butler
College students found themselves in an unenviable position in March when COVID-19 put much of the country in lockdown. Many states’ stay-at-home and shelter-in-place orders came at a time when college students were about to begin spring break or actively taking part in it. The decision made by colleges and universities across the country to get students out of their dorms likely prevented the spread of infection and saved lives, even while it disrupted healthcare access in other ways.
At Northwestern University in Evanston, IL, the campus’s student health center provides vital healthcare services and insurance to undergraduate and graduate students who might otherwise be unable to afford it. When Illinois Governor J.B. Pritzker instituted the state’s stay-at-home order and Northwestern added an additional week to spring break—and then transitioned to remote learning for the remainder of the spring semester—students were caught in a variety of situations. Some had chosen to stay on campus for spring break, while others went home. International students were in a particular bind due to a patchwork of travel restrictions and bans.
The Northwestern University Health Service (NUHS) stays open even when school isn’t in session, and remained open despite the campus itself closing following the stay-at-home order. “In the winter recess period when the university is closed, our reason for staying open is because the international students might not celebrate those holidays, and more importantly, it might be cost prohibitive to go home,” explained Dr. Kim Seipel Carrow, MD, medical director at NUHS. “So a significant number of students who have stayed on campus [during the pandemic] are the international students. And we’re their only point of care and it’s free. That’s where we consider ourselves essential.”
Carrow, who has taken part in pandemic planning at NUHS for several years, said she and her colleagues, which included health information management (HIM) professionals, knew they had to take action when the university added an additional week to spring break.
To continue providing healthcare to any student who needed it—whether they were still on campus or back in their hometowns—Carrow knew telehealth was the best way to deliver care.
The two typical barriers for telehealth adoption, reimbursement and HIPAA, were not issues for NUHS. The clinic does not bill for any services, and Northwestern complies with the Family Educational Rights and Privacy Act (FERPA), which more readily permits telehealth. Carrow says that Northwestern students who have an established relationship with clinic staff were already used to frequent phone consultations and secure messaging in their patient portals with providers, so telehealth wasn’t a big leap for them.
The university helped NUHS obtain enough laptops to provide telehealth services and advised them on the security of various video platforms, while Carrow and her staff figured out the best way to use their electronic health record (EHR) to document telehealth visit notes.
Prior to the pandemic, NUHS facilitated more than 100 daily visits with its physicians, nurses, nurse practitioners, and mental health providers. At its busiest—when performing new student immunizations—NUHS can see up to 250 visits per day.
After Carrow and her colleagues decided to start offering telehealth services for the remainder of the school year, it took about a week to get e-visits up and running. On the first day telehealth went live, they conducted 28 virtual encounters.
Telehealth services are offered to every student, regardless of their current location.
“We are very lenient regarding licenses across state lines,” Carrow said. “If you are an NU student and you are eligible to use our service, then we can provide a service. We are not saying, ‘Okay, you’re a Northwestern student but you’re in the state of New York. I can’t help you.’ We are interpreting the law in saying, ‘Since you are a Northwestern student and you’re eligible to use us because you’re currently enrolled, we can service your healthcare provider across state lines.’ So, that’s how we are interpreting it.”
Mary Butler ([email protected]) is senior editor at the Journal of AHIMA.
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