Center for Rural Health Initiatives (CRHI)

Center for Rural Health Initiatives (CRHI)

Executive Summary

The Center for Rural Health Innovation (CRHI) is a non-profit based in North Carolina with a mission to apply innovative technologies to improve access to health care in rural communities. CRHI’s Health-e-Schools program is designed to improve access to healthcare for students through telemedicine. The program relies on grant funding and in the past has utilized telemedicine carts that proved difficult to scale. By implementing TytoCare’s portable, reliable, and cost-effective remote examination platform, the program was able to address the limitations of the traditional cart solution and offer telehealth to more schools at a lower cost.  Since Tyto was implemented in 2017, 98% of all telehealth exams were performed successfully, 26% more often than with traditional telemedicine carts.



The CRHI Health-e-Schools program relies on grant money to fund their telehealth programs. The program’s goal is to provide telehealth services to over 50 schools across four counties. Thanks to a grant received in early 2014, the program was able to purchase 6 telemedicine carts for Burke County schools, with each cart costing between $20 to $25 thousand dollars.

Although the carts enabled the schools to conduct telehealth exams, there were limitations to the cart solution, including:

  • Poor Portability: The carts were not portable and therefore each cart could only provide telehealth for a single school. As a result, only six out of 26 Burke county schools were covered.
  • Poor Reliability: The software that was used with the carts was not always reliable, and often required manual workarounds. Staff members using the carts also experienced technological issues related to image and sound quality.
  • Difficult to Use: The exam peripherals (e.g. otoscopes, stethoscopes) were not always easy to use and required more training and expertise from the nursing staff.
  • High Cost: The cost per cart was expensive, limiting the coverage they could provide across the counties served. 


TytoCare Solution

When Allison Bell, Program Director of Health-e-Schools for Burke County, received new grant funding in 2017, she worked with her team to find a better solution. They purchased 10 TytoPro™ exam kits at a similar cost as one telemedicine cart, thus enabling them to provide telemedicine to the 20 additional schools in Burke County.


Since piloting the program, 89% of students that completed a telehealth visit using TytoCare were able to return to class.  The most common reasons for using telehealth included acute conditions (85%), well-care (6%), follow-up (4%) and chronic conditions (2%).

TytoCare provided a significant improvement over CRHI’s previous telehealth solution, including:

  • Ease-of-Use: Hands-on implementation was easier and took less time with TytoCare than with the traditional telemedicine carts. CRHI staff also found it easier to train nurses, health professionals, and nonmedical personnel to use Tyto than previous solutions. TytoCare’s modular design makes it easy to switch from one exam to the next.
  • Portability: Tyto is easy to transport between schools, thereby extending the reach of nurses and reducing associated costs of hiring further staff.
  • Improved Access and Coverage: Using TytoCare enabled more sites to have telehealth coverage versus traditional carts. With this expanded coverage nurses are able to examine and present common complaints including strep throat, ear, sinus and respiratory infections, chronic conditions, and flu.
  • Improved Reliability: Since Tyto was implemented in 2017, 98% of all telehealth exams were performed successfully, 26% more often than with traditional telemedicine carts.

“I am so excited to see what this technology can do to help our community. There are so many children with limited access in need of healthcare. Reaching people in my own community in a way we have not been able to do before is a game changer and will have significant value for our children. We plan to roll out TytoCare to our other counties as well to extend the reach of telehealth to the communities we serve.” – Allison Bell, Program Director of Health

Get Tyto