Tiffany A. Clarke Tiffany A. Clarke NASBHC NASBHC McKesson Meeting McKesson Meeting May 3, 2007 May 3, 2007 Bringing Health Care to Schools for Student Success
Dec 30, 2015
Tiffany A. ClarkeTiffany A. ClarkeNASBHCNASBHC
McKesson MeetingMcKesson MeetingMay 3, 2007May 3, 2007
Bringing Health Care to Schools for Student Success
Objectives for today…Objectives for today… Identify opportunities and challenges for SBHCs to convert to
Electronic Health (Medical) Record (EHR) Determine the basic requirements for an EHR system within a
SBHCs Provide recommendations to the SBHCs on how to deal with the
following challenges:– data collection– confidentiality– staffing– change in culture
Explore education and health care policies and finance mechanisms that support the conversion to EHR
Respond to a proposed set of common data elements for SBHCs Identify resources, training and the infrastructure needed by SBHCs
and sponsoring organizations to respond to the need to convert to EHR.
What is happening now? What is happening now?
The national health IT agenda is moving forward and there will be widespread adoption of EHRs with in the next decade.
SBHCs are asking for information, networking opportunities and support around data collection and the EHR.
“Electronic health records and other information technology tools have the potential to speed advances in medicine and help doctors make more rapid and informed decisions about medical care for their patients. Health information technology is expected to fill major gaps in medical knowledge and help doctors learn on a real-time basis what works and what doesn’t for their patients.”
Health Affairs Briefing: Health Information Technology and Rapid Learning, Friday, January 26, 2007
Current State of TechnologyCurrent State of Technology
Management Information System/Clinical Fusion
Electronic Health (Medical) Records
Clinical FusionClinical Fusion
• We are not certain how many SBHCs are currently using Clinical Fusion or what other software programs they are using.
• We are aware that in some states the Health Department has required the use of Clinical Fusion in order to facilitate reporting and evaluation.
• There have been no major changes in Clinical Fusion for some time.
Data Collected by SBHCs Data Collected by SBHCs (Census 2001, N=959)(Census 2001, N=959)
En
rollm
en
t
Vis
it
Dat
a o
n D
iag
no
ses
Fin
anci
al
Info
/Co
st a
nal
ysis
0
20
40
60
80
100
120Process
ER Use 15%
School Attendance 36%
Contraceptive Use 18%
Health Behaviors 36%
Pregnancy Rates 34%
STI Rates 25%
Impact
What SBHCs do With Their What SBHCs do With Their Data (Census 2001, n=956)Data (Census 2001, n=956)
0102030405060708090
Report toSchool
Parents Funders Media PolicyMakers
Publish inProfessional
Journal
Other
0 20 40 60 80 100
Gender
DOB Provider Type
Race/Ethnicity
Insurance Status
Enrollment/Registration
ICD CodesGrade
CPT Codes
Lab Tests
Referrals
Length of VisitDSM IV Codes
Student Sent back to Class
Communication with Parents
Electronic Data Collected (n=1252)
Do you Collect These Data Do you Collect These Data Elements? (Census 2004-05)Elements? (Census 2004-05)
Accountability: Types of Data Accountability: Types of Data Collected by States (State Collected by States (State Policy Survey, 2006)Policy Survey, 2006)
0 10 20 30 40 50 60 70 80 90 100
Cost per visit
Cost per user
Billing/collections
Budgets
diagnosis
enrollment
staffing
SBHC users
number of visits
States that Fund SBHCs (n=20)
SBHCs that Bill and CollectSBHCs that Bill and Collect2004-05 Census of SBHCs2004-05 Census of SBHCs
0
10
20
30
40
50
60
70
% o
f al
l S
BH
Cs
Medicaid SCHIP Private Self Pay
Bill CollectCen
sus
2004
-05
Cen
sus
2004
-05
Electronic Health (Medical) Electronic Health (Medical) RecordsRecords
Currently, sponsoring organizations of SBHCs are moving forward with new MIS and EHR systems
The sponsoring organization may not have considered the SBHCs and thus resulting in MIS and/or EHR systems that do not meet either the reporting or billing needs
SBHCs have disclosed their belief that they will be left out of any information technology improvements occurring in the sponsoring agency or will be the last to receive the technology
Constraints are financial, technical and legal
ChallengesChallenges Data collection
– Practice Management– Billing– Collection and Reporting
Confidentiality Staffing Change in the clinic culture Cost
– Software– Additional costs:– Hardware– Remodeling– IT support– Training
Maintenance“The number of hours both needed administratively and pulling staff out of clinics to
prepare for the EMR, so there is a loss in productivity”
Opportunities Opportunities
Improved Quality of CareNever having lost chartsImproved communication between health
care sites and increased opportunity of cross coverage
Ability to close the gap between the medical literature and the medical field
Minimum Data Set for SBHCsMinimum Data Set for SBHCs DOB Gender Race/Ethnicity Provider type CPT Codes ICD 9 Codes Insurance status at visit Referrals (internal or external) Registration Student sent back to class Communication with parent (elementary and middle
school) Primary language spoken in the home
Next Steps: What should we Next Steps: What should we recommend?recommend?
Identify resources, training and infrastructure needed by SBHCs and sponsoring organization to respond to the overall conversion to an EHR system
Key data elements for the EHR system– Allow for interface with Clinical Fusion– Allow for optimum billing– Will enable SBHCs to issue timely reports to
their states and sponsoring organizations