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