nyc school health automated student health record oxiris barbot, m.d. medical director december 6,...
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NYC School Health Automated Student Health Record
Oxiris Barbot, M.D.
Medical Director
December 6, 2006
Mission
Promote the physical, emotional, social
and environmental health of the 1.2
million public school children of New
York City.
Office of School Health Structure
• Department of Health and Mental Hygiene – HPDP Division– ~800 nurses– 54 doctors– ~ 150 public health advisers
• Department of Education – Office of Youth Development and School-
Community Services – ~300 nurses– 5 Health Content Experts
Program ResponsibilitiesHealth Services
• Physician of Last Resort• Students with IEP and Section 504 Needs
– Nursing, OT, PT
• New Entrant and Other Exams• Vision and Hearing Screening• Coordinate response to communicable diseases• Immunization and other mandates compliance
ASHR Goals
• Computerize student health-related data • Easily accessible, yet secure • Improve the way health related information is
maintained, tracked and retrieved • For the purpose of providing medical services,
tracking mandated activities and providing follow up on identified health needs (case management).
• Supply real-time data to Syndromic Surveillance
Automated Student Health Record (ASHR)
• Web-based ‘EHR’ • In house ASHR 1.0
development Spring 2003
• Limited pilot September 2003
• Complete roll out of 811 sites June 2006
• Phase in ASHR 2.0 September 2006
ASHR Content• Student demographics (imported
from DOE)• PMD & specialist contact info• Immunizations (imported from DOE)• Chronic Diagnoses• Allergies• Activities Restrictions• Vision and Hearing• Medication orders• Individual health plans• New Admission Exam• Asthma profile• Walk-in (exports to Syndromic
Surveillance)• Diabetes module (under
construction)
Use Case
• State and City mandate that every newly entering student is required to submit a new admission examination (NAE aka 211S)
New Admission Exam Form (211S)
• Form may change from year to year
• Some fields are age dependant e.g. lead
• Some fields are grade dependant e.g. TST
• Some fields are historically poorly complied with e.g. complete vision screening to rule out amblyopia
CHC EHRS Reports
ReportsChild with parent visits
provider
Provider completes
211S
Parent deliver 211S
to school
Patient Record
School DB
School nurse enter 211S data
into ASHR
ASHR
211SForm
DOHMHmaintains
ASHR
211SForm
211SForm
211SForm
EHR
Current Work and Data Flow Model
CHC-IEHRS
EHR
AutomatedStudent Health
Record (ASHR)System
SchoolForms
School-IISystem
SchoolForms
School-NSystem
SchoolForms
School-ISystem
SchoolForms
CHC-IIEHRS
EHR
CHC-NEHRS
EHR
211SForm
RESForm
MUMForm
Consent
Form
Goal: Electronic Data Exchange
Benefits and Challenges:OSH
• Benefits– Improve case management and initiation of related
services– Increase number of students with mandated exams– Reduce paper that could potentially get lost– Reduce redundancy– Reallocate staff time to other school health activities
• Challenges– Identity management of outside providers– “Wet signatures”– “Communicating” with numerous EHRs– Administering system for tracking consents
Benefits and Challenges:Providers
• Benefits– Improve care coordination with schools– Improve productivity
• Time to complete forms• Redoing work already done
• Challenges– Determining which diagnoses to transmit and which
not to– “Keeping parents in the loop”– Administering consent system
Benefits and Challenges:Parents
• Benefits– Compliance with school requirements– Less missed school and work days– Improved care coordination between PCP and
school system
• Challenges– Knowing what is being transmitted to schools
Overall Goals for NAE Electronic Transmission
• Traditional school health – ensure full participation in school activities – Students are free of communicable diseases– Students’ academic needs accommodated– Delivery of direct services
• Public Health Oriented School Health– Population-based chronic disease management
(chronic disease reporting)– Resource allocation– PH equivalent of clinical decision support
Benefits of Bi-directionality: Parents
• Minimize unnecessary go-between activities
• Updates on child’s status – e.g. # of visits to medical room
• Reports on when and what type of information was transmitted
Benefits of Bi-directionality:Provider
• List of patients and schools they attend with nurse contact info– Medication services– Related services – e.g. PT/OT/ST– Accommodations – e.g. barrier-free schools
• Updates on patient status – e.g. # of visits to medical room
• Profile as compared to other providers
Benefits of Bi-directionality:OSH
• Improve communications with providers
• Expand from NAE to “doctor’s notes”
Data transfer to Syndromic Surveillance
• Began March 1, 2005• Data fields transferred
– Student Age - Walk-In Time In– ATS School DBN - Grade Level– Official Class - Zip– Complaint Description - Comments– Record Last Update
• Process – Nightly Data transfer Service (DTS) of de-identified
student walk-in data by school
Syndromic Surveillance Potential
• Syndromes tracked– Allergy - AsthmaResp– Diarrhea - FeverFlu– Injury - Neuro– Rash - Vomiting
• Once a week email now; daily once system fully functional
• Potential for tracking to citywide, but too early to determine overall utility
Flu signals correspond to city-wide signals