sherrie williams
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TRANSCRIPT
School-Based Health:School-Based Health:School Based, Student School Based, Student
ConnectedConnectedUsing Telemedicine to Bridge the Gap
SBHC SummitNovember 9, 2012
Sherrie L. Williams, LCSW
About GPT• GPT is leading the nation as the most comprehensive
telemedicine network• 265+ rural and specialty sites within the GPT network. • Over 190 specialists, representing 40 specialties. • 8 encounters in January 2006 • 9,973 encounters in 2008 • 31,040 encounters in 2010• 40,000 + encounters in 2011• 75,000 + encounters anticipated for 2012
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GPT – “Open Access” Network Model
• Creates a web of access points• Any Presentation Site can connect to any other site
Specialty Center
Specialty Center
Specialty Center
Presentation Site
Presentation Site
Presentation Site
Presentation Site
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• Technical assistance in development and implementation of telemedicine programs
• Equipment and installation • Comprehensive support services: scheduling,
credentialing, program coordination• On going education and training: National School of
Applied Telehealth• 24/7 technical support• Dedicated telehealth liaison – ongoing program
support
Services Provided through GPT
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Key for Key for SuccessSuccess
Community Involvement!!!
Who Needs To Be At The Table?
School Superintendent School Board School Nurses School Social Workers Local Primary Care Doctors Community Hospital Community Mental Health Health Department Community Pharmacies
From Individual Practice to…
… A Collaborative Healthcare Model
Collaborative care combines medical
and behavioral health services to more fully address the spectrum that
defines the patient.
School nurse completes normal triage process according to
school policy to determine if the symptoms require a physician
Nurse assesses that a physician is not required. Parent is called or
note is sent home following typical school procedures.
Nurse assesses that student should probably see a physician
to address symptoms/illness
Student presents to school nurse
with symptoms/compl
aints
Student presents to school nurse
with symptoms/compl
aints
Parent/guardian is contacted and educated on the school-
based health center and asked if they want their child to use the
SBHC
Parent does not wish for student to use SBHC; parent is advised to follow-up with PCP
Parent does not wish for student to use SBHC; parent is advised to follow-up with PCP
Child returns to class; parents are notified as
needed
Child returns to class; parents are notified as
needed
Parent agrees to use SBHC. If not done so already, parent
fills out student intake packet required by SBHC
(can be faxed)
Parent agrees to use SBHC. If not done so already, parent
fills out student intake packet required by SBHC
(can be faxed)
Physician is called by SBHC and notified of
student needing care; school nurses takes vital signs and faxes or emails
to physician
Physician is called by SBHC and notified of
student needing care; school nurses takes vital signs and faxes or emails
to physician
Student either waits in clinic or is sent back to
class to wait for physician to call in via telemedicine
equipment
Student either waits in clinic or is sent back to
class to wait for physician to call in via telemedicine
equipment
Physician works this patient into the
normal workflow as if a walk-in
Physician works this patient into the
normal workflow as if a walk-in
SBHC makes sure student is ready for
encounter prior to the connection; physician assesses, diagnoses,
treats, and orders labs/medications
SBHC makes sure student is ready for
encounter prior to the connection; physician assesses, diagnoses,
treats, and orders labs/medications
If not present, parent is contacted by nurse or clinic coordinator and
apprised of appointment, treatment, and orders. Parent may or may not be required to pick student up from
school.
If not present, parent is contacted by nurse or clinic coordinator and
apprised of appointment, treatment, and orders. Parent may or may not be required to pick student up from
school.
Acute Care Flow for Student
Questions to be answered:•Do we have a pediatrician who will participate?•What roles can the local hospital fill?•How will the center handle indigent students?•What resources are available in the community to help?•Who will handle mental health issues? Guidance counselors? School social worker? 3rd party provider?•What tests can the school clinic perform? Is there a CLIA waiver in place?•How will the program be introduced and marketed to the local community?
School nurse completes normal triage process according to
school policy to determine if the symptoms require a physician
Nurse assesses that a physician is not required.
Nurse assesses that adult should probably see a physician to address symptoms/illness
Adult presents to school nurse with symptoms/compl
aints
Adult presents to school nurse with symptoms/compl
aints
Adult to be seen is educated on the school-based health center
and asked if they want to use the SBHC
Adult patient does not wish to use SBHC; nurses advises to follow-up with
PCP
Adult patient does not wish to use SBHC; nurses advises to follow-up with
PCP
Faculty/staff is released to return to
duty
Faculty/staff is released to return to
duty
Adult patient agrees to use SBHC. If not done so already, fills out adult intake packet required by SBHC (can be
faxed)
Adult patient agrees to use SBHC. If not done so already, fills out adult intake packet required by SBHC (can be
faxed)
Physician is called by SBHC and notified of adult needing care;
school nurses takes vital signs and faxes or emails
to physician
Physician is called by SBHC and notified of adult needing care;
school nurses takes vital signs and faxes or emails
to physician
Adult either waits in clinic or is sent back to duty to wait for physician to call
in via telemedicine equipment
Adult either waits in clinic or is sent back to duty to wait for physician to call
in via telemedicine equipment
Physician works this patient into the
normal workflow as if a walk-in
Physician works this patient into the
normal workflow as if a walk-in
SBHC makes sure patient is ready for
encounter prior to the connection; physician assesses, diagnoses,
treats, and orders labs/medications
SBHC makes sure patient is ready for
encounter prior to the connection; physician assesses, diagnoses,
treats, and orders labs/medications
Patient is educated on orders, medications, and treatments, as needed,
by nurse or clinic coordinator.
Patient is educated on orders, medications, and treatments, as needed,
by nurse or clinic coordinator.
Acute Care Flow for Faculty/Staff
Questions to be answered:•Which doctor will see adult patients?•How will classes be covered if a teacher is in a appointment?•What other services can we provide to the faculty staff? Annual health screenings as required by some insurance plans?
Clinic coordinator determines if that specialty is in the network.
If so, GPT scheduling is contacted for an appointment.
Patient/Parent is notified of appointment date/time.
Patient is referred to a
medical specialist
Patient is referred to a
medical specialist
On the day of the appointment, patient/parent should arrive at
least 30 minutes early. This time will be used to have the
patient/parent fill out forms that are specific to that specialist and for vitals to be taken and sent to
the doctor.
Patient/parent is educated on orders,
medications, and treatments, as needed,
by nurse or clinic coordinator. GPT
scheduling is contacted for follow-up
appointments if needed.
Patient/parent is educated on orders,
medications, and treatments, as needed,
by nurse or clinic coordinator. GPT
scheduling is contacted for follow-up
appointments if needed.
Specialty Care Flow for All Patients
Questions to be answered:•Who will manage these appointments?•Is there a waiting area for patients?
General School Based Health Center Questions
Prior to starting a SBHC, it is recommended that the community is involved. All of the successful centers have done great work in developing a community involvement
strategy. One way to achieve this is to establish an advisory board that incorporates various aspects of the community.
•How will we fund a SBHC? How will we sustain it?•What grants are available?•Who can write grants for us?•Who will be the clinic coordinator? How will we pay that person?•How can we support the school nurses as they take on a new responsibility?•How can we serve indigent patients?•How will prescriptions be handled? Do we have a local pharmacy we can partner with to deliver prescriptions to school?•Do we have local doctors who will participate? How will they fund their own telemedicine equipment?•What other local resources do we have?•How will we educate the public about telemedicine and school based health centers?•Will we only see students or open the center to faculty/staff? •Will we open the center to others? Family members of students?•Which school will we begin with? Where is the highest need?•Do we have school support?•Has the school nurse been involved in planning? What do we do if there is no school nurse?•How will we gather metrics regarding the success of our SBHC?