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 Organizational structure

Program Responsibilities Health 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 Average tenure of a student is 3 years per school. Records often misplaced

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 only 10% record separate visual acuity for each eye and a fusion test

Current Work and Data Flow Model Child with Provider Parent School nurse DOHMH Reports parent visits completes deliver 211S enter 211S data maintains provider 211S to school into ASHR ASHR Patient 211S 211S 211S 211S Record Form Form Form Form ASHR School DB EHR Reports CHC EHRS

Goal: Electronic Data Exchange EHR School Forms CHC - I EHRS School - I School Forms System EHR 211S Consent School Form Form Forms CHC - II RES MUM EHRS Form Form School - II System Automated Student Health EHR Record School (ASHR) Forms System CHC - N School - N EHRS System

Benefits and Challenges: OSH 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 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 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 PH equivalent of clinical decision support; e.g complete vision screens, prompting for medication services or other medical/related services needs

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