1. Tiffany A. Clarke NASBHC McKesson Meeting May 3, 2007 Bringing Health Care to Schools for Student Success

2. 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.

3. 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.

4. “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

5. Current State of Technology Management Information System/Clinical Fusion Electronic Health (Medical) Records

6. Clinical 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.

7. Data Collected by SBHCs (Census 2001, N=959) Enrollment Visit Data on Diagnoses Financial Info/Cost analysis 0 20 40 60 80 100 120 Process ER Use15% School Attendance36% Contraceptive Use18% Health Behaviors36% Pregnancy Rates34% STI Rates25% Impact

8. What SBHCs do With Their Data (Census 2001, n=956) 0 10 20 30 40 50 60 70 80 90 Report to School ParentsFundersMediaPolicy Makers Publish in Professional Journal Other

9. Do you Collect These Data Elements? (Census 2004-05)

10. Accountability: Types of Data Collected by States (State Policy Survey, 2006) States that Fund SBHCs (n=20)

11. SBHCs that Bill and Collect 2004-05 Census of SBHCs Census 2004-05

12. Electronic Health (Medical) Records 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

13. Challenges 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”

14. Opportunities Improved Quality of Care Never having lost charts Improved communication between health care sites and increased opportunity of cross coverage Ability to close the gap between the medical literature and the medical field

15. Minimum 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

16. Next Steps: What should we 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