IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORD INTO A SCHOOLBASED HEALTH CENTER PROGRAM

1
IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORD
INTO A SCHOOL-BASED HEALTH CENTER PROGRAM

• Kristin Case, FNP,MSN
• Multnomah County Health Department

2
NASBHCs (National Assembly of School Based
Health Centers)Findings

• Identifications of challenges facing some
  (School-Based Health Centers) SBHCs as they are
  moving forward
• Identification of opportunities when going
  paperless
• Recommendation of data elements for reporting and
  evaluation purposes
• Developed next steps to continue the move
  forward

3
What is happening nationally?

• The national trend is moving forward and there
  will be widespread adoption of EHRs within the
  next decade in the school settings
• Frequently, EHRs are being implemented without
  meeting the unique needs of SBHCs

4
Multnomah County Health Department SBHC Program

• 12 School Based Health Center Sites
• Clinics in elementary, middle, high school
  settings
• 3 school districts
• Comprehensive health care to school aged youth
• Health department has primary and specialty care
  clinics
• Seek reimbursement from Medicaid and third party
  payer systems

5
COMMUNITY NETWORK

• Oregon Community Health Information Network
  (OCHIN)
• Developed 5 years ago
• Multnomah County one of multiple organizations
  using a shared network
• Non profit organization that functions as a
  community health information network
• EPIC Practice Management and EMR

6
EPIC Practice Management

• Demographics
• Billing
• Insurance status
• Confidentiality status
• School attends
• Added household members, head of household,
  grade, outside healthcare provider

7
EPIC EMR

• 100 Paper to 100 Paperless!
• Includes
• Charting
• Computerized Order Entry
• Decision Support

8
SBHC EMR Preparation

• Workflow meetings
• IT/facility challenges
• Developing staff readiness

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PRE-IMPLEMENTATIONWORKFLOW SAMPLE
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Preparation of Clinic Staff

• Demonstrations prior to Go-Live
• Basic computer assessment
• Presentations
• Abstraction of paper records

11
SCHOOL- BASED IMPLEMENTATION

• Classroom training by discipline
• Productivity-decreased and duration
• Site support
• Staff morale-debriefs by clinic, sharing of
  ideas, challenges, input
• Remote support
• Skill check list by discipline
• Living with 2 record keeping systems while
  transitioning

12
SBHC pre-EHR CHALLENGES

• Larger network needs
• Confidentiality
• Data collection
• The Go-No Go criteria

13
Meeting the pre-EHR Challenges

• Risk Assessment Build
• Staff cross-training
• Confidentiality
• Social History
• Parent Contact

14
CLINICAL OPPORTUNITIES

• Evaluation of all systems that existed
• Continuity of care
• Immediate access to records
• Clients in transition-1 chart
• Improved clinical care
• Provider coverage
• Easy access to consults

15
What it is and what it is not!

• Quality improvement
• Shared client network
• Productivity tool
• Clinic flow issues
• Replacement for providing quality care

16
ONGOING CHALLENGES

• Need for ongoing trainings to increase efficiency
• New employee orientation
• Workflow improvement
• Bringing updates to program
• EMR resource guide

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Future Opportunities

• Decision Support
• Health Care Maintenance/ Reminders
• Interfacing with outside agencies to improve care
• Immunizations
• Clinical audits/reporting

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LESSONS LEARNED

• Communication is key
• Clinical Champion
• Administrative leadership support
• Be ok to live in ambiguity in early
  implementation phase
• On-going need for process of change and
  reevaluation (CQI)
• Staff development-ongoing