NYC School Health Automated Student Health Record

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NYC School Health Automated Student Health

Record

• Oxiris Barbot, M.D.
• Medical Director
• December 6, 2006

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Mission

• Promote the physical, emotional, social
• and environmental health of the 1.2
• million public school children of New
• York City.

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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

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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

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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

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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

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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)

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Use Case

• State and City mandate that every newly entering
  student is required to submit a new admission
  examination (NAE aka 211S)

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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

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Current Work and Data Flow Model
Reports
Child with
Provider
Parent
School nurse
DOHMH
parent visits
completes
deliver 211S
enter 211S data
maintains
provider
211S
to school
into ASHR
ASHR
Patient
211S
211S
211S
211S
Form
Record
Form
Form
Form
ASHR
School DB
EHR
Reports
CHC EHRS
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Goal Electronic Data Exchange
EHR
School
Forms
CHC
-
I
School
-
I
EHRS
School
System
Forms
EHR
211S
School
Consent
Form
Forms
Form
CHC
-
II
RES
MUM
EHRS
School
-
II
Form
Form
System
Automated
Student Health
Record
EHR
School
(ASHR)
Forms
System
CHC
-
N
School
-
N
EHRS
System
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Benefits and ChallengesOSH

• 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

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Benefits and ChallengesProviders

• 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

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Benefits and ChallengesParents

• 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

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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

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Benefits of Bi-directionality Parents

• Minimize unnecessary go-between activities
• Updates on childs status e.g. of visits to
  medical room
• Reports on when and what type of information was
  transmitted

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Benefits of Bi-directionalityProvider

• 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

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Benefits of Bi-directionalityOSH

• Improve communications with providers
• Expand from NAE to doctors notes

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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

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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

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Flu signals correspond to city-wide signals