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Mission. Promote the physical, emotional, socialand environmental health of the 1.2 million public school children of NewYork City.. . Office of School Health Structure. Department of Health and Mental Hygiene HPDP Division~800 nurses54 doctors~ 150 public health advisersDepartment of Education Office of Youth Development and School-Community Services ~300 nurses5 Health Content Experts.
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1. NYC School Health Automated Student Health Record Oxiris Barbot, M.D.
Medical Director
December 6, 2006
2. Mission Promote the physical, emotional, social
and environmental health of the 1.2
million public school children of New
York City.
3. 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 structureOrganizational structure
4. 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
6. 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 misplacedAverage tenure of a student is 3 years per school. Records often misplaced
7. 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
8. 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)
9. Use Case State and City mandate that every newly entering student is required to submit a new admission examination (NAE aka 211S)
10. 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 testonly 10% record separate visual acuity for each eye and a fusion test
11. Current Work and Data Flow Model
18. Goal: Electronic Data Exchange
19. Benefits and Challenges:OSH 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
20. Benefits and Challenges:Providers 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
21. Benefits and Challenges:Parents 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
22. 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 needsPH equivalent of clinical decision support; e.g complete vision screens, prompting for medication services or other medical/related services needs
23. 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
24. 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
25. Benefits of Bi-directionality:OSH Improve communications with providers
Expand from NAE to doctors notes
26. 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
28. 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