Written by Dr. Page McNall
In our schools, more often than not, the nurse is not in the office. More than half of the nation’s schools have only a part-time nurse or no nurse at all. Meanwhile, students, particularly Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, are suffering from chronic conditions at a rate nearly double 20 years ago. For Medicaid and CHIP enrollees, the lack of attention is reaching critical levels. A 2011 GAOreport found Medicaid and CHIP enrollees were falling far short of the 80% participation rate in Early Periodic Screening Diagnosis and Treatment (EPSDT) programs, while 63% needing care coordination didn’t receive it, and 40% of enrollees hadn’t had a well-child checkup in more than two years. The impact on the health care infrastructure and expense to the Centers for Medicaid and Medicare Services (CMS), both through health care costs and poor data reporting is profound.
According to the National Association of School Nurses (NASN), a quarter of the nation’s public schools is not served by a nurse at all. Another 30 percent are served by a “cluster nurse,” a single nurse who splits time between several schools. While Federal guidelines recommend one school nurse for every 750 students, only 17 states meet that requirement. Many of the basic health needs of school-aged children, particularly Medicaid and CHIP, are left untreated. Eligible students with unmet medical needs place a greater burden upon local education agencies (LEAs), which frequently have been unable to keep pace with the changing landscape of health care. While advances in health care information technology (IT) have moved doctors from prescription pads to iPads, and the range of medications brought into schools has increased dramatically, many schools are still relying on pencil-and-paper solutions that remain unchanged over decades. However, schools also represent an opportunity. As CMSitself writes in guidance literature, “School-based health services can represent an effective tool which can be used to bring more Medicaid-eligible children into preventive and appropriate follow-up care.”
We have seen several school electronic health records, however they appear to fall short of meeting the goals and outcomes for which they are intended. How well do they help manage cases? How well do they help coordinate care between the school and the student’s physician? Do they provide insight to the students’ health? Does it inform the public of health risks using syndromic surveillance across the district? Does it feed to the CDC as an early warning system of potential epidemics? The technology exists and could be used to understand health threats to the population and individual in real time. Does your school system have this level of health insight?
Every year, I filled out paperwork on my child who attended the same school for 4 years and despite the information previously given, I was asked for the same information again and again. Anecdotally, I have seen this with many other parents in various other school systems. Is there an electronic health record specifically for schools that serves as an integrated health care platform to improve health outcomes, reduce expenses through automation and improved data integrity of student health information, and cut the tangled knots of poor reporting plaguing CMS?
Further complicating matters, according to a 2011 NASN member survey, just 46 percent of school nurses are currently using a fully electronic student health record. Twenty-one percent of NASN members are still relying on paper-and-pencil solutions only. Including schools without nurses, the numbers drastically increase, leading to data errors, poorer health care and poorer health outcome.
Ideally, a school electronic health record should provide improved health care through better access to student health information and monitoring. (For example, tracking prescription medications as they’re administered, or recording basic triage and other health encounters). Providing the link between schools and parents for educational information that are meaningful to that parent and child, invite the opportunity for better health and care coordination. Educational content delivers high value in the management of chronic conditions where both parents and the school nurse participate in the child’s care. Lastly, it provides a cost savings through several separate avenues, notably savings in time and reduction in errors as a result of introducing an electronic record, decreased costs related to fewer student absences through better preventative care, and standardized data collection.
Many public schools suffer from dwindling budgets, which directly impacts the school health program. When creating the budget, I doubt that the school districts understand the multi-faceted return on investment that and electronic student health record would reap for this generation of children. After learning about the school nurse dilemma, It only makes sense to give our school nurses the tools they need to take care of our children.