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Infusing Technology into an Old Public Health Practice What’s New in School Health Nursing?

Infusing Technology into an Old Public Health Practice What’s New in School Health Nursing?. CHC Connect. Theresa Gillette, RN Program Coordinator. No matter how good schools are, students won't be able to learn if they're not healthy. ‐ Secretary of Education Arne Duncan.

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Infusing Technology into an Old Public Health Practice What’s New in School Health Nursing?

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  1. Infusing Technology into an Old Public Health Practice What’s New in School Health Nursing?

  2. CHC Connect

  3. Theresa Gillette, RN Program Coordinator No matter how good schools are, students won't be able to learn if they're not healthy.‐ Secretary of Education Arne Duncan

  4. Presentation Outline • Background • Community Needs Assessment • Tele-health Solution • Collaboration • Implementation • Innovative Technologies • Outcomes • Sustainability

  5. Background

  6. In 2012… • CDC Recommendation • 1 nurse to 750 Students • 54% of Michigan Schools have no nurses • Branch County = 0 nurses • Issues Identified • Student health at risk • Liability issues for schools • Rural challenges

  7. Community needs assessment

  8. Needs Assessment… • Access to Care is a Problem in our Community (County Health Rankings, 2013) • Clinical Care Ranking – 69th out of 83 counties • High rates of population to health professional ratios • Higher rates of uninsured/underinsured • Higher rates of children in poverty • Higher rates of low income families (ACS, 2010-12)

  9. Student Risk Factors… MIPhy, 2012

  10. Tele-health solution

  11. School Tele-health • Tele-health connects student to primary care providers while student is at school. • Connection uses a secure, two-way audio/ video link. • Student and school nurse on one end and a mid-level practitioner on the other end. • Student is screened, examined, diagnosed, treated and monitored utilizing special equipment. • Parents consent to services prior to services being delivered. • Information is available via electronic medical record for child’s primary care provider.

  12. Jessica McKinley, RN School Nurse collaboration

  13. Partners • Community Health Center of Branch County • Intermediate School District • Coldwater, Bronson and Quincy Community Schools • Branch-Hillsdale-St. Joseph Community Health Agency

  14. Feasibility Study • School Personnel • Parents • Students

  15. implementation

  16. Equipment Choices • Video Telephone - Simple • Universal Kiosk - Complex • AMD Telemed Ed Cart – our choice • Cost – affordable • All inclusive • Portable Cart • A tangible product that people can view and understand • Point to point – only to home base

  17. Hub and Spokes Model Viking Connect (Bronson) Coldwater Pediatric Clinic Cardinal Connect (Coldwater) Oriole Connect (Quincy)

  18. Health Center Structure • Interagency Agreements • Location • Services to be Offered • Staffing Mix • Connectivity

  19. Policy Implications • Confidential services • P.A. 226 – Reproductive Health • HIPAA and FERPA

  20. Funding Implications • Sliding Fee Schedule • Write Offs • Telehealth Waiver • Telehealth Modifier • RN Billing

  21. Operations • Protocols • Procedures • Guidelines Lori Loveberry, RNC School Nurse

  22. Student Enrollment/Referral • Enrollment packets sent home via backpack method • Incentives • Available electronically on hospital and community schools website

  23. Community Engagement Presentations given to: • School Boards • Interagency Agreement • Service Clubs • School Staff • Students • Community Presence

  24. Training • Telehealth equipment – ease of use • Agnes Software easy to navigate • Self-taught with the assistance of IT • Nurses shadowed physicians for some examinations (hernia, palpation of abd., lymph node assessment)

  25. innovative technologies

  26. Live DEMO

  27. Risk Assessment • RAAPS – stands for Rapid Assessment for Adolescent Preventive Services • Distributed on Tablets • At Enrollment • Confidential • More Accurate • Immediate results • Online • Annually • Aggregate Data

  28. Electronic Medical Records • Streamlined • Access from multiple sites • Billing is generated • Escribe for prescriptions

  29. Other Technologies/Innovations • Facebook/Twitter • Smart phones/Applications • Electronic Newsletter • Survey Monkey

  30. Health Insurance Enrollment • Underinsured or non-insured identified • Appt. with certified navigator arranged • Assistance to enroll provided

  31. Kristin Smith, RN, BSN Director of Patient Experience outcomes

  32. Progress to Date • 3 School Tele-health clinics have been opened and staffed to serve students in 6th through 12th grades • Coldwater Middle/High Schools • Bronson Junior/High Schools • Quincy Middle/High Schools • Tele-health visits January to Sept. – >600 visits • 875 students enrolled in program between the 3 sites – which represents 32% of the junior/senior high student body.

  33. Community Advisory Committee/Youth Engagement • Role Committee • Membership • Guidance • Community • Customer Satisfaction • Policy Approval • Recruitment

  34. Customer Satisfaction/Case Studies • Customer satisfaction results • Patient • Parent • School Personnel • Preliminary Results: Over 90% of school personnel feel that students benefit from CHC Connect clinics • Heart Arrhythmia's identified

  35. sustainability

  36. Partnerships • Community Donations (approx. $65,000) • School support of a portion of RN salaries • Currently, 1 school supports a portion of the School RN • BISD Support • Negotiating with other two schools with passage of their mileage to gain additional support • In kind support • Schools – space and connectivity ($7,000 per school) • Health Department – in kind consultation • Hospital – billing services, medical records, IT support, grant administration

  37. Billable Services • Insurance Mix • Total billable charges in first 9 months • $65,000 charges for peds • $45,000 for school clinics • $110,000 overall billable charges

  38. Future Plans • Explore options related to other services (behavioral health) • Further develop advisory committees to guide progress and assist with: • Seeking ways to engage youth in prevention education • Measure customer satisfaction with the clinics • Coordinating clinic activities with other school groups to improve outcomes and messaging • Build community support and long-term sustainability

  39. Questions?

  40. Contact Information • Kristin Smith, RN, BSNDirector of Patient Experience274 East Chicago StreetColdwater, MI 49036(517) 279-5006, ksmith@chcbc.com • Theresa Gillette, RN, Program Manager 274 East Chicago StreetColdwater, MI 49036(517) 279-5295, tgillette@chcbc.com • Rochelle Bassage, BS, Navigator/Health Educator 570 N. Marshall Coldwater, MI 49036 (517) 279-9561, ext. 0104#, bassager@bhsj.org

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