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 structure

4. Program Responsibilities Health 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 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 test

11. Current Work and Data Flow Model
Child with
Provider
Parent
School nurse
DOHMH
Reports
parent visits
completes
deliver 211S
enter 211S data
maintains
provider
211S
to school
into ASHR
ASHR
Patient
211S
211S
211S
211S
Record
Form
Form
Form
Form
ASHR
School DB
EHR
Reports
CHC EHRS

18. Goal: Electronic Data Exchange
EHR
School
Forms
CHC - I
EHRS
School - I
School
Forms
System
EHR
211S
Consent
School
Form
Form
Forms
CHC - II
RES
MUM
EHRS
Form
Form
School - II
System
Automated
Student Health
EHR
Record
School
(ASHR)
Forms
System
CHC - N
School - N
EHRS
System

19. Benefits and Challenges: OSH
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
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
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 needs

23. Benefits of Bi-directionality: Parents
Minimize unnecessary go-between activities
Updates on child’s 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 “doctor’s 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 now; daily once system fully functional
Potential for tracking to citywide, but too early to determine overall utility

29. Flu signals correspond to city-wide signals