Listen to this 5-minute micro-presentation by Dr. Debbie Tomek from Children's Hospital Medical Center, Omaha who gives you a brief overview of how to begin electronically bridging your health care team with school nurses. Feel free to contact Dr. Tomek with questions and please give us feedback.
Hello. My name is Dr. Debbie Tomek. I am a general pediatrician, and the Associate Medical Director Children’s Hospital & Medical Center in Omaha, Nebraska Center for the Child & Community and former school- based health center medical advisor. I’m here to talk to you about the lessons learned and key considerations as we linked with our school nurse partners via electronic health record (EHR) portal dashboard.
American Academy of Pediatrics 2016 policy statement concerning school nursing strongly recommends that primary care practitioners and school nurses share health information after obtaining parental permission.
Sharing Information is Critical
Let’s focus on Head Start and its current process. Children within Head Start must have required examination with lab testing reported to the federal program annually. Parents sign a release of information to allow Head Start nurses to request key health status markers from the primary care provider. Obtaining the health results requires paper or faxed requests to the health information management department for printed records to be sent back to Head Start. Even if a phone call is made, often a message is left and times is lost.
This portal would allow school nurses to more efficiently access relevant health information and have timely communication with the health care team. This is why the portal is needed.
School nurses attend to multiple priorities. In an average school day, nurses triage acutely physically or emotionally stressed kids, or perform required vision screening or dispense allowed medications; therefore, only the health activities that align with the essential educational duties get accomplished.
Components for Success
It takes work, but the electronic portal provides better and more timely information for the school nurse to make the best decisions for the child’s health. Despite a strong desire to exchange information electronically, it took us nearly 3 years for all of these “resources for success” to align. For example, you’ll need:
- A school nurse willing to utilize a portal;
- A health information management team willing to try a more timely record- sharing pathway;
- A legal/compliance team willing to review the workflow to support Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) laws; and
- An information technology portal manager willing to develop the confidential electronic health record access to the key data that is also easy to navigate.
Points to Consider
- Providing the health portal within a school health setting requires that the user follow the privacy rules of personal health information governing medical practice (HIPAA) and school confidentiality (FERPA).
- HIPAA protects individual identifiable health information. Health systems require “legal guardian”’ consent to release information to schools.
- FERPA protects students’ educational records which include health information, school nurse notes, and special education records. School nurse sharing of this information requires written parental consent. The allowed exceptions: health & safety emergency; instance of abuse/neglect legal issues/criminal investigations.
- Two essential steps are the legal guardian’s permission to allow the school nurse to communicate with the health team AND to allow the medical team to supply the key health information.
- Only the school nurse names supplied by the school health administrator are granted access by the portal manager. We established a user agreement for each school nurse to agree to follow the confidentiality rules of HIPPA and FERPA. The nurse must upload release of information before accessing the student record.
I am hopeful that this has given you motivation to begin electronically bridging your health care team with school nurses and has helped you be more knowledgeable and confident with FERPA and HIPAA rules. Be prepared that it takes time to align resources and allies, but it is in the best interest of the health and well-being of our children.
My name is Dr. Debbie Tomek. I look forward to sharing more information about school-based health and other topics that may be important to you. Thank you.