Transcript States that Define SBHC as Medicaid Provider

Bringing Health Care to Schools for Student Success
Tiffany A. Clarke
NASBHC
McKesson Meeting
May 3, 2007
Objectives for today…
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Identify opportunities and challenges for SBHCs to convert to
Electronic Health (Medical) Record (EHR)
Determine the basic requirements for an EHR system within a
SBHCs
Provide recommendations to the SBHCs on how to deal with the
following challenges:
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data collection
confidentiality
staffing
change in culture
Explore education and health care policies and finance mechanisms
that support the conversion to EHR
Respond to a proposed set of common data elements for SBHCs
Identify resources, training and the infrastructure needed by SBHCs
and sponsoring organizations to respond to the need to convert to
EHR.
What is happening now?
The national health IT agenda is moving
forward and there will be widespread
adoption of EHRs with in the next decade.
 SBHCs are asking for information,
networking opportunities and support
around data collection and the EHR.
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“Electronic health records and other
information technology tools have the
potential to speed advances in medicine and
help doctors make more rapid and informed
decisions about medical care for their
patients. Health information technology is
expected to fill major gaps in medical
knowledge and help doctors learn on a realtime basis what works and what doesn’t for
their patients.”
Health Affairs Briefing: Health Information Technology and Rapid Learning, Friday, January 26, 2007
Current State of Technology

Management
Information
System/Clinical
Fusion
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Electronic Health
(Medical) Records
Clinical Fusion
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We are not certain how many SBHCs are
currently using Clinical Fusion or what other
software programs they are using.
We are aware that in some states the Health
Department has required the use of Clinical
Fusion in order to facilitate reporting and
evaluation.
There have been no major changes in
Clinical Fusion for some time.
Data Collected by SBHCs
(Census 2001, N=959)
Impact
100
20
0
Visit
40
Enrollment
60
Data on Diagnoses
80
Info/Cost analysis
Process
Financial
120
ER Use
15%
School Attendance
36%
Contraceptive Use
18%
Health Behaviors
36%
Pregnancy Rates
34%
STI Rates
25%
What SBHCs do With Their
Data
(Census
2001,
n=956)
90
80
70
60
50
40
30
20
10
0
Report to
School
Parents
Funders
Media
Policy Publish in Other
Makers Professional
Journal
Do you Collect These Data
Elements? (Census 2004-05)
Electronic Data Collected (n=1252)
Communication with Parents
Student Sent back to Class
DSM IV Codes
Length of Visit
Referrals
Lab Tests
CPT Codes
Grade
ICD Codes
Enrollment/Registration
Insurance Status
Race/Ethnicity
Provider Type
DOB
Gender
0
20
40
60
80
100
Accountability: Types of Data
Collected by States (State
Policy Survey, 2006)
number of visits
SBHC users
staffing
enrollment
diagnosis
Budgets
Billing/collections
Cost per user
Cost per visit
0
10
20
States that Fund SBHCs (n=20)
30
40
50
60
70
80
90
100
SBHCs that Bill and Collect
70
60
% of all SBHCs
Census 2004-05
2004-05 Census of SBHCs
50
40
30
20
10
0
Medicaid
SCHIP
Bill
Private
Collect
Self Pay
Electronic Health (Medical)
Records
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Currently, sponsoring organizations of SBHCs
are moving forward with new MIS and EHR
systems
The sponsoring organization may not have
considered the SBHCs and thus resulting in MIS
and/or EHR systems that do not meet either the
reporting or billing needs
SBHCs have disclosed their belief that they will
be left out of any information technology
improvements occurring in the sponsoring
agency or will be the last to receive the
technology
Constraints are financial, technical and legal
Challenges
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Data collection
– Practice Management
– Billing
– Collection and Reporting
Confidentiality
Staffing
Change in the clinic culture
Cost
– Software
– Additional costs:
– Hardware
– Remodeling
– IT support
– Training
Maintenance
“The number of hours both needed administratively and pulling staff out of clinics to
prepare for the EMR, so there is a loss in productivity”
Opportunities
Improved Quality of Care
 Never having lost charts
 Improved communication between health
care sites and increased opportunity of
cross coverage
 Ability to close the gap between the
medical literature and the medical field
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Minimum Data Set for SBHCs
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DOB
Gender
Race/Ethnicity
Provider type
CPT Codes
ICD 9 Codes
Insurance status at visit
Referrals (internal or external)
Registration
Student sent back to class
Communication with parent (elementary and middle
school)
Primary language spoken in the home
Next Steps: What should we
recommend?
Identify resources, training and
infrastructure needed by SBHCs and
sponsoring organization to respond to the
overall conversion to an EHR system
 Key data elements for the EHR system
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– Allow for interface with Clinical Fusion
– Allow for optimum billing
– Will enable SBHCs to issue timely reports to
their states and sponsoring organizations