School Nurses & the Medical Record

Delaware health system’s secure web portal gives school nurses access to a child’s EMR.

For many years, school nurses were perceived as being outside the traditional healthcare delivery system.

Their physical location and lack of regular communication with community physicians limited a school nurse’s ability to support a child’s care in the very place where he spends the majority of his day.

But with the advent of electronic medical records, school nurses are increasingly playing a critical role in the delivery of high-quality pediatric care.

In Delaware, Nemours Children’s Health System and its partners made great strides in this regard through the Student Health Collaboration.

With the simple goal of enhancing communication between healthcare providers, the Collaboration forged a partnership between the healthcare and education systems by giving school nurses access to electronic medical records for Nemours patients with chronic conditions, such as diabetes, asthma, seizures, food allergies and more.

School Nurses Connect

While technology is at the center of the program, relationships, team building and open collaboration have been the cornerstone of its success.

Consider one recent example: An elementary school child was hospitalized with a new diagnosis of type I diabetes and was getting ready to return to school, where his teachers, bus driver and school administrators likely would have been unprepared to help him adjust to his diagnosis and aid him in case of emergency. But before he was even discharged from Nemours/Alfred I. duPont Hospital for Children, his school nurse was able to electronically access his medical record and prepare for his return. The transition was seamless.

Initiated by a multidisciplinary team from Nemours, the Delaware Department of Education and the Delaware School Nurses Association, the program connects primary care physicians and specialists at Nemours facilities with school nurses throughout the state, representing every public school district, more than half of all charter schools and a handful of private schools.

Through NemoursLink, a secure portal that allows community providers to access and view a child’s electronic medical record, the program has developed a means to facilitate the exchange of critical medical information between Nemours clinicians and school nurses.

The record provides the student’s complete health background as well as current care plan for families that opt-in to the program: diagnosis, medications, treatment, and instructions for care following an injury, illness or hospitalization.

To make sure these nurses feel comfortable with the technology, Nemours offers an orientation and NemoursLink training, and we are recruiting super-user nurses to mentor others in best practices for navigating the tool.

The collaboration, created two years ago, is not meant for every child, focusing instead on those with chronic conditions and special needs.

This year (2013-2014), the program has enrolled more than 1,500 students and we are already hearing many stories about how the program is succeeding in creating better outcomes for particularly vulnerable pediatric patients.

Challenges to Overcome

To get this program off the ground, we had to overcome barriers, particularly those presented by privacy laws, including federal HIPAA strictures and those of the Family Educational Rights and Privacy Act, which strongly protects student records. It took us several months to finalize a parental consent form that complies with both laws. This form must be filled out every school year, and permits the nurse view-only access to the record.

We’ve been particularly fortunate in Delaware, because the state mandates every public school in the state to have a registered nurse. Moreover, unlike many districts nationwide where budget cuts have put school nurses on the chopping block, our state’s policymakers fortunately understand that school nurses are part of the very fabric of the community. In our experience, everybody benefits: the Nemours health providers have come to appreciate the role school nurses play in making the continuity of care a more effective process.

The school nurses, with real-time access to vital medical data, save valuable time by not having to repeatedly fill out authorization forms and track down busy primary care providers and specialists for insight on a student’s care. Families already see school nurses as a trusted resource and often ask the nurses for clarity on instructions or reinforcing the plan of care they’ve received from primary care providers and specialists.

Our nation’s healthcare system is increasingly heading toward the medical home model, with a focus on patient-centered, team-based, coordinated care. School nurses are often not recognized as part of that effort, but the Student Health Collaboration is working to put them in their rightful place in the forefront of that vital collaboration.

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