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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?


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

presentation outline
Presentation Outline
  • Background
  • Community Needs Assessment
  • Tele-health Solution
  • Collaboration
  • Implementation
  • Innovative Technologies
  • Outcomes
  • Sustainability
in 2012
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
needs assessment
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)
school tele health
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.
  • Community Health Center of Branch County
  • Intermediate School District
  • Coldwater, Bronson and Quincy Community Schools
  • Branch-Hillsdale-St. Joseph Community Health Agency
feasibility study
Feasibility Study
  • School Personnel
  • Parents
  • Students
equipment choices
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
hub and spokes model
Hub and Spokes Model

Viking Connect


Coldwater Pediatric


Cardinal Connect


Oriole Connect


health center structure
Health Center Structure
  • Interagency Agreements
  • Location
  • Services to be Offered
  • Staffing Mix
  • Connectivity
policy implications
Policy Implications
  • Confidential services
  • P.A. 226 – Reproductive Health
funding implications
Funding Implications
  • Sliding Fee Schedule
  • Write Offs
  • Telehealth Waiver
  • Telehealth Modifier
  • RN Billing
  • Protocols
  • Procedures
  • Guidelines

Lori Loveberry, RNC

School Nurse

student enrollment referral
Student Enrollment/Referral
  • Enrollment packets sent home via backpack method
  • Incentives
  • Available electronically on hospital and community schools website
community engagement
Community Engagement

Presentations given to:

  • School Boards
    • Interagency Agreement
  • Service Clubs
  • School Staff
  • Students
  • Community Presence
  • 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)
risk assessment
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
electronic medical records
Electronic Medical Records
  • Streamlined
  • Access from multiple sites
  • Billing is generated
  • Escribe for prescriptions
other technologies innovations
Other Technologies/Innovations
  • Facebook/Twitter
  • Smart phones/Applications
  • Electronic Newsletter
  • Survey Monkey
health insurance enrollment
Health Insurance Enrollment
  • Underinsured or non-insured identified
  • Appt. with certified navigator arranged
  • Assistance to enroll provided

Kristin Smith, RN, BSN

Director of

Patient Experience

progress to date
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.
community advisory committee youth engagement
Community Advisory Committee/Youth Engagement
  • Role Committee
  • Membership
  • Guidance
  • Community
  • Customer Satisfaction
  • Policy Approval
  • Recruitment
customer satisfaction case studies
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
  • 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
billable services
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
future plans
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
contact information
Contact Information
  • Kristin Smith, RN, BSNDirector of Patient Experience274 East Chicago StreetColdwater, MI 49036(517) 279-5006,
  • Theresa Gillette, RN, Program Manager

274 East Chicago StreetColdwater, MI 49036(517) 279-5295,

  • Rochelle Bassage, BS, Navigator/Health Educator

570 N. Marshall

Coldwater, MI 49036

(517) 279-9561, ext. 0104#,