Marie DeSisto is an innovator when it comes to electronic health records (EHRs) and improving health care in schools. Thanks to her efforts, school nurses in Waltham, MA, are linked by an EHR system that helps them serve students in ways that go far beyond the basics. Just one example: EHR data on student obesity convinced budget-conscious administrators not to eliminate recess.
In honor of National Nurses Week and National School Nurse Day, ONC talked with Ms. DeSisto about Waltham’s EHRs—how the system was implemented, how it works, and how students and nurses benefit.
First tell us a little about yourself and how you became interested in EHRs.
I’m an RN with a master’s in nursing administration, and I’m also a nationally certified school nurse. I’m director of nurses for Waltham Public Schools. We have about 5,000 students, pre-K through grade 12, in 10 schools. We have a nurse in each school—three at the high school.
I’ve been at Waltham for 12 years, and before that I was a school nurse in another district. We had kind of a homegrown EHR program there, cobbled together by our IT people. I knew what a huge timesaver it could be, and there were all kinds of ways we could use data from a good system to improve health care in schools. So when I came to Waltham, I decided to look for a program that would really fill the bill. We’ve been using our EHR system for 11 years. Every nurse has a computer, and we’re all linked.
Any challenges getting your system up and running?
Cost is always an issue. But we were able to get a grant from the Massachusetts Department of Public Health, called an Essential School Health Service Grant. They didn’t tell us what software we had to get, just gave us some parameters. The system we chose, SNAP, is from a company called Professional Software for Nurses. The company’s trainer was a nurse herself, with experience in a school health room. It helped a lot that she spoke our language.
Another challenge was that some of the nurses were a little hesitant about converting to EHRs. But we had a couple of very enthusiastic early adopters, and they really helped get everybody on board. The whole process only took about two months. To motivate our nurses, we emphasized the timesaving aspect of the system. For example, our accident-reporting system had been burdensome—paper forms in triplicate. SNAP does it with the click of a button. That had a big wow factor, and the accident reports made a big impression on administration. It got us off to a good start.
Tell us about how you use your EHR system—some examples of what it can do, or rather what you and your team can do with it.
Vision screening comes to mind. We do the screenings and refer students for treatment or corrective lenses if they don’t pass. The big thing with our EHR system is that we can keep track of those referrals, and do follow-ups. Our completion rate for referrals jumped from 63 percent to 92 percent when we started using EHRs.
SNAP also helps us keep track of immunizations. Say there’s a concern about a potential problem in your school and the principal wants to know the status of immunizations. It can take hours and hours to check for immunization information on documents students have brought from the doctors, but you can pull it instantly from the EHRs.
We’ve also been using our system to track concussions. There’s so much interest now in sports-related injuries. Our trend data show an increase over the past four to five years. That may be because reporting is better, and people are just more aware. We’re helping parents, students, and primary care providers understand that concussions can have serious implications for learning ability.
The EHRs were very helpful when the H1N1 flu virus was going around. We could quickly track how many kids the nurses were dismissing from school, and the symptoms the nurses were seeing. We reported to the Massachusetts Department of Public Health every day, and they could see the patterns.
Another really useful thing—very practical—has been keeping track of injuries from falls. For example, we saw that a lot of first and second graders were getting hurt in falls during recess. So we worked with the principals to train recess monitors in safety. Our data also showed lots of slip-and-falls first thing in the morning, especially on rainy days. Most of that was staff, and it was taking up a great deal of nursing time. Just installing some carpet cut that down almost 100 percent.
Can you give us some more examples of how the EHRs help the school nurses meet the students’ health needs or how EHRs can improve health care in schools?
We have quite a few students with chronic conditions, like asthma or diabetes. We can do an individual health care plan for these students, with everything on medications, nursing interventions. We can track blood pressure and blood sugar readings, make graphs that show changes, and print those out for parents to take to the doctor. The system also helps us with medications. It tracks how many doses we’ve administered, so we know if the student is forgetting to come in for meds. That’s so important. And we can see when we need to ask the parent for more pills.
The system also gives us nursing assessment templates. Say a student comes in for a headache, the nurse can click on the headache template and it prompts questions such as “Did you have a head injury?”
Any other examples of how you’ve been able to use EHR data?
We have always measured student height and weight, but our EHRs let us put that information to use. Our data showed that 40 percent of students in our district are either overweight or obese. The data documented this problem, and that convinced the superintendent to reinstate health education programs and not to cut recess. I really think if all schools in the country used EHRs, we wouldn’t have a child obesity problem. We could have seen it coming and taken action.
What’s on your “wish list” for EHRs?
We aren’t yet linked with other school districts, and we aren’t linked directly with providers. That would be great. I’d also like to see standardization across the country. For example, we have about 190 students with EpiPens for life-threatening allergies. We send data on EpiPen administrations to the Massachusetts Department of Public Health. Massachusetts is the only state that does that. If everyone did it, think what we could learn by comparing states and regions, and how that would affect health care in schools.
Any advice for other school districts that are thinking about implementing EHRs?
Take plenty of time to check available systems carefully. Make sure that the one you choose links to your district’s administrative software—what they use for attendance and demographics. It should be a one-way link, though; you don’t want any outside access to your students’ EHRs.
Make sure the system is visually easy to use and that it’s intuitive to the way nurses think. It also needs to be flexible, so the nurses can make it work for them. For example, you should be able to log more than one student at a time.
You also have to be very careful about privacy and security. The system has to be password protected, and you should be able to track who is making changes. I can hit a button and see right away who entered a particular statement or number.
Any final thoughts?
I am the Massachusetts director for the National Association of School Nurses (NASN). NASN is a strong advocate for EHR adoption in school systems and believes it can help improve health care in schools. School nurses work hard to keep students safe, healthy, and ready to learn. A good EHR system supports this work in so many ways. It’s worth every penny.
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