School-Based Health:School-Based Health:School Based, Student School Based, Student

ConnectedConnectedUsing Telemedicine to Bridge the Gap

SBHC SummitNovember 9, 2012

Sherrie L. Williams, LCSW

About GPT• GPT is leading the nation as the most comprehensive

telemedicine network• 265+ rural and specialty sites within the GPT network. • Over 190 specialists, representing 40 specialties. • 8 encounters in January 2006 • 9,973 encounters in 2008 • 31,040 encounters in 2010• 40,000 + encounters in 2011• 75,000 + encounters anticipated for 2012

2

GPT – “Open Access” Network Model

• Creates a web of access points• Any Presentation Site can connect to any other site

Specialty Center

Specialty Center

Specialty Center

Presentation Site

Presentation Site

Presentation Site

Presentation Site

4

• Technical assistance in development and implementation of telemedicine programs

• Equipment and installation • Comprehensive support services: scheduling,

credentialing, program coordination• On going education and training: National School of

Applied Telehealth• 24/7 technical support• Dedicated telehealth liaison – ongoing program

support

Services Provided through GPT

5

6

Key for Key for SuccessSuccess

Community Involvement!!!

Who Needs To Be At The Table?

School Superintendent School Board School Nurses School Social Workers Local Primary Care Doctors Community Hospital Community Mental Health Health Department Community Pharmacies

From Individual Practice to…

… A Collaborative Healthcare Model

Collaborative care combines medical

and behavioral health services to more fully address the spectrum that

defines the patient.

School nurse completes normal triage process according to

school policy to determine if the symptoms require a physician

Nurse assesses that a physician is not required. Parent is called or

note is sent home following typical school procedures.

Nurse assesses that student should probably see a physician

to address symptoms/illness

Student presents to school nurse

with symptoms/compl

aints

Student presents to school nurse

with symptoms/compl

aints

Parent/guardian is contacted and educated on the school-

based health center and asked if they want their child to use the

SBHC

Parent does not wish for student to use SBHC; parent is advised to follow-up with PCP

Parent does not wish for student to use SBHC; parent is advised to follow-up with PCP

Child returns to class; parents are notified as

needed

Child returns to class; parents are notified as

needed

Parent agrees to use SBHC. If not done so already, parent

fills out student intake packet required by SBHC

(can be faxed)

Parent agrees to use SBHC. If not done so already, parent

fills out student intake packet required by SBHC

(can be faxed)

Physician is called by SBHC and notified of

student needing care; school nurses takes vital signs and faxes or emails

to physician

Physician is called by SBHC and notified of

student needing care; school nurses takes vital signs and faxes or emails

to physician

Student either waits in clinic or is sent back to

class to wait for physician to call in via telemedicine

equipment

Student either waits in clinic or is sent back to

class to wait for physician to call in via telemedicine

equipment

Physician works this patient into the

normal workflow as if a walk-in

Physician works this patient into the

normal workflow as if a walk-in

SBHC makes sure student is ready for

encounter prior to the connection; physician assesses, diagnoses,

treats, and orders labs/medications

SBHC makes sure student is ready for

encounter prior to the connection; physician assesses, diagnoses,

treats, and orders labs/medications

If not present, parent is contacted by nurse or clinic coordinator and

apprised of appointment, treatment, and orders. Parent may or may not be required to pick student up from

school.

If not present, parent is contacted by nurse or clinic coordinator and

apprised of appointment, treatment, and orders. Parent may or may not be required to pick student up from

school.

Acute Care Flow for Student

Questions to be answered:•Do we have a pediatrician who will participate?•What roles can the local hospital fill?•How will the center handle indigent students?•What resources are available in the community to help?•Who will handle mental health issues? Guidance counselors? School social worker? 3rd party provider?•What tests can the school clinic perform? Is there a CLIA waiver in place?•How will the program be introduced and marketed to the local community?

School nurse completes normal triage process according to

school policy to determine if the symptoms require a physician

Nurse assesses that a physician is not required.

Nurse assesses that adult should probably see a physician to address symptoms/illness

Adult presents to school nurse with symptoms/compl

aints

Adult presents to school nurse with symptoms/compl

aints

Adult to be seen is educated on the school-based health center

and asked if they want to use the SBHC

Adult patient does not wish to use SBHC; nurses advises to follow-up with

PCP

Adult patient does not wish to use SBHC; nurses advises to follow-up with

PCP

Faculty/staff is released to return to

duty

Faculty/staff is released to return to

duty

Adult patient agrees to use SBHC. If not done so already, fills out adult intake packet required by SBHC (can be

faxed)

Adult patient agrees to use SBHC. If not done so already, fills out adult intake packet required by SBHC (can be

faxed)

Physician is called by SBHC and notified of adult needing care;

school nurses takes vital signs and faxes or emails

to physician

Physician is called by SBHC and notified of adult needing care;

school nurses takes vital signs and faxes or emails

to physician

Adult either waits in clinic or is sent back to duty to wait for physician to call

in via telemedicine equipment

Adult either waits in clinic or is sent back to duty to wait for physician to call

in via telemedicine equipment

Physician works this patient into the

normal workflow as if a walk-in

Physician works this patient into the

normal workflow as if a walk-in

SBHC makes sure patient is ready for

encounter prior to the connection; physician assesses, diagnoses,

treats, and orders labs/medications

SBHC makes sure patient is ready for

encounter prior to the connection; physician assesses, diagnoses,

treats, and orders labs/medications

Patient is educated on orders, medications, and treatments, as needed,

by nurse or clinic coordinator.

Patient is educated on orders, medications, and treatments, as needed,

by nurse or clinic coordinator.

Acute Care Flow for Faculty/Staff

Questions to be answered:•Which doctor will see adult patients?•How will classes be covered if a teacher is in a appointment?•What other services can we provide to the faculty staff? Annual health screenings as required by some insurance plans?

Clinic coordinator determines if that specialty is in the network.

If so, GPT scheduling is contacted for an appointment.

Patient/Parent is notified of appointment date/time.

Patient is referred to a

medical specialist

Patient is referred to a

medical specialist

On the day of the appointment, patient/parent should arrive at

least 30 minutes early. This time will be used to have the

patient/parent fill out forms that are specific to that specialist and for vitals to be taken and sent to

the doctor.

Patient/parent is educated on orders,

medications, and treatments, as needed,

by nurse or clinic coordinator. GPT

scheduling is contacted for follow-up

appointments if needed.

Patient/parent is educated on orders,

medications, and treatments, as needed,

by nurse or clinic coordinator. GPT

scheduling is contacted for follow-up

appointments if needed.

Specialty Care Flow for All Patients

Questions to be answered:•Who will manage these appointments?•Is there a waiting area for patients?

General School Based Health Center Questions

Prior to starting a SBHC, it is recommended that the community is involved. All of the successful centers have done great work in developing a community involvement

strategy. One way to achieve this is to establish an advisory board that incorporates various aspects of the community.

•How will we fund a SBHC? How will we sustain it?•What grants are available?•Who can write grants for us?•Who will be the clinic coordinator? How will we pay that person?•How can we support the school nurses as they take on a new responsibility?•How can we serve indigent patients?•How will prescriptions be handled? Do we have a local pharmacy we can partner with to deliver prescriptions to school?•Do we have local doctors who will participate? How will they fund their own telemedicine equipment?•What other local resources do we have?•How will we educate the public about telemedicine and school based health centers?•Will we only see students or open the center to faculty/staff? •Will we open the center to others? Family members of students?•Which school will we begin with? Where is the highest need?•Do we have school support?•Has the school nurse been involved in planning? What do we do if there is no school nurse?•How will we gather metrics regarding the success of our SBHC?