Cabarrus County Schools Identify Patterns and Increase Response Time with New School Health App
Local Public Health Expert Recognized Issues with School Health Lag Time, Put a Plan in Motion to Alleviate the Problems.
Cabarrus County is the first county in the state of North Carolina to have a school nurse in every school. These nurses serve the more than 36,000 students who attend K-12 schools across the county. Each day, approximately 240 Cabarrus County students per hour are seen by a school nurse. This translates to five students per hour, per school.
Unfortunately, too often students were lining up outside the nurse’s office waiting to be seen. While nurses worked as quickly as possible to deliver patient care, they were also burdened by paperwork and inefficient tools. School health nurses had to submit manual reports. These reports were designed to share information with other private physicians and school nurses in the community so that providers could be alerted to specific symptoms that school-age children were experiencing. School nurses relied on their contacts within the community to identify patterns in symptoms, and could often spend a good portion of their day calling their colleagues to learn more about the environments in other schools.
Despite these efforts, the community was still lagging two to three days behind when it came to identifying outbreaks of illnesses and communicating the need for treatment or increased watchfulness. Identifying such patterns required collaboration and exchange of data between physicians, public health organizations and labs, and that couldn’t happen as quickly as it needed to in order to provide the best care possible for the community. “Paper charting was time consuming and increased filing that could only be done by the nurses due to HIPAA confidentiality. Auditing records required Supervisors to go to school sites.” reported Alice Luttman, School Nurse Supervisor, Cabarrus Health Alliance (CHA), a private, non-profit that provides public health services to Cabarrus County. Fortunately, Dr. William Pilkington, Chief Executive Officer and Public Health Director of CHA, recognized the issue and put a project in motion to alleviate the issue.
Dr. Pilkington has seen first-hand the value that technology brings to the public health arena. In fact, the Alliance is heavily involved in information technology initiatives, with $30 million worth of IT grants. With this mindset, Dr. Pilkington and his support team began seeking a technology partner to help them address the issues that the schools were having.
“We saw that the current computers that nurses were using had limited abilities. We wanted to provide as much technology to them as we could,” said Dr. Pilkington. “Our goal was to develop a powerful desktop-based solution that would allow nurses to detect early warning signals and take this information to the entire community and local physicians.”
Dr. Pilkington and his project support team, which consisted of school health nursing supervisors, nurses and others, identified several parameters under which this solution must be created. It needed to:
- Be able to identify 10 leading symptoms of illness or outbreak in the community that were leading to student absenteeism
- Be focused – the solution should not be too broad, but should be targeted at school health providers
- Be available at a reasonable price point
- Be able to be used across the community and easily replicated from school to school
The team also collaborated with the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security to discuss the potential benefits of the solution and ensure alignment of objectives. These organizations are particularly concerned with a community’s ability to respond quickly to an identified outbreak, and this solution stood to play a critical role in such issue identification. Then, after establishing the project parameters, the team began vetting potential vendors.
Many of the vendors presented concepts that were overly elaborate, or too expensive. Patagonia Health, however, understood the team’s goals and delivered a proposal that would achieve each of CHA’s specific objectives. The “School Health App” would be able to report the 10 symptoms that nurses identified as problematic and communicate these to physicians in the community. After discussion and testing, it was determined that the app would support the goals as requested, and the project was on-target.
“Patagonia Health created the school health app using a collaborative design method. We involved the users in the iterative design process to insure a user friendly application” said Abhi Muthiyan, Chief Technical Officer of Patagonia Health.This allowed users to try out the solution and identify issues or improvements so they could be fixed before complete go-live. Luttman adds “We have definitely liked being so involved in the development process. We also liked being able to use the paper student encounter form that we were already using to develop the documentation app. It made the process easier to roll out for all nurses.” The Patagonia Health team offered thorough training and support both on-site in a classroom setting and online in order to ensure a seamless transition for the users. Overall, the implementation was very quick and Patagonia Health’s easy-to-use technology required only a minimal training period for users. Everyone was eager to use the app.
Since implementation, all users have reported a high degree of satisfaction with the app. The app has been in use for one year, and 43 schools throughout Cabarrus County and Kannapolis city have incorporated the solution into their daily workflows.
Physicians can use School Health App reports to better prepare for any outbreaks and provide the highest-quality patient care. Information about specific outbreaks or illnesses will also be able to be shared with parents to ensure proper hygiene and other precautions. Also, this information helps parents determine whether or not to send their children to school, which will help prevent the further spread of symptoms. Because the app allows the sharing of data, nurses can use it to more easily determine if symptoms are localized or if they are present throughout the region.
“We’ve been able to short-circuit the process that exists between identifying symptoms, making a diagnosis and prescribing treatment,” said Dr. Pilkington. “We’ve seen a notable difference in the school health process. The solution saves nurses time and allows them to help more patients.” Luttman concurs, “It is more efficient and documentation is timelier. It allows us to query data for reports and supervisors can now audit records remotely.” According to Kim Ragan, School Nurse Supervisor of CHA, the School Health App has reduced paperwork by 110,000 pages in the 2013-14 school year.
School Health app also speeds the response time of primary care providers. When students across the school systems begin experiencing similar symptoms of specific nature, CHA administrators will be alerted. Nurses and administrators can analyze real-time reports, immediately recognize patterns and communicate appropriate information to providers, parents and teachers. This should contain the spread of any contagious diseases. Typical response time of approximately 48 hours could be shortened to six hours by using the School Health App.
The long-term vision for the project is to implement the app in additional locations, including urgent care centers and hospital emergency departments to create a county-wide system that allows for the sharing of data and tracking of patterns. Dr. Pilkington also envisions that the app could be developed into a social networking application that would allow parents access to some of the same information school nurses are seeing. This could be a powerful decision-making tool for parents whose students are exhibiting signs of illness, and it would reinforce their decisions to keep students home from school, thereby preventing further spreading of the illness.
To learn more about Cabarrus Health Alliance please visit www.cabarrushealth.org.