What to Look for in an EHR

Among the expectations, pressures, and responsibilities placed on school nurses, documentation might be one of the most important, yet tedious, of all. Compliance requirements like those associated with FERPA and HIPAA make proper documentation more complex. And with a mounting mental health crisis in addition to the impact of the pandemic, managing student health along with the data it brings is no easy task.

One additional factor? A shortage of school nurses and mental health professionals.

Retaining your school health professionals is crucial at the precise moment that their jobs have only gotten more difficult and demanding.

What is an EHR system?

The National Association of School Nurses (NASN) describes an electronic health records system (EHR) for school nurses as a “software platform for student electronic health records that includes nursing language/medical terminology and complies with standards of confidentiality, security, and privacy.”

But an EHR system by itself doesn’t automatically mean better care for students, or a better work day for school nurses. Meaningful use (MU) of an EHR is the key differentiator.

The Centers for Medicare & Medicaid Services defined meaningful use after the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009.

What can an EHR system help you do?

When used properly, EHRs have the potential to “maximize quality, decrease cost, and prevent errors, as well as promote the interoperability of school health records with providers in other care settings.”

School nurses might use an EHR for:

• Tracking student health trends
• Ensuring health documentation is secure and compliant
• Managing regular health screenings and immunization tracking
• Administering medication
• Making Medicaid claiming easier for everyone

Secure and compliant documentation is not simply in the district’s interest — interoperable, thorough documentation is critical for excellent student care. That’s in part because students often move between buildings or districts, and many receive care from a diverse array of sources in and outside the district. Family physicians, emergency room doctors, school counselors, psychiatrists, and others need secure access to health data.

An EHR built for schools is a big step toward ensuring your school nurses can do their best work.

What should you look for in an EHR?

If you’re ready to start looking for an EHR, it might feel overwhelming to think about all of the questions you’ll ask potential vendors. Here is a list to get you started.

• Are the software’s workflows designed for school nurses?
• What kinds of reports can we create? Can we track trends by school across the district?
• How does documentation work in the system? Is it intuitive for end users?
• Will we be able to track and report on vaccinations with the software? Can we import staff and student vaccine information from our state’s immunization registry?
• How secure will student data be in this software? Where is student data stored, and who at the company has access to it?
• Does the software allow us to manage prescription inventory and keep controlled substances safe?
• Does the software help us take a holistic approach to student health?
• Can I manage staff certifications with the system?
• How will the EHR integrate with our other, existing software?
• Does the system give us a secure way to communicate with parents?
• Will the system make Medicaid claiming easier?
• Does the system help us maintain FERPA and HIPAA compliance?
• Can the system help me support students’ mental health, too?
• Will the system allow me to monitor compliance with COVID-19 testing, mask mandate exemptions, contact tracing, and other COVID-19 specific needs?

What will an EHR provide beyond COVID-19?

Beginning in spring 2020, districts were faced with a health crisis. The unthinkable became reality. And information was neither readily available nor certain. Many schools suddenly realized they had no way of tracking who — students or employees — was affected by the illness. With school closures and remote instruction, school nurses were tasked with figuring out how to track virtual student encounters while maintaining standards of care, security, and compliance. In response, many schools started using an EHR for the first time, but some limited their use to COVID-19 functionality.

If the above situation sounds familiar, here are four questions to get you started on exploring other ways to use your EHR.

1. Have you tapped into your state immunization registry (if applicable) to help ensure your vaccination data is up to date?
2. Do school health professionals across your district have a standard method of scheduling, administering, and tracking medication administration and inventory? If not, can your EHR help with that?
3. Have you explored the full range of reports you can create in your EHR?
4. Are your school nurses and Medicaid team using built-in billing codes for student encounters?

It’s clear that questions related to COVID-19 are not disappearing, and the pandemic has had lasting impacts. Whether it’s a question related to COVID-19 vaccination requirements, managing COVID-19 vaccination data, or maintaining accurate COVID-19 testing data, the reality is that you likely still have pandemic-related reasons to use your EHR system.

You might even have started to see dedicated immunization information systems (IIS) appear in the news, but depending on your EHR, you might have IIS built right into your existing software. If you aren’t sure whether you’re taking full advantage of your software, contact your vendor representative to talk through your needs and questions.

EHRs vs. SIS health modules

In some ways, comparing a SIS to an EHR is like comparing apples and oranges. Most student information systems are very good at making sure student data is entered in the right format. They’re linear, following students from enrollment to graduation. Completing state and federal reporting each year without a SIS might be unthinkable.

But a SIS is not the standard for health records outside of schools. That means that any health provider outside the district may not have the information they need to properly care for that student. A SIS also falls short on HIPAA and FERPA compliance and doesn’t focus solely on health data, so school nurses might struggle to accurately document services in a way that makes Medicaid reimbursement easy.

Student mental health in crisis

Mental and behavioral health are crucially important pieces of holistic student health care. Although EHRs are generally designed for physical health documentation, they often have an accompanying mental health module to provide more detailed insights on student wellbeing.

When a school identifies a student’s mental health need, that school is responsible for providing care for that child. At the same time, schools often face resource constraints that make it difficult to hire enough mental health professionals to support the student body.

An EHR’s mental health module can make it easier for fewer mental health professionals to support students at scale. With built-in flags for concerning patterns of behavior, it’s one simple way to help your mental health providers care for students.

The school nurse shortage

Only 40% of schools have a full-time registered nurse on staff. How does that number relate to EHR systems? While software is not a quick fix, implementing systems that help nurses avoid administrative work can increase job satisfaction.

While you face many challenges in K-12 in any given school year, it seems like the next few years will be especially taxing for school health professionals and administrators. You owe it to yourself to set your team up for success, and an EHR is certainly a step in the right direction.