Unique Features (Open vs. H&S) - - Multiple specialty centers allow for more resources, more competition and more support for patient population - Flexibility for accessing services - Flexibility for adding/augmenting new locations based on needs - Creation of a new market force for the specialty centers (augment their clinical panel to address needs) - Improved Access “Webbing” - primary to primary - peer review, education - primary to specialty - more options to address needs - Access any specialty center - e.g., added independent derm based on need
Sherrie to discuss (5 minutes)
Charles to begin discussion on Collaborative Care
Charles to discuss the “why’s” and “how’s” of collaborative care
School-Based Health: School Based, Student Connected the GapUsing Telemedicine to Bridge SBHC Summit November 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 Presentation Site Specialty Center Presentation Site Specialty Presentation Center Site Presentation Site Specialty Center
Services Provided through GPT• 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 4
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
… A Collaborative Healthcare ModelCollaborative care combines medical and behavioral health services to more fully address the spectrum thatdefines the patient.
Acute Care Student presents Student presents to school nurse to school nurse with with symptoms/compl symptoms/complFlow for aints aintsStudent School nurse completes normal triage process according to school policy to determine if the symptoms require a physician Nurse assesses that a physician is Nurse assesses that student Child returns to class; Child returns to class; not required. Parent is called or should probably see a physician parents are notified as parents are notified as note is sent home following to address symptoms/illness needed needed typical school procedures. Parent/guardian is contacted Parent does not wish for and educated on the school- Parent does not wish for student to use SBHC; student to use SBHC; based health center and asked if parent isis advised to they want their child to use the parent advised to follow-up with PCP follow-up with PCP SBHC Parent agrees to use SBHC. If If Parent agrees to use SBHC. not done so already, parent not done so already, parent fills out student intake fills out student intake Questions to be answered: packet required by SBHC packet required by SBHC •Do we have a pediatrician who will (can be faxed) (can be faxed) participate? •What roles can the local hospital fill? Physician isis called by Physician called by Student either waits inin SBHC and notified of •How will the center handle indigent Physician works this Student either waits SBHC and notified of Physician works this clinic or isis sent back to students? patient into the clinic or sent back to student needing care; student needing care; patient into the class to wait for physician school nurses takes vital •What resources are available in the normal workflow as class to wait for physician school nurses takes vital normal workflow as to call inin via telemedicine if if a walk-in a walk-in to call via telemedicine signs and faxes or emails signs and faxes or emails community to help? equipment equipment to physician to physician •Who will handle mental health issues? Guidance counselors? School social worker? 3rd party provider? SBHC makes sure SBHC makes sure If If not present, parent is not present, parent is •What tests can the school clinic student isis ready for student ready for contacted by nurse or contacted by nurse or perform? Is there a CLIA waiver in encounter prior to the encounter prior to the clinic coordinator and clinic coordinator and place? connection; physician connection; physician apprised of apprised of appointment, treatment, •How will the program be introduced and assesses, diagnoses, assesses, diagnoses, appointment, treatment, and orders. Parent may and orders. Parent may marketed to the local community? treats, and orders treats, and orders labs/medications labs/medications or may not be required or may not be required to pick student up from to pick student up from school. school.
Acute Care Adult presents to Adult presents to school nurse with school nurse with symptoms/compl symptoms/compl aints aintsFlow forFaculty/Staff School nurse completes normal triage process according to school policy to determine if the symptoms require a physician Faculty/staff isis Faculty/staff Nurse assesses that adult should Nurse assesses that a physician is probably see a physician to released to return to released to return to not required. address symptoms/illness duty duty Adult to be seen is educated on Adult patient does not Adult patient does not the school-based health center wish to use SBHC; nurses wish to use SBHC; nurses and asked if they want to use the advises to follow-up with advises to follow-up with SBHC PCP PCP Adult patient agrees to use Adult patient agrees to use SBHC. If If not done so already, SBHC. not done so already, fills out adult intake packet fills out adult intake packet Questions to be answered: required by SBHC (can be required by SBHC (can be •Which doctor will see adult patients? faxed) faxed) •How will classes be covered if a teacher is in a appointment? Physician isis called by Physician called by Adult either waits inin clinic •What other services can we provide to Physician works this Adult either waits clinic SBHC and notified of SBHC and notified of Physician works this or isis sent back to duty to the faculty staff? Annual health patient into the or sent back to duty to adult needing care; adult needing care; patient into the wait for physician to call school nurses takes vital screenings as required by some insurance normal workflow as wait for physician to call school nurses takes vital normal workflow as inin via telemedicine via telemedicine signs and faxes or emails plans? if if a walk-in a walk-in signs and faxes or emails equipment equipment to physician to physician SBHC makes sure SBHC makes sure patient isis ready for patient ready for encounter prior to the encounter prior to the Patient isis educated on Patient educated on connection; physician connection; physician orders, medications, and orders, medications, and assesses, diagnoses, assesses, diagnoses, treatments, as needed, treatments, as needed, treats, and orders treats, and orders by nurse or clinic by nurse or clinic labs/medications labs/medications coordinator. coordinator.
Specialty Care Patient isis Patient referred to aa referred to medical medical specialist specialistFlow for AllPatients 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. 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. Questions to be answered: •Who will manage these appointments? •Is there a waiting area for patients? Patient/parent isis Patient/parent educated on orders, educated on orders, medications, and medications, and treatments, as needed, treatments, as needed, by nurse or clinic by nurse or clinic coordinator. GPT coordinator. GPT scheduling isis contacted scheduling contacted for follow-up for follow-up appointments if if needed. appointments needed.
General School Based Health Center QuestionsPrior 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?