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Case Study

A Legacy of Better Student Health Care

How Tornillo Independent School District meets 21st century challenges with Frontline School Health Management.

Tornillo Independent School District Hero Image

District Background

Linda Rivero is a District Registered Nurse at Tornillo Independent School District, 25 miles east of El Paso, Texas. Along with a team of one school nurse and one medical assistant, Linda oversees healthcare in the small, close-knit, rural district. Many students are from immigrant families, and school nursing is often a primary source of health care for those kids.

“The perception is that we put on band-aids and don’t do a whole lot, but my staff is always busy,” says Linda. “There are always scheduled procedures, there are always medications, there are always students that we need to take care of who have chronic conditions.”

Linda also handles administrative tasks at the district level. “I go to most 504 meetings, the special ed meetings, so it’s a bit of a time management challenge because when I’m pulled away to do those tasks, my staff has to cover the other campuses.”

The Beginning: A Single Laptop and File Folders

Linda was the first nurse at Tornillo ISD when she joined the district nearly 10 years ago. While being able to offer care in schools was a major step forward, keeping track of student health records was a stressor. “I had to do a lot of it manually. The data had to be collected manually. The screenings entered manually, and it just took so much more time.”

The pandemic was the tipping point. “We didn’t have a system in place to track positive cases, quarantines, even communication with the parents. We didn’t have a system in place at all.” Linda says that although they tracked rudimentary health information in their student information system, the drawbacks were clear. “What we had was very basic. It was incorporated into the student information system, so it wasn’t separate. There was no privacy for the protected health information — it just didn’t exist.”

Choosing Frontline

Linda has a background in critical care, and she knew the benefits that electronic health records (EHR) bring to medicine. She says that COVID brought attention to healthcare in education, which presented school districts with an opportunity to modernize the health office. “Now they’re realizing the importance of having systems in place, having an EHR in place, that functions properly.”

When Linda encountered Frontline School Health Management, an EHR system designed specifically for school districts, she began speaking with her district leadership about what it would take to begin using it at Tornillo ISD. After meeting with the technology team to understand what it might take to get started with the system, she worked to get buy-in across the district. “We showed it to some administrators and finally presented it all the way to the top. They liked it and have praised it ever since. It works for everybody.”


What started out as a way to track COVID cases turned into something critical for other health office operations. “We need this for COVID. It’s a critical component. But now that we have moved away from COVID a little bit, [our EHR system] is still very important,” says Linda.

Access to Information, Quicker Documentation, Time Savings

With Frontline, nurses can now see all the necessary information on the screen when a student visits the health office. “They can pull up their record and see everything in one place. You can see all their history, all their screenings, all their immunizations.” Linda says it helps that the system is user-friendly. “Changes in IT make me a little nervous, because I’m old school. I didn’t grow up with this… But this is more user friendly for me. I don’t have to stress about it. It’s pretty easy.”

Documenting care is quicker and easier. “Templates let you document a visit in what, a minute? It saves a lot of time on documentation, on paperwork.” This allows care providers to spend more time caring for students.

Scheduling group screenings is far simpler as well. “It saves a lot of time for me, scheduling screenings, scheduling follow-ups, scheduling group visits. That used to take forever.” When conducting group screenings, nurses can enter information quickly. “They can put them in really quick in a group setting. They don’t have to go through each one, so that saves a lot of time as well.”

Linda Rivero Photo

“I really like the system. It makes it easier for me and my staff time management-wise because it’s so much easier to manage cases, it’s so much easier to manage medications and procedures and immunizations and screenings. All those little tasks that take up a lot of time during the day are managed so much easier with this system.”

Linda Rivero
– District Registered Nurse

Nurses can now focus their time on proactive care. “It gives them more time to meet the needs of the campus. It gives them more time away from the nurse’s office to help in other areas, education- wise, presentations on nutrition, presentations on safety at the playground, presentations in classrooms. It gives them more time out of the office to care for all of the needs of the campus.”

Dashboards and Data and More

Linda can now see what’s happening in health offices across the district. “The different dashboards that I have, I can see how many people have been online. I can see all of the data, I can see all of their movements. I just like having everything in the same spot.”

If she needs information from a particular campus, she can quickly pull it up on her computer. “I can find the data that I need quickly. I can pretty much do everything I need with the system. Before, if I needed a file, I had to go over to the other campus to get the file. If I needed some information, I would have to call or go get the information from somebody else. Now, I can find everything in one spot.”

“It’s comprehensive, the data is useful, it’s easy to access. It’s a godsend for me.”

Linda Rivero
– District Registered Nurse

Reports let Linda see if nurses are overloaded with office visits, so she can request additional hours or more funding for an extra nurse. She can see if flu or other illness cases are rising throughout the district and take action. And she can quickly pull up her nurses’ calendars, contact information for a student’s doctor, emergency contacts, and more — all things that used to require looking in multiple places.

Linda can even track information that the security team finds useful, such as the prevalence of student vaping across the district. “Security will give me their numbers, I’ll grab the numbers that I have, and we’ll see how they differ between the campuses, how they differ between my numbers and the security numbers, because mine are more accurate.”

Benefits for Leadership

The administration uses Frontline to generate reports showing which students are frequently absent due to illness. Health data can be easily aggregated and shared to help the school board make decisions as well. “The way that the data is collected, it can be presented at a board meeting, or it can be presented at a district advisory board meeting where they can see the data: ‘This is what our data is showing us, and this is the direction that we need to go.’”

Expanding Use

Linda says the district continues to find more uses for Frontline School Health Management. This year for the first time, they are using it to track care provided for Medicaid reimbursement. With Frontline’s Third-Party Medicaid Extract, the district doesn’t have to worry about entering data in multiple systems or missing eligible Medicaid reimbursements. The Frontline EHR system collects all the necessary Medicaid claiming information needed and delivers that data in an export file for any Medicaid vendor to use.

The counseling team is also beginning to use Frontline’s Mental & Behavioral Health, which complements the EHR system. This will let counselors use a secure system, rather than spreadsheets, to document cases. “Now we can add in the social emotional needs with the counselors, and they’re going to be on board this coming school year. I did a presentation for them and showed them how easy it was to collect data, how easy it is to case manage your students when you have the data in front of you.”

Leaving a Legacy

Linda’s work in the district goes beyond making health care easier today. From implementing an EHR, to establishing a system for immunizations, to developing templates for care plans and communication with parents, she’s working to ensure the nurses who come after her are set up for success. “We’ve come a long way, and that’s what I’m most proud of: the legacy that we leave here. There are systems in place, there are procedures in place, there are people in place that will outlast that, and that will move the district forward,” says Linda. “They’re pretty set up for the future.”

“The screening templates are there as well, that system is in place. The systems for screenings, the systems for immunizations, the systems for office planning, the systems for care planning, the systems for training, all of that is in place. A lot of that had to do with Frontline.” 

Linda Rivero
– District Registered Nurse