Case Study

Using Electronic Health Records at Greenwood School District 50

How the health office at Greenwood ensures nurses have what they need to provide exceptional student care.

Greenwood School District 50 Hero Image

District Background

At Greenwood School District 50, twenty school nurses provide care for close to 9,000 students across 16 sites. They’re kept hopping — most nurses see 25-30 students each day. “Some see closer to 40,” says Director of Nursing Laura Garrett. “It depends on the time of year, too. Flu season, everybody’s seeing 40.”

The nurses’ days begin with a sprint. “When they come in, they usually have students waiting for them who have gotten sick on the bus, or parents send them to school sick, or they need medication. A lot of different things hit them right when they walk in the door.” The fast pace continues throughout the day as nurses distribute medicines, help students who have chronic illnesses like diabetes or asthma, and care for the inevitable skinned knee.

Before: Health Records on Paper

When Laura began working at Greenwood in the early 2000’s, the health office looked very different to what it does today. “When I started, I was in the janitor’s closet, and I didn’t even have a phone,” she says. The office didn’t have a consistent practice for keeping students’ health records and documenting care provided. They kept records on paper.

Each year, nurses hand-compiled the data they needed to send to the state. “We’ve always had to do a state report at the end of the school year. Of course, it was all by hand, so it wasn’t really accurate, but we knew pretty much what questions they were going to ask, so we knew what data to keep up with throughout the year.”

When the district began billing Medicaid for health services, they were only able to bill for reimbursement for students who had IEPs. “It was just a small number of students. We did it all by hand as far as the codes and sending in the forms.”

Once South Carolina began allowing districts to bill for services provided to all Medicaid-eligible students — not simply those who had IEPs — the health office found itself devoting far more time to Medicaid billing. “I can remember spending hours trying to keep up with codes and billing and all that on paper,” says Laura. “We realized there was no way we could keep up with who was on Medicaid and who was not. The lists were long and we were trying to weed through them, and of course it changed every month because one month they’re eligible, the next month they’re not. And we realized there was no way we could keep up with that.”

It was clear that the district would need to maintain detailed records for every student — and they needed a better way to do it.

Electronic Health Records with Frontline

The decision to move to electronic health records was spearheaded by Nancy Moore, who was the Director of Nursing at the time. Greenwood School District 50 chose Frontline School Health Management — known then as HealthOffice — which helps the nursing staff in numerous ways:

Easier Documentation

Frontline helps the nursing staff at Greenwood keep up with paperwork and medications. When a student arrives in the health office, the nurse can pull up that student’s profile and instantly see their immunizations, relevant health information, notes from previous visits, times and doses for medications — everything they need to provide appropriate care and stay in compliance.

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Note: All personally identifiable information has been obfuscated.

They also have a single place to enter service documentation for Medicaid billing. “We have to keep up with so much paperwork anyway, because we have to have Medicaid consents and parental permission, and the doctor has to sign the form. It helps to keep it organized so that we know what we have going on,” Laura says.

Faster & More Accurate Reporting

Frontline recently added the state report for South Carolina to the system, which will make it easier for Greenwood to pull the information required by the state. The district has adjusted their practices to take full advantage of the data, and Laura explained that the reporting capability has been very helpful. “It’s a lot more accurate than it was before when we were just making a guesstimate.”

Laura can access data far more quickly than she could before. When their state school nurse consultant was looking for some specific data, it was no sweat for Laura to find what she needed. “Using those reports really helped. She wanted to know how many students we saw, how many we sent home, how many we sent back to class, how many times we called EMS. I just ran one report and added up the numbers. ‘Here you go.’”

Data to Support Staffing Requests

When the workload reaches a certain point and Laura needs to request additional staff, Frontline gives her the data she needs to justify the request. Laura can easily see how busy each nurse is. “If a nurse says, ‘I cannot keep up with what I’m doing,’ I can pull it up and see all the visits she documented. That gives me a voice to say, ‘This nurse is seeing 50 students [each day].’”

Staff Evaluations

Laura also uses data from Frontline School Health Management to support her staff and ensure compliance. “I have to do evaluations annually for each nurse, and I can just pull up their visits and evaluate their documentation and make sure that they’re doing everything according to the procedures we’ve set up.”

Equipping Substitute Nurses

When substitute nurses enter a building, they have quick access to the information they need. “They don’t know the students. I teach them, when a student walks in the door, to pull their name up. That way you see, ‘Oh, that student is diabetic,’ or ‘That student has asthma and is having breathing problems.’ Before electronic records, you would have to rely on what someone told you, or we would have it in the file, but you’d have to go hunt for it. To me, that’s the most important thing: it has made it a lot safer for all the nurses when they’re trying to take care of children.”

Laura Garrett Photo

“Before electronic records, you would have to rely on what someone told you, or we would have it in the file, but you’d have to go hunt for it. To me, that’s the most important thing: it has made it a lot safer for all the nurses when they’re trying to take care of children.”

Laura Garrett
– Director of Nursing

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Note: all personally identifiable information has been obfuscated.

Caring Support

As with all software, sometimes the need for extra support arises. Laura and her team were having an issue, and when Mylee, one of Laura’s contacts at Frontline, found out about it, she reached out to Laura.

“We talked back and forth. She got people involved and they started really working on what our problems were. We weren’t the only district having them — others in the area were also having those problems. They reached out to all of us and that really went a long way. Even though it was annoying that we were having the problems, they really reached out and wanted to help and really did a great job. They just jumped in and said, ‘We’re going to fix this.’”

Today, Laura can’t imagine doing her job without Frontline. “It would not be good. It really wouldn’t. There are too many students who have serious illnesses and chronic conditions and serious allergies, and if we didn’t have access to that information, we would not be able to do our jobs very well.”