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Parting with Paper: Electronic Health Records

In 1902, Lina Rogers, this country’s first school nurse, was sent for one month to various neighborhood schools in New York City where she not only cared for and treated students, but meticulously and painstakingly collected and evaluated data on the status of school health.  Thankfully today, electronic health record (EHR) software has dramatically increased the way in which school nurses can provide care to students in the ever-changing landscape of school health services. The use of an EHR in school health programs opens the door for school health professionals to holistically collaborate in a timely manner, creating innovative approaches to deliver quality healthcare and support to students and staff. The National Association of School Nurses, NASN, holds the position that “all school nurses should have access to a software platform for student electronic health records that complies with standards of confidentiality, security, and privacy.”

What and Why

Electronic Health Records are real-time, essential data collection tools that allow instant, secure availability to authorized users.  Different from educational student data management systems that may not provide for interoperability of records with other members of the healthcare and school-based teams and which often don’t contain appropriate privacy and confidentiality standards, or contain medical/nursing nomenclature, quality EHRs provide an efficient process for tracking and monitoring the health and wellness of both individual students as well as entire school populations. Further, EHRs facilitate comprehensive care between various providers, ensure accurate and appropriate documentation, and more definitively identify inefficiencies in care delivery and opportunities for quality improvement.

Selecting an EHR

The first step in determining which EHR is right for your school or district is establishing a working foundation.  This includes verifying an adequate internet connection and suitable computer equipment and operating systems.  A successful EHR system should be role-specific and serve in a capacity that supports standardized documentation across multiple disciplines while also maintaining strict compliance with all privacy, confidentiality, and security laws and regulations regarding health records.  Within the system, both structured (facts, figures, standardized nursing language) and unstructured (notes, narrative text) methods of data entry must be accessible and available to appropriate users.

Some important questions to consider before purchasing and implementing an EHR :

  • Are the system’s workflows consistent with school nurse workflows?
  • What types of reports and/or data analysis is available?
  • What is the system’s security and is it HIPAA/FERPA compliant?
  • What are the secure communication capabilities within the EHR?
  • Is it conducive to holistic care (counselors, trainers, etc.) documentation?


Optimization of your EHR

The majority of schools already use electronic health record systems, but there are many opportunities to improve their functionality and further improve the quality, safety, and efficiency of care in the school setting.  While many school nurses tapped into a multitude of different tracking features within many EHRs for COVID purposes, those same applications might be expanded to collect and aggregate student health data for a variety of other purposes intended to improve student health and safety.  Exploring report capabilities, integration capacities, and mechanisms for standardizations with scheduling, care protocols, and communication procedures can maximize the support and assistance a quality EHR can provide to school nurses.

EHRs are a valuable asset for school nurses and a powerful innovation that Lina Rogers set in motion at the start of the 20th century.  Now, for the 21st-century school nurse, EHRs have the potential to expand their care and support of student health, safety, and educational success.

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