1. School-Based Health:
School Based, Student
Connected the Gap
Using Telemedicine to Bridge
SBHC Summit
November 9, 2012
Sherrie L. Williams, LCSW

2. 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

3. 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

4. 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

5. 5

6. 6

7. Key for
Success
Community
Involvement!!!

8. 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

9. From Individual Practice
to…

10. … A Collaborative Healthcare Model
Collaborative care
combines medical
and behavioral
health services to
more fully address
the spectrum that
defines the patient.

11. Acute Care
Student presents
Student presents
to school nurse
to school nurse
with
with
symptoms/compl
symptoms/compl
Flow for
aints
aints
Student 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.

12. Acute Care Adult presents to
Adult presents to
school nurse with
school nurse with
symptoms/compl
symptoms/compl
aints
aints
Flow for
Faculty/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.

13. Specialty Care Patient isis
Patient
referred to aa
referred to
medical
medical
specialist
specialist
Flow for All
Patients 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.

14. General School Based Health Center
Questions
Prior 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?