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Why School-Based Health Centers Are the Front Lines for Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Feb 28, 2018 @ 06:42 AM

eye-for-ebony-402230-unsplash.jpgThis February weather has us reflecting a bit about the origins and core purpose of what we do at ClickCare. 

We are passionate about the big picture of collaboration in medicine. We're intrigued by the evolution of technology that allows us to build and refine our software. We're fascinated by medical advancements and new ways of doing medicine. 

But ultimately, the thing we're most passionate about is people. Specifically, the real and meaningful difference that thoughtful, effective, healthcare can make in a person's life. And the place we've seen that play out in the most interesting, powerful, subtle ways are in School-Based Health Centers -- which also happens to be where ClickCare started.

ClickCare wasn't started in a brainstorming session or at the keyboard of a programmer's computer. ClickCare was started in a school nurse's office.

Cheryl, our co-founder is a pediatrician in the Binghamton area, has focused her practice on the underserved in our community. Over time, she became connected with the school-based health centers near her office. There were several elementary schools that weren't especially wealthy in resources but were wealthy in caring teachers and caring nurse practitioners in their health centers -- the "nurse's office."

ClickCare was started -- with much more basic technology of course -- so the nurse practitioners at the school could collaborate with Cheryl on cases. It let the NPs use their insight in combination with Cheryl's perspective to keep students in class and get them healthy as fast as possible. We found quickly that the dynamics and reasons that iClickCare was so important and effective in that context made it particularly well suited to other care contexts as well. 

What few people realize is what a complex care context a school-based health center is. To give you a sense, we wanted to tell you the story of Shawn, an 8-year-old, just finishing first grade. He struggles a little bit with reading but is great at math. When asked his career goals, he says he'd like to be President one day, but would settle for being a scientist.

One Tuesday at 10:30am, Shawn raises his hand in class and tells Ms. Kapison, his teacher, that he doesn't feel well. He says he's having stomach pains and dizziness. She sends him to the health center within the school, which is where the care story continues:

  1. Kate, the nurse practitioner in the care center receives Shawn. She notices that beyond the flu or a cold, he may have psychosocial concerns as well. She remembers a few issues he had recently with other kids and also thinks about some of his challenges at home. 
  2. Kate makes an assessment, but with limited tools. Mostly, she is doing a thoughtful history and physical.
  3. Under significant pressure and great responsibility, Kate decides what happens next. Can she keep Shawn in school and coordinate care? It might sound like a small decision, but the ramifications are extensive. Shawn could get worse and there could be a delay in treatment if appropriate transfer is not made. On the other hand, his parents will be forced to take unnecessary time off from work if the child is sent out for no good reason except "to be safe."  Further, the referral may be to the wrong specialist.
  4. The child’s pediatrician can take over, but faces very sparse data. The process is prone to the same management challenges.
  5. Should the child need treatment, then the school’s role in post care management becomes important. When to return to gym? Is a rest period needed? Are there factors that interfere with learning?

Pediatricians often say: "A child is not a small adult."

For a child, the onset of illness is often quicker. And chronic disease needs to be managed as a growth project as opposed to a "holding" or "maintenance" project. Psychological overlay can be set up as a lifelong problem rather than as a compensation, as it would be for an adult. Like an athlete or soldier with the emphasis on keeping in play, the child needs to be kept in school in order to learn, and of course needs to be healthy to learn.

Children's problems tend to be a mix of simple and complex. And because the child is dependent, a caregiver is needed more often. A sick child means missed work for a working parent. Thus, a speedy, accurate, and specific diagnosis and treatment plan is important. Because specialty care is more likely to be needed, good communication and collaboration is even more necessary. 

This is why we developed iClickCare -- to allow all of these complex issues to be navigated, with telemedicine that involves multiple providers, across the continuum of care, to collaborate without interrupting their busy schedules, on complex cases. Children in schools need care coordination and healthcare collaboration on their behalf -- but, it turns out, those dynamics -- economic, psychological, social, personal as well as medical -- are present in every case. Children are not small adults; similarly, no person is simply "just another case."

Particularly today, this last day of African American History month, we want to pause to recognize the value of healthcare in caring for everyone in our country -- black and white, young and old, wealthy and not. We pause to recognize the complexity and intricacy that each person's life presents, and the importance of tending to these issues with respect, if we are to provide truly excellent healthcare.

Store-and-Forward healthcare collaboration keeps children healthy and in school while keeping Mom and Dad at work and siblings focused. And this means that all of us can be healthy enough to reach our potential.


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: care coordination, healthcare collaboration

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