Electronic data collection and screening label creation systems increase accuracy and savings for School Health Program.

State: FL Type: Model Practice Year: 2015

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The School Health Program  at the Florida Department of Health in Seminole County implemented two electronic processes to improve data collection and screening efficiency.

Our program collects data on health services provided to 14,000 students in 64 elementary, middle and high schools in Seminole County.  

In previous years, data was hand tallied by school nurses and collected in paper forms each month.  Numbers were verified by the lead school board nurse, mailed to our program manager and data specialist who reviewed the data, conducted calculations and entered data into our Health Management Systems (HMS).  We had several challenges with this system:

-High number of paper forms.  This made it difficult to track school data submissions, errors and data duplication.

-Increased processing time

-Difficulty ensuring school staff had access to the most updated form.

-Handwritten entries were often difficult to read.

-Additional time was spent collating the data, mailing forms and performing calculations.

 Our inter-agency team developed an electronic data collection form that automated the collection process and the calculations to decrease errors, reduce reporting process time and speed data entry onto HMS.  The system is easy and user friendly.

In a related improvement, our program uses screening forms to gather the data obtained from BMI screenings.  A label containing student identifying information is affixed to each screening form prior to the screening day.   In previous years, these labels were created by each school and delivered to our program.  Several challenges were noted with this system:

-Labels often had incorrect, missing and/or unnecessary information.

-School staff changed often and new staff was uncertain of the process for creating labels.

-School staff would not always have access to the student information electronic systems.

-Additional time and resources was spent training staff, picking up or delivering labels, correcting information, reprinting labels, etc.

-Delays in generating the labels at the schools and errors often led to delays in the screening process. 

 Our inter-agency team devised a system to electronically generate labels in-house, minimizing the time school personnel spends on this process, eliminating errors and reducing the time from printing to affixing, ensuring forms are ready for the screening day.    

 

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Seminole County Health Department
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Electronic data collection and screening label creation systems increase accuracy and savings for School Health Program.
Demographics & Background The Seminole County Public Schools (SCPS) system serves 64,831 students, as reported Florida Department of Education Membership Report 2013-2014.  The Florida Department of Health in Seminole County  (DOH-Seminole) School Health Program provides student health services and collects data from 64 elementary, middle and high schools in Seminole County.  Based on our School Health Services Summary from 2013-2014, over 17,000 of these students reported having some type of health condition such as asthma, diabetes or allergies.   This same year, school nurses and school health personnel provided over 776,000 health services in schools, including treatment, first aid and complex medical procedures.  In addition, approximately 50,700 health screening services were provided to students in targeted grades.     Public health issue Data gathering and analysis helps our program offices  and school partners at the local and state level identify priorities, trends, and make resource allocations.   Ensuring data collected is accurate in turn ensures that interventions and resource allocations are appropriately assigned.   Maximizing processes for efficient data collection, frees time, money and other resources that can be used in other areas, such as service delivery.  Process improvement opportunities: In previous years, our program created data rubric forms with the various service codes used by our program.  The school nurses would enter by hand the total number of services provided at the schools each month, numbers were verified by the lead school board nurse and then submitted monthly via mail to our program office.  Our data specialist would then verify the numbers conduct calculations to obtain aggregate data and enter into our Health Management Systems (HMS).  In addition, our program uses screening forms to gather the data obtained from BMI screenings.  A label containing student identifying information is affixed to each screening form prior the screening day.   In previous school years, these labels were created by each school and delivered to our program office to affix to the screening form.  Challenges for both of these processes include increase processing time, mailing and faxing costs, travel expenses, errors etc. Goals and objectives To reduce processing time and cost of data collection                Objective 1: Create a standardize simple electronic forms for data collection                Objective 2: Systematize electronic health service data collection To reduce costs and errors associated with generating screening forms                Objective 1: Standardize label template and implement in-house label printing capabilities Practice Implementation The School Health Program Coordinator met with the SCPS lead school board nurse and key staff to plan and design the new electronic data collection system. Feedback from staff using old system and assessment data was used to guide the development of the new system. Once the new electronic forms were created, testing of the new forms and staff training on use and submission of forms was conducted.   For the screening label process, our School Health Coordinator met with the SCPS Information Technology personnel to obtain access to the student information database needed for the screening forms.  The coordinator then met with the programs administrative assistant to develop a label template that could merge with the students’ database to generate the labels for the screening forms.   Training and testing of these systems was conducted before launching.  Both systems were fully launched on school year 2013-2014.   Results/Outcomes Implementation of both systems significantly reduced errors, costs and time spent collecting and processing data and generating screening forms.  Cost for postage and faxing were eliminated and data revision time was reduced significantly.  Collection of forms is done via e-mail and labels are now generated in-house with the exact specifications needed by our program.  Both systems are easy to use and require minimal expenditure by both school partners and program staff.  Regarding the screening form labels these are now generated in-house with few or no errors.  Delays in delivery of labels have been eliminated and screening forms are ready 3-4 days prior to screening day.  Costs associated with travel, error correction and re-printing have been minimized and or eliminated. Public Health Impact: Maximizing the data collection and label making processes delivered the following: -Allowed our program more time to more effectively track health service data -Increased accuracy of health service data reported -Reduced screening time for nurses at schools   -Strengthened collaboration between school district, school health programand department of health   website: www.seminolecohealth.com
Statement of Problem and Target audience The Seminole County Public Schools system serves 64,831 students, as reported Florida Department of Education Membership Report 2013-2014.  The Florida Department of Health in Seminole County School Health Program provides student health services and collects data from 64 elementary, middle and high schools in Seminole County.  Based on our School Health Services Summary from 2013-2014, over 17,000 of these students reported having some type of health condition such as asthma, diabetes or allergies.   This same year, school nurses and school health personnel provided over 776,000 health services in schools, including treatment, first aid and complex medical procedures.  In addition, approximately 50,700 health screening services were provided to students in targeted grades.    Data gathering and analysis helps our program offices at the local and state level identify priorities, trends, and make resource allocations.   Ensuring data collected is accurate in turn ensures that interventions and resource allocations are appropriately assigned.   Maximizing processes for efficient data collection, frees time, money and other resources that can be used in other areas, such as service delivery. Improvement Practice Implementation Data collection improvement project: In previous years, our program created data rubric forms with the various service codes used by our program.  The school nurses would enter by hand the total number of services provided at the schools each month, numbers were verified by the lead school board nurse and then submitted monthly via mail to our program office.  Our data specialist would then verify the numbers conduct calculations to obtain aggregate data and enter into our Health Management Systems (HMS).  After an assesment, the following challenges were identified: -A large number of paper forms were generated.  This made it difficult to track school data submissions and data duplication. -As forms were revised annually, it was difficult to ensure all staff had access to the most updated form. -Handwritten entries were often difficult to read. -Additional time was spent collating the data, mailing it in and performing calculations. -Clinic staff may not always be familiar with the service codes.  -No contact information what gathered on who completed the forms for when questions would arise.     Our data specialist, lead school board nurse and program coordinator developed a new electronic data collection process and form that automated the collection process and the calculations to decrease errors, reduce time spent in the reporting process and mathematical calculations and data entry onto HMS.  The system is easy enough most clinic staff feel comfortable using, while on the data processing end, it helps calculate and generate more accurate data. Screening forms and label improvement project: In another related improvement, our program uses screening forms to gather the data obtained from BMI screenings.  A label containing student identifying information is affixed to each screening form prior the screening day.   In previous school years, these labels were created by each school and delivered to our program office to affix to the screening form.  Following a process assesmetn, the following challenges were identified: -Oftentimes, labels had incorrect or missing information and/or additional information not needed. -School personnel designated to do the labels would change often and new staff was uncertain of the process for creating label or where to obtain the student information. -Student personnel designated to do the labels would not always have access to the student information electronic systems. -Additional time and resources were spent training staff, picking up or delivering labels, correcting information, reprinting labels, etc. -Delays in generating the labels at the schools and errors often led to delays in the screening process.  Our senior clerk, school district IT personnel and school health coordinator devised a system so that the screening labels can now be generated electronically in-house, minimizing the time school personnel spends on this process, eliminating errors and reducing the time from printing to affixing to the screening forms so that these are ready for the screening day. Practice Implementation The School Health Program Coordinator met with the SCPS lead school board nurse and key staff to plan and design the new electronic data collections system. Tools like SWOT analysis and process mapping were used to help our teams identify needs and opportunites for improvement. Feedback from staff using old system and assessment data was used to guide the development of the new system. Once the new electronic forms were created, testing of the new forms and staff training on use and submission of forms was conducted. For the screening label process, our School Health Coordinator met with the SCPS Information Technology personnel to obtain access to the student information database needed for the screening forms. The coordinator then met with the programs administrative assistant to develop a label template that could merge with the students’ database to generate the labels for the screening forms. Training and testing of these systems was conducted before launching. Both systems were fully launched on school year 2013-2014. Goals and objectives Our program had two main goals for this improvement: To reduce processing time and cost of data collection Objective 1: Create a standardize simple electronic forms for data collection Objective 2: Systematize electronic health service data collection To reduce costs and errors associated with generating screening forms Objective 1: Standardize label template and implement in-house label printing capabilities Objective 2: Train personnel to generate labels in-house   Results/Outcomes Implementation of both systems significantly reduced errors, costs and time spent collecting and processing data and generating screening forms. Cost for postage and faxing were eliminated and data revision time was reduced significantly. Collection of forms is done via e-mail and labels are now generated in-house with the exact specifications needed by our program. Both systems are easy to use and require minimal expenditure by both school partners and program staff. Since full implementation of the electronic data collection system, monthly school reporting has increased from an average of 45 (75%) schools in school year 2011-2012 to an average of 60 (93.7%) schools in school year 2014-2015. In addition, formulas have been included in the forms, cutting back on calculation time and errors. Regarding the screening form labels these are now generated in-house with few or no errors. Delays in delivery of labels have been eliminated and screening forms are ready 3-4 days prior to screening day. Costs associated with travel, error correction and re-printing have been minimized and or eliminated. Calculated cost savings for both proprocess amounts to approximately $13,600. Public Health Impact: Maximizing the data collection and label making processes delivered the following: -Allowed our program more time to more effectively track health service data- Our team can quickly identify missing or erred data and communicate with our schools partners to help resolve issues. -Increased accuracy of health service data reported- Health service data helps our School Health Program and school partners identify students’ health needs, drives resource allocation, helps us highlight best practices and ensures we are meeting goals. Increased data accuracy ensures our resources are delivered appropriately to meet students’ health needs, which in turn support successful student academic achievement. Accurate service data is also helping our teams identify future process improvements and service efficiencies. -Reduced screening time for nurses at schools- Nurses can spend less time addressing label errors and can focus on health screening activities, referrals and follow up. -Strengthened collaboration between school district, school health programand department of health- Collaborating with our school district partners on process improvement opportunities, has helped us build communication bridges, strengthen our trust and fostered a productive relationship. Use of Evidence Based Practices Tools like SWOT analysis and process mapping were used to help our teams identify needs and opportunites for improvement and during implementation phase.
Statement of Problem and Target audience The Seminole County Public Schools system serves 64,831 students, as reported Florida Department of Education Membership Report 2013-2014. The Florida Department of Health in Seminole County School Health Program provides student health services and collects data from 64 elementary, middle and high schools in Seminole County. Based on our School Health Services Summary from 2013-2014, over 17,000 of these students reported having some type of health condition such as asthma, diabetes or allergies. This same year, school nurses and school health personnel provided over 776,000 health services in schools, including treatment, first aid and complex medical procedures. In addition, approximately 50,700 health screening services were provided to students in targeted grades. Data gathering and analysis helps our program offices at the local and state level identify priorities, trends, and make resource allocations. Ensuring data collected is accurate in turn ensures that interventions and resource allocations are appropriately assigned. Maximizing processes for efficient data collection, frees time, money and other resources that can be used in other areas, such as service delivery. Improvement Practice Implementation Data collection improvement project: In previous years, our program created data rubric forms with the various service codes used by our program. The school nurses would enter by hand the total number of services provided at the schools each month, numbers were verified by the lead school board nurse and then submitted monthly via mail to our program office. Our data specialist would then verify the numbers conduct calculations to obtain aggregate data and enter into our Health Management Systems (HMS). After an assesment, the following challenges were identified: -A large number of paper forms were generated. This made it difficult to track school data submissions and data duplication. -As forms were revised annually, it was difficult to ensure all staff had access to the most updated form. -Handwritten entries were often difficult to read. -Additional time was spent collating the data, mailing it in and performing calculations. -Clinic staff may not always be familiar with the service codes. -No contact information what gathered on who completed the forms for when questions would arise. Our data specialist, lead school board nurse and program coordinator developed a new electronic data collection process and form that automated the collection process and the calculations to decrease errors, reduce time spent in the reporting process and mathematical calculations and data entry onto HMS. The system is easy enough most clinic staff feel comfortable using, while on the data processing end, it helps calculate and generate more accurate data. Screening forms and label improvement project: In another related improvement, our program uses screening forms to gather the data obtained from BMI screenings. A label containing student identifying information is affixed to each screening form prior the screening day. In previous school years, these labels were created by each school and delivered to our program office to affix to the screening form. Following a process assesmetn, the following challenges were identified: -Oftentimes, labels had incorrect or missing information and/or additional information not needed. -School personnel designated to do the labels would change often and new staff was uncertain of the process for creating label or where to obtain the student information. -Student personnel designated to do the labels would not always have access to the student information electronic systems. -Additional time and resources were spent training staff, picking up or delivering labels, correcting information, reprinting labels, etc. -Delays in generating the labels at the schools and errors often led to delays in the screening process. Our senior clerk, school district IT personnel and school health coordinator devised a system so that the screening labels can now be generated electronically in-house, minimizing the time school personnel spends on this process, eliminating errors and reducing the time from printing to affixing to the screening forms so that these are ready for the screening day. Practice Implementation The School Health Program Coordinator met with the SCPS lead school board nurse and key staff to plan and design the new electronic data collections system. Tools like SWOT analysis and process mapping were used to help our teams identify needs and opportunites for improvement. Feedback from staff using old system and assessment data was used to guide the development of the new system. Once the new electronic forms were created, testing of the new forms and staff training on use and submission of forms was conducted. For the screening label process, our School Health Coordinator met with the SCPS Information Technology personnel to obtain access to the student information database needed for the screening forms. The coordinator then met with the programs administrative assistant to develop a label template that could merge with the students’ database to generate the labels for the screening forms. Training and testing of these systems was conducted before launching. Both systems were fully launched on school year 2013-2014. Goals and objectives Our program had two main goals for this improvement: To reduce processing time and cost of data collection Objective 1: Create a standardize simple electronic forms for data collection Objective 2: Systematize electronic health service data collection To reduce costs and errors associated with generating screening forms Objective 1: Standardize label template and implement in-house label printing capabilities Objective 2: Train personnel to generate labels in-house   Results/Outcomes Implementation of both systems significantly reduced errors, costs and time spent collecting and processing data and generating screening forms. Cost for postage and faxing were eliminated and data revision time was reduced significantly. Collection of forms is done via e-mail and labels are now generated in-house with the exact specifications needed by our program. Both systems are easy to use and require minimal expenditure by both school partners and program staff. Since full implementation of the electronic data collection system, monthly school reporting has increased from an average of 45 (75%) schools in school year 2011-2012 to an average of 60 (93.7%) schools in school year 2014-2015. In addition, formulas have been included in the forms, cutting back on calculation time and errors. Regarding the screening form labels these are now generated in-house with few or no errors. Delays in delivery of labels have been eliminated and screening forms are ready 3-4 days prior to screening day. Costs associated with travel, error correction and re-printing have been minimized and or eliminated. Calculated cost savings for both proprocess amounts to approximately $13,600. Public Health Impact: Maximizing the data collection and label making processes delivered the following: -Allowed our program more time to more effectively track health service data- Our team can quickly identify missing or erred data and communicate with our schools partners to help resolve issues. -Increased accuracy of health service data reported- Health service data helps our School Health Program and school partners identify students’ health needs, drives resource allocation, helps us highlight best practices and ensures we are meeting goals. Increased data accuracy ensures our resources are delivered appropriately to meet students’ health needs, which in turn support successful student academic achievement. Accurate service data is also helping our teams identify future process improvements and service efficiencies. -Reduced screening time for nurses at schools- Nurses can spend less time addressing label errors and can focus on health screening activities, referrals and follow up. -Strengthened collaboration between school district, school health programand department of health- Collaborating with our school district partners on process improvement opportunities, has helped us build communication bridges, strengthen our trust and fostered a productive relationship. Use of Evidence Based Practices Tools like SWOT analysis and process mapping were used to help our teams identify needs and opportunites for improvement and during implementation phase.
Evaluation, Results & Outcomes Data reports submitted for school year 2011-2012 and 2013-2014 were compared for timely submission and data accuracy.  Staff time spent for data processing, collection, data calculation, travel, technical support and fixing errors was also compared.  In addition, costs associated with delivery travel, mailing and faxing, printing, paper were also compared. Feedback from staff was also gathered through out the process. Implementation of both systems significantly reduced errors, costs and time spent collecting and processing data and generating screening forms. Cost for postage and faxing were eliminated and data revision time was reduced significantly. Collection of forms is done via e-mail and labels are now generated in-house with the exact specifications needed by our program. Both systems are easy to use and require minimal expenditure by both school partners and program staff. Since full implementation of the electronic data collection system, monthly school reporting has increased from an average of 45 (75%) schools in school year 2011-2012 to an average of 60 (93.7%) schools in school year 2014-2015. In addition, formulas have been included in the forms, cutting back on calculation time and errors. Regarding the screening form labels these are now generated in-house with few or no errors. Delays in delivery of labels have been eliminated and screening forms are ready 3-4 days prior to screening day. Costs associated with travel, error correction and re-printing have been minimized and or eliminated. Calculated cost savings for both proprocess amounts to approximately $13,600. Cost savings detail analysis Cost incurred with previous data collection process:    ·        Average time collecting and reviewing data forms        4hrs/month x 9 months school yr =36 hrs (faxing and delivering paper forms, collecting,                             2 specialists(36x2) 36hrs x $21/staff hourly rate = $1,512 cost organizing forms, reviewing documentation, going      1 coord 36hr x $30/staff hourly rate=$1,080 through the schools making sure that duplicates           1 lead nurse 36hr x $35/staff hourly rate=$1,260 were not sent, making sure the information                   64 clinic staff X .5hrs X 9months X $21.79 = $6,275 was correct and sometimes calling the schools and reaching the correct person in the school to help out, etc)   ·        Faxing and mailing costs (sending and                                           $4 monthly cost of postage for monthly packets X 9months= $36 delivering paper forms to lead nurse and data                              $2 school fax/print data forms X 64 schools X 9months=$1,152 specialist)   ·        Average time per month conducting calculations         4 hours/month X 9monthsX $21/staff hourly rate=$756 on data (hand calculation needed for reporting             1hr/month x 9monts X$30/staff hrly rate=$270 aggregate data on HMS)   ·        Average time per month correcting and editing            1 data spec. 5 hours/month X 9months X $21/staff hrly rate=$756 data collected in forms and in HMS system                    1 coord.  2 hours/month X 9 month x $30/staff hrly rate=$540                                                                                                          1 lead nurse 1 hours/month X 9month X $35/staff hrly rate= ·        Organizing, filing and storage of paper forms                 $315   Cost for previous screening label process: ·        Staff time for label pick up or delivery                                            10hrs/month X 9months X $15/staff hourly rate= $1,350 (for 36 elementary schools administrative professional or clinic personnel)   ·        Travel costs (gas, and vehicle maintenance)                  4 schools/month X 8.5miles avg. X .44cents/mile X 9month= $135 ·        Technical support provided by admin staff                     2hr/month x $15/staff hrly rate X 9 month= $270 ·        Staff time fixing errors, organizing labels,                       30mins/school x 36 schools X $15/staff hrly rate= $250 Handwriting information, etc              ·        Delays in nurses screening time                                        3 nurse 2.5hrs/month= 7.5hrs X 9month X $30 avg rate= $2,025 ·        Printing costs(includes extra print jobs to correct forms) Est. $400   Total annual cost for both: $18,418 Cost of new electronic data system:   ·        Meeting with team to plan, design and implement        1 data specialist X 4hrs X$21hrly rate= $84 electronic data collection system                                     1 lead nurse x 1.5 hrs X $35 avg hrly rate= $52.5 1 coord  x 8 hrs X$30 avg hrly rate=$240   ·        Time spent researching, creating and testing new        1 coordinator X 15 hours X $30hrly rate=$450 electronic form                                                                       ·        Staff training time to test and use electronic form        1 hour X 36 staff X $21.79avg hrly rate= $784 1 lead nurse X1 hr X $35 avg hrly rate= $35 1 data specialties X 2 hr X$21 hrly rate= $42   ·        Average time collecting and reviewing data forms        1 data spec. 15min/month X 9month X$21hrly rate = $47 64 clinic staff X .125 hrs x 9months X $21.79= $1,569   ·        Faxing and mailing costs                                                     0   ·        Average time per month conducting calculations         1 data spec.  .5hr/month X 9monthsX $21/staff hrl rate=$94.5 on data (hand calculation needed for reporting             aggregate data on HMS)   ·        Average time per month correcting and editing            1 data spec. 5 hours per school year X  $21/staff hrly rate=$105 data collected in forms and in HMS system                    1 coord.  2 hours per school year x $30/staff hrly rate=$60   ·        Organizing, filing and storage of paper forms                 0   Cost for new screening label process: ·        Meeting with team to plan, design and implement        1 admin professional X 4hrs X$15 hrly rate= $60 electronic data collection system                                     1 coord. X 4 hours X $30 hrly rate=$120   ·        Time spent researching, creating and testing new        1 coordinator X 8 hours X $30hrly rate=$240 electronic form                                                                       ·        SCPS IT staff preparing databases                                      2 hr X 9 month x $21.79 = $392 ·        Staff training time to test and use electronic form        3 hours X 1 staff X $15avg hrly rate= $45 ·        Staff time for label pick up or delivery                                            0 (for 36 elementary schools administrative professional or clinic personnel)   ·        Travel costs (gas, and vehicle maintenance)                  0 ·        Technical support provided by admin staff                     0 ·        Staff time fixing errors, organizing labels,                       0 ·        Printing costs (includes labels, print time,                     9hrs x $15 hrly=$135 Printer supplies)                                                                   $75 labels cost                                                                                                   $100 printing supplies   Total new process: $4,730   Cost savings:   $18,418 -$4,730 = $13,688 difference ($13,700) Cost reduction of %74  
This improvement required a minimun investment on research, training by maximizing the use of tools that were already available to both DOH and SCHPS teams.  Maximizing the data collection and label making processes delivered the following: -Allowed our program more time to more effectively track health service data- Our team can quickly identify missing or erred data and communicate with our schools partners to help resolve issues. -Increased accuracy of health service data reported- Health service data helps our School Health Program and school partners identify students’ health needs, drives resource allocation, helps us highlight best practices and ensures we are meeting goals. Increased data accuracy ensures our resources are delivered appropriately to meet students’ health needs, which in turn support successful student academic achievement. Accurate service data is also helping our teams identify future process improvements and service efficiencies. -Reduced screening time for nurses at schools- Nurses can spend less time addressing label errors and can focus on health screening activities, referrals and follow up. -Strengthened collaboration between school district, school health program and department of health- Collaborating with our school district partners on process improvement opportunities, has helped us build communication bridges, strengthen our trust and fostered a productive relationship. Sustainability This process has now been in place for school year 2013-2014 and is ongoing for 2014-2015.  With reduced cost and increased data accuracy and reporting, we expect the system to remain in place.  Our teams continue to evaluate the system and identify additional opportunities to improve. 
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