Training Attendance Essential with Enhanced Health Record System

By Editor Ken Harvey

Enhancements in the online migrant information system will simplify work for migrant record clerks in the long run but mandates attendance at this year’s regional training workshops, says Mike Taylor, Migrant Health State Supervisor.

One reason the training is essential is so local staff understands related federal regulations to keep themselves and their school districts in compliance.

The federal No Child Left Behind Act (NCLB) requires local education agencies (LEAs) to provide migrant students with health care assistance, as well as to gather and transfer health information through the Migrant Student Data and Recruitment (MSDR) information system – the Migrant Student Information System (MSIS) -- to other education agencies.

However, conflicting federal laws have state officials wondering just how to fulfill the requirements.

NCLB dictates that LEAs provide "advocacy and outreach activities for migratory children and their families … helping such children and families gain access to … health, nutrition and social services" (Section 1304, Part C).

"Unless children have their most basic needs met," Mr. Taylor says, "they are not going to be healthy and reach their full potential."

"The only way I have figured to accomplish this is to create partnerships," Mr. Taylor adds. The partnerships involve parents, LEAs, the Department of Social and Health Services (DSHS) Medical Assistance Administration, and Basic Health (insurance), and medical providers, who deliver services.

School-based physical and dental exams are provided to thousands of migrant children each year in a cooperative effort coordinated by the Migrant Education Health Program (MEHP). The agency now has over 80 school districts involved in its program, with over 20 health providers from 40 clinic locations providing school-based examinations and follow-up care.

Of the children examined, a high percent have health problems serious enough to be referred for follow-up, Mr. Taylor notes.

Migrant children are particularly at risk because of low income, increased isolation, language and cultural barriers, eligibility requirements, discrimination and a mobile lifestyle. Mobility compounds migrant students’ health problems further because families frequently are not connected to a community, they do not have a family doctor, dentist, or a documented medical history to share with health providers when they move to a new area.

For this reason the NCLB law also mandates "interstate and intrastate coordination of services for migratory children, including how… the State will provide for educational continuity through the timely transfer of pertinent school records, including information on health, when children move form one school to another" (Section 1304, Part B).

Questions arise, however, because the HIPAA (Health Insurance Portability and Accountability Act) for reasons of confidentiality makes it difficult to transfer health information without specific and timely authorization by individuals for release of records.

But a third federal law, FERPA (Family Educational Rights and Privacy Act) passed prior to HIPAA, indicates that agencies CAN transfer health information as long as it is part of an educational record, Mr. Taylor explains.

"We have three laws – the No Child Left Behind Act, HIPAA and FERPA -- that often conflict, and state officials are unsure which law takes precedence in a given situation," Mr. Taylor says.

He hopes the NCLB and FERPA regulations will take priority because they are more flexible than HIPAA in the electronic transfer of student education/health records. His office is working with the MSDR office to develop the best migrant student health records database in the nation – no matter which regulations they are required to follow.

Currently, Mr. Taylor and other state officials are presuming the worst-case scenario. They have already transferred existing data required by NCLB into MSDR’s MSIS database, which also contains demographic, assessment, transcript, transfer and other education-related records.

"We are hands-down the best system in the nation," says MSDR Director Lee Campos, describing how other states are now coming to Washington for help in establishing or enhancing their migrant record systems.

At the Statewide MSDR Conference, attending record clerks and home visitors were provided some training on how to gather, input, extract and transfer migrant students’ education and health information.

"No one else in the country is doing this yet," Mr. Taylor says, referring to the HIPAA compliance health portion of the information system.

Regional training workshops for federal project directors, migrant record clerks, home visitors, school nurses and other school officials involved in providing the health screenings is provided yearly to update them on new programs, regulations, insurance coverage, record-keeping, local health district services including immunizations and tuberculosis control, MSDR services, and other issues, Mr. Taylor says.

One specific item that needs to be covered in the training is the new updated electronic summary/claim, Permission to Examine, and Authorization for Release of Health Care Information Forms. Mr. Taylor hopes to have the conflict in federal laws resolved before the trainings so the forms can be finalized.

Working with Mr. Taylor in establishing the online database is programmer Shaoshu Jiang of MSDR. The support of MSDR and Lee Campos has been marvelous, Mr. Taylor says. "They are an exemplary organization."

The key electronic form and procedures influenced by the HIPAA and FERPA relate to parent permission to examine and electronically transfer student health information.

"The MSIS system is going to fill this form out," Mr. Taylor explains. "All the critical data, such as names, addresses and birth dates will be filled in. The only thing you have to fill in is which parent is interviewed. Then the parent will have to sign it. And it will have to be witnessed."

And if over a certain age, the student will have to sign the form, as well, the MEHP director explains. The parent can no longer sign for older students on issues relating to HIV/AIDS, sexually transmitted diseases, alcohol, and mental health.

This year’s trainings begin in Yakima on Sept. 13. A schedule of regional trainings for the 2005-06 school year is located at www.ncesd.org/migranthealth, along with health provider information, physical examination dates, and other health and program related information.

"The whole vision is to take all the data that comes into the MSIS and slide that data into one spot for reports, etc.," Mr. Taylor says. "We focus on the bonding of health and education."

"This is a way to comply with the law. Then everyone will be in compliance and students will realize the full benefits the program has to offer," Mr. Taylor says.

The enhanced online database is tying together previously separate and distinct systems – including the main MSIS database -- so record clerks and other officials don’t have to input the same information more than once.

"We are going to make it as simple as possible for you. But people have to come to the training this year," Mr. Taylor urges.

"You can send as many people as you would like," he says, but all federal project directors, record clerks and home visitors should attend in order to avoid unnecessary complications. We are always available to answer subsequent questions.

Mr. Taylor and the MSDR staff have been working hard to refine the process.

"Mike calls me 10 times a day to make improvements, and it takes more time to tell him no than to just do it," says Mr. Jiang.

The improved information system will save record clerks a lot of time, says Mr. Campos, the MSDR director. "This will help the record clerks a lot, but now you need to start cross-checking your information. We want to make sure this is as easy as possible for you, but we also have to make sure it is accurate. There is more time now to monitor the data."

MEHP HONORS DENTAL HEALTH PROVIDERS

The Migrant Education Health Program (MEHP) uses flexible partnerships to provide physical exams and related health services exams at no cost to thousands of migrant students every year.

"This is the epitome of a collaborative effort. We partner with every organization we can that helps improve health care to migrant children," says Supervisor Mike Taylor.

Federally funded community and migrant health centers are a vital part of the network MEHP has developed, says Mr. Taylor. They provide the majority of school-based exams for us and then needed follow-up care.

"If insurance does not provide follow-up coverage, the federally funded clinics provide services with a sliding scale fee. The families typically don’t have to pay more than 25 percent, and often that is forgiven if families cannot pay," Mr. Taylor says.

Health problems diagnosed during these exams frequently include: dental disease, positive tuberculosis skin tests, anemia, visual problems, obesity, skin problems, abnormal physiological development, heart murmurs and asthma, according to Mr. Taylor.

"It is not that parents don’t want to care for the health of their children," he says. "There are just a lot of barriers out there that they are forced to contend with."

Of increasing priority to MEHP is providing dental health care to migrant students. Health checkups provided through MEHP have found poor dental health to rank at the top of all health problems for the 15 years that Mr. Taylor has been involved in the program.

Comprehensive dental services are a new part of the MEHP-coordinated services. "Things started out slow last year, but by the end of the school year, it was amazing," he says.

He honored six dental health partners with the Health Provider of the Year Award at the Statewide MSDR Conference in August.

"In past years we have honored one provider, but these folks provided so much care, we could not signal one out over the others," Mr. Taylor says.

The Washington Dental Service SmileMobile, Moses Lake Community Health Center, Family Health Centers in Okanogan, Columbia Valley Community Health Services in Wenatchee and Chelan, La Clinica in Pasco, and Columbia Basin Health Association in Othello were co-recipients of the award for together donating over $100,000 in no-cost dental services to migrant children, Mr. Taylor says.

Attending the conference to receive the awards were: Carmen Garcia, Columbia Valley Community Health Center; RexAnne Hennigs, Family Health Centers; Monika Foro, Washington Dental Service SmileMobile; Azure Buckenberger, CHC La Clinica; Carla McKean, Moses Lake Community Health; and Dora Beraza, Columbia Basin Health Association.