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Office of the Chief Information Officer - Victorian Government Agency Case Studies: School Nurses Information System

Department of Human Services

The Victorian government has always considered the accessibility and quality of health services a top priority. The school nurse program is one element of the Victorian government’s commitment to improve the health and wellbeing of children and young people in schools. The school nurses travel to schools all across Victoria, including rural and regional areas, to provide health services and monitor the health conditions of children in schools. Apart from examining and monitoring the health of the children, the nurses also collect statistical data that assists with planning and projections in the Department of Human Services (DHS).

The old information system used by the school nurses was largely manual and paper-based. The system did not provide administrative support to nurses’ work processes. Data was only collected manually on pre-printed forms, which would then be forwarded, to a central location to be scanned into electronic documents. This process was laborious and inefficient and there was a risk of paper documents being damaged or lost before scanning, and of the security of personal medical information being compromised.

The School Nurse Information System (SNIS) is an electronic information system designed to give school nurses the ability to create and access data on the health of school children. The up-to-date health information also allows the department to more accurately assess funding allocation for health services to schools. The system provides a central data repository to enable better management of data collection and, as well reduces the need for pre-printed stationeries.

In short, SNIS was developed to allow more detailed, accurate and timely management of information through an automated process. On a business level, the benefits of the new system extends in areas of:

• elimination of the manual handling associated with gathering data and producing reports
• reduced requirements for pre-printed stationery. The new systems contains all the forms as electronic templates with the added benefit of being partially completed with client’s name, address, etc.
• more detailed, accurate and timely reporting, available to all parties at the same time through an automated process
• facilitate the availability of data for inter school transfers, worker replacements and at the Nurse Management level.

Currently, the expanding number of system users and health records has challenged the operational capacity of the SNIS database. The future objective of the SNIS project team will be to expand the capacity of the SNIS database to ensure that school health services can be delivered efficiently and effectively throughout Victoria.

"No administrative support for work processes"

The School Nursing Program is a project run by the Rural and Regional Health and Aged Care Division within DHS. The previous paper-based system provided no administrative support for the nurses’ work processes, for example, revisiting schools and individual student follow-up. There were also a number of other issues identified within the business processes of the program, these included:

• lack of formal or uniform procedures for collection of performance statistics across regions
• difficulty of determining where employee nurse were at any time
• reliance on local knowledge regarding new schools
• information on paper-based forms was lost to the nurses after forwarding the forms to head office for processing unless copied and retained locally
• data collected was often incomplete and of dubious quality, and hence of limited value
• potential breach of confidentiality regarding student information, because the files and information would be carried over several days to many different schools with the potential for loss or theft.

Overall, a more effective information system was needed to assist school nurses to collect high quality and relevant data and to provide the data to the head office on a timely manner.

"Replacing existing paper based systems"

The new system, SNIS, involved the introduction of laptop PC for each school nurse to use in their work, replacing existing manual, paper-based systems. A new Lotus Notes application was developed and placed on each laptop to enable the school nurses to capture the student information at the time of their school visit and student assessment. When the nurse returned to an office site and logged on to the central computer system, the information on their laptop PC would be up loaded to a central database which would store and undertake further processing and analysis of the data.

The new system eliminated the need for paper-based returns and the manual processing of those returns to produce reports. It also incorporated significant management and reporting features including:

• immediate data validation (at point of input) to ensure consistently high quality data
• templates to provide standard information to parents, teachers, students and schools and to assist nurses in their work
• capacity for encryption to ensure appropriate and secure data storage and transfer.

There was significant consultation and involvement of school nurses in the development and introduction of the new system.

Major challenges

The principle obstacle faced by SNIS project team was the potential technology resistance from the user group. The introduction of the SNIS is revolutionary for the regional school nurses and the nursing administration. For the project to be successfully implemented, high level of buy-in and support would be required from end users. To address the issue of ownership, the SNIS project team had to ensure participation and communication between all stakeholders of the project.

Investment returns

Service Enhancement

• Expansion of existing service - the use of ICT greatly improves the quality of services delivered by School Nurse Program;
• Responsiveness - With higher data quality, the health system is able to respond quickly to the children in need;
• Quality - Allow the department to deliver higher quality services to the public;
• Convenience - Reduced requirements for pre-printed stationery. The new systems contains all the forms as electronic templates with the added benefit of being partially completed with client's name, address etc.

Financial

• Reduced cost / increased productivity of government - Reduce the need for pre-printed stationery. Streamlined data collection process.

Social Capital

• People to turn for support - Promoting the public health sector to support more children and young people in need.

Organisation Improvement

• Aligned accountability - More detailed, accurate and timely reporting, available to all parties at the same time via an automated process.

Human Resource Development

• Improved technology skills - Elimination of the manual handling associated with gathering data and producing reports.
• Commitment to government strategy - Government objective in the policy "Growing Victoria Together". Higher quality, accessibile health and community services.

Challenges for the future

School Nurse Information System is a successful transformative initiative implemented by the Department of Human Services. Its success has, however, become its greatest problem. The streamline data process created an efficient environment for information collection. With more, high-quality data collected, the capacity of the database is reaching its maximum. The new challenge for the SNIS project team is to combine Lotus Notes application with SQL server, to create greater database storage space to ensure the central database can store increasing volume of data.

School Nurse Information System Contact Details:

Max Walker
Manager Information System & Services
Planning & Resources
Rural & Regional Health & Aged Care Services Division
Department of Human Resources
Email: max.walker@dhs.vic.gov.au

A copy of the School Nurses Information System case study is also available for printing pdf format (this document requires the use of Adobe Acrobat Reader) (218kb).

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