Q: What issues are important to consider when evaluating school health office software?  
A: The following issues are important to consider when looking at school health office software:

• • Password protection: Passwords should be easily remembered but not easily guessed – the best passwords combine simple words and numbers. Passwords should provide different access to specific users – some school employees should be able to view only demographic information to protect the confidentiality, while the school nurse should be the one with full access to health records. Nurses should be sure to know who has access to health records!
  • Rejection: Health record software should be designed to reject a user when multiple attempts are made to enter an improper password to prevent hacking into and unauthorized access to the health records.
  • Authentication: A person’s access should be limited to a specific login name (multiple users should not use the same identity) in order to be able to secure who has accessed the records and/or alter the record.
  • Audit Capability: Each access to the electronic record should record the name of the person accessing the record for security purposes.
  • Health Office Precautions: Arrange the health office with the computer screen facing away from students and staff to discourage viewing of confidential health information. A password-protected screen saver provides security when stepping away from the computer for treatment or other purposes. Discuss with the technology department that the nurse’s computer must not be removed for upgrades or service without managing the integrity of the medical records or deleting the files permanently from the system. Special arrangements must be made if the computer is to leave the district for repair.
  • Overwrite Protection: Software must protect against the record being altered after an entry is made. The software must guarantee that information entered may not be altered after it is entered. 
  • Data Loss and Retention: Files must be backed up in a secure and confidential manner to avoid loss.

 Summary of Software Features:

• Overwrite protection
• Multi-level user access and passwords
• Rejection features
• Authentication

Q: If your district uses Electronic Records, must you also keep a paper cumulative health record?  
A: No, according to the American Health Information Management Association.
“EHRs (Electronic Health Records) are admissible if the system that produced them is shown to be accurate and trustworthy”. On AHIMA’s website is an article, Update: Maintaining a Legally Sound Health Record—Paper and Electronic, which goes into depth about the criteria needed to make sure a record is a sound legal document. 

Q: What documents should be kept as paper copies?
A: A paper copy of:

• • The most recent and complete immunization record
  • The last physical (until the next physical is received) should be kept
  • Other documents such as original medication and treatment orders, PE excuses, copies of the IHP, Emergency Care Plans, and evacuation plans for students with disabilities requiring one should also be kept in a separate file

Q: If the recommended paper documents are uploaded to the Electronic Health Record and can be printed, are paper copies still needed?
A: If a paper document is uploaded and can be printed, it is not required to be kept unless there is an original signature (signed in ink) on it.