Medical clinics and hospitals throughout the United States are being tasked to find an electronic medical record (EMR) vendor, contract with them, and initiate an electronic medical record system. Student health centers are not any different. I am going to outline how we initiated an EMR system at a student health center. I will address the different systems that had to be integrated, what those systems are and some of the challenges that had to be addressed during the integration. The student health center (SHC) that I will be discussing is on a health science campus and serves a population of about 3200 graduate students who are studying in a health field. This center only sees students from the health science campus. No faculty, staff or outside persons or student from the larger sister campus are allowed to be seen at this facility. The SHC sees about 11000 visits annually. Obviously, because it is a student health center the volume is higher at the beginning of the school year and the end but is very light during the summer months. The staff comprises 5 Medical Assistants who run both the front office and the back office, an immunization coordinator, a project manager, and a clinic manager. The provider mix is diverse, consisting of 1 full time family medicine physician, a part time internal medicine physician, 2 GYN’s, 1 dermatologist, 1 nutritionist, 3 psychologists and 1 psychiatrist. There are also a number of per diem providers to fill in when one of the other providers are out. The SHC is unique in a number of ways. The SHC budget is completely funded by the Student Health Fee (SHF), a mandatory fee that the University sets. Every student enrolled at the University is mandated to pay the SHF. Because of this fee, many of the services provided to the students are free of cost. For example, there is no cost for the visit to the provider, for X-rays, or any counseling visits. However, there is a charge for other services like laboratory tests or immunizations. Another way the SHC is unique is that we do not bill the patient’s insurance company for services not covered under the SHF. If the student has the University Student Insurance, only immunizations can be automatically billed to their insurance via an interface that I will discuss more a bit later. If the student does not have the University Student Insurance, then they would have to pay for the service out of pocket and submit a claim to their own insurance. Lastly, the SHC is unusual is because we only see University students. I know I said this already, but there is another aspect of it that needs explaining. The SHC only sees current students, so if the student has been seen by a physician or counselor, but is no longer a University student, they cannot be seen at the SHC. The payment of the SHF allows a student to be seen. If the fee is not paid, a student cannot be seen. These last 2 points are important to draw attention to because of the systems that have to be integrated into the EMR in order to minimize confusion and allow the SHC to be able to see the students. Electronic Medical Records The EMR chosen for our SHC is called Point and Click. This system was chosen because it advertised itself as a Student Health Center system. It was designed and is maintained as a system that understands the intricacies of the student health populations. This system was already employed at the sister campus that had a population of 40,000+ students. When we decided to get an EMR, we contacted the other campus and asked to share their instance of the EMR. This would mean that we use the same system just in a different location. This agreement was great at first. Many items, such as provider templates, schedules, billing, had been established because they had been on the system for over a year prior to us. The drawback was only seen years later when the obvious difference in how the system was used between the two sites became apparent. At that time, the two student health centers split and each went on their own instance. Registration As I mentioned before, the status of the student was important as to whether we could see them and provide services to them or not. Because of this, there had to be a robust interface between the EMR and the registration system of the University. The EMR that we choose stated they could do this. The system not only had to talk to the registration system and let us know if the student was an active student, but it also had to tell us if the student had paid the SHF. Another aspect that we needed the system to do was the ability to link to the bursar’s office at the university. We needed to be able to place bills onto the student’s university account and/or pay bills that were on their account from our system. The EMR that we choose was one of the few that could not only do this, but had done it in a number of other universities around the US. Insurance The insurance interface is one that is fairly new.