Louisiana Ryan White Data Workgroup

Louisiana CAREWare Access Network User Training #1:

LaCAN & CAREWare BasicsNovember 2011

1LaCAN OverviewLaCAN data policies & standardsAccessing & navigating CAREWareEntering data

Todays Topics2Mute your phonesWe will have designated times to take questionsFeel free to use chat for questions at any timeA recording of the webinar will be available online

Housekeeping3HIV services data partnership between:

Louisiana STD/HIV Program (aka Part B)

City of New Orleans Office of Health Policy & AIDS Funding (aka NOLA Part A)

City of Baton Rouge Division of Human Development & Services (aka BR Part A)

NO/AIDS Task Force What is LaCAN?4One CAREWare system for LA Ryan White Part A, Part B, & NO/AIDS

Fully networked, all providers see real-time information

Housed at Louisiana STD/HIV Program

Uniform trainings & standards

What is LaCAN?5How big is LaCAN?PartnerCurrently Active CW DomainsClients Served in 2009SHP Part B216,479NOLA Part A113,400BR Part A92,128NO/AIDS21,700Including inactive clients and agencies that are no longer funded, the LaCAN system will start at approximately 30,000 client records.6November 2011 User Trainings:Week of Nov 8: LaCAN Policies & CW Data EntryWeek of Nov 18:HIPAA & Data Sharing in CWWeek of Nov 29:CW Referrals & Custom ReportsProvide user documents and CAREWare manual

December 2011:Begin importing of active domains on rolling scheduleApproximate 2 week downtime per imported agency

Current LaCAN Timeline7January/February 2012:Complete importsEnact services and clinical data sharing in CAREWareStart attaching scanned client documents in CW

February/March 2012: All LaCAN agencies and users online

Current LaCAN Timeline8LaCAN User ResourcesDocuments you are getting today:LaCAN User Manual & PoliciesNew User FormsLaCAN Partner Designations (who to contact first)

Resources being developed:LaCAN website with all documents & web trainingsLaCAN Data Quality Management ManualOnline HIPAA & data security training for new users

9LaCAN Policies & StandardsMinimum requirements for all LaCAN sites

Follow HRSA and grantee requirements

Provide framework for agencies to develop internal policies

10LaCAN Policies & StandardsData Security & Confidentiality (2nd training)Data Sharing in CAREWare (2nd training)Hardware RequirementsRequired Fields & Data Entry TimelinesEntering Client Identifiers & Addresses

11Policy: Hardware RequirementsWindows XP or higherBroadband connectionColor screenLaptops by special approval only12Policy: Required Fields & Data Entry TimelinesProviders are responsible for ensuring their CAREWare data is complete, accurate, & entered in timely manner.These are minimum requirements each agency can implement additional requirements for their staff.

Required fields (see handout):Ryan White Services Report (RSR) fieldsClient Information tabEmergency Contacts tabAdditional fields as required by the LaCAN Partner funding each agency

13Policy: Required Fields & Data Entry TimelinesData Entry Timelines:Enter new clients within 5 business days of enrollmentEnter services by 5th business day of the following monthEnter referrals & referral updates within 5 business days of activityEnter client information changes within 5 business days of receipt of new information (e.g. new insurance, address change)

Extensions may be granted with prior written notice to grantee14Policy: Entering Client Identifiers & AddressesProvides specific guidance on how to enter identifiers required for the client URN and address

Intended to decrease number of duplicate client records in CAREWare

Providers are responsible for reviewing procedure for entering client names, DOBs, gender, and address

15A user may have additional permissions added, depending on role in agency and LaCAN Partner request.Management User

Broad permissions:Add and edit client informationAdd and edit servicesDelete services is dependent upon funderRun all reportsCreate and edit all reportsExport all reportsSet client sharing statusGeneral UserBroad permissions:Add and edit client informationAdd and edit servicesRun all reportsCreate and edit custom and client reportsCreate and edit clinical encounters (for primary care providers)Create and follow-up on referralsSet client sharing statusData Entry UserBroad permissions:View client information Add and edit servicesAdd and edit clinical information if necessaryRun custom reports and other reports if necessaryCAREWare User Types16Your homework after todayReview the LaCAN CAREWare Manual it will provide more in-depth information than todays training

Discuss the policies, procedures, & requirements within your agency make sure you have a plan to meet the minimum requirements

Contact your Designated LaCAN Partner with questions or requests for additional technical assistance

Come back on the 18th for the next training: Data Confidentiality, Security, HIPAA, & Sharing in CAREWare

17To Follow Todays Training in CAREWareIf you have access to LaCAN CAREWare (formerly the Part B system):

Log in with your usual CW username/passwordSelect the LaCAN Demo domain

18

Basics in CAREWareDaniel Anderson, MPHServices Data Management CoordinatorLouisiana HIV/AIDS ProgramLogging InClick the CAREWare icon

Starts on Page 23 of LaCAN ManualBeing Locked Out

Selecting DomainSelect Domain

Your domain or provider must be selected before 20 seconds or the program will close completely out!22Main Menu

Changing PasswordsFrom the main menu click My Settings then Change My Password

CAREWare PasswordsMust not be:User or agency nameLoved ones nameSame as other passwords

Must be:8-16 charactersInclude letters and 2+ non-lettersCase sensitiveChanged every 30 days

Creating Client RecordsSelect Add Client from main menu

-Legal first, middle and last name-Legal DOB dont estimate -Legal gender unless client identifies as transgender Legal-information from an identification card, drivers license, birth certificate, social security card, passport, or some other official document.Starts on Page 30 of LaCAN ManualNamingFirst Name Examples:

Last Name Examples:

See policy on p7 of LaCAN ManualTransgender ClientsFollow Ryan White Services Report (RSR) guidance for entering client gender

If a client is transgender but has not legally changed their name, put their preferred first name in parentheses after their legal first name (e.g., client legally named William but goes by Tanya would be William (Tanya)).

Gender- if a client identifies as transgender or has transitioned to a different sex, select either Transgender Male-to-Female or Transgender Female-to-Male.Creating Client RecordsIf your client is already in CAREWare

Starts on Page 31 of LaCAN ManualCreating Client Records

Return to possible matches w/o creating recordConfirm match & create recordIf your client does not match this oneFinding Clients

Search by full name or partial nameAgency-defined ID, full or partialHRSA-established ID, full or partialUncheck to include inactive clientsWildcard (*) SearchThe wildcard feature allows you to increase the breadth of a search by using the symbol * to replace individual letters, or sequences of letters.

For example, M*cDonald will find both McDonald and MacDonald.

s*t will find'secret', 'serpent', 'sailing boat' and 'sign over document', etc

Client URNCAREWare creates for youExampleJohn Doe 01/01/1980 TransMTFFormula:1st & 3rd characters of first name1st & 3rd characters of last nameBirth dateGender codeJHDE0101804U=Finding ClientsResults matching your criteria appear

To open the clients record, select the client and double click on the clients name or click the Details button. If you want to find someone else, click the New Search button.The Client Record

Starts on Page 36 of LaCAN Manual

The Client Record ContinuedStarts on Page 36 of LaCAN ManualLogging Out

After you close out the client record it will bring you back to the main menu. Select Exit if you would like to completely exit CAREWare. Select Log Off if you would like to just log off your username and keep the CAREWare system open.37Client ID: This field is provider specific.

Address, City, State, Zip Code, County, and Phone Number: Enter the clients address, city, state, and zip code here. Enter the parish name of the client under the county field.

Note: Only use Include label on report checkbox if mail can be sent to the clients address reported.Ethnicity & Race: is based on the clients self-identification.

Note: For Part A New Orleans, enter the UIN number in the client field.

Demographics TabStarts on Page 36 of LaCAN Manual38 Select one of the following options for HIV Status:

HIV StatusHIV Positive (not AIDS)HIV Positive (AIDS status unknown)CDC-defined AIDS) HIV Negative (affected)HIV IndeterminateUnknown

Demographics TabStarts on Page 36 of LaCAN Manual HIV Risk Factors: select all that apply

Demographics Tab

Starts on Page 36 of LaCAN Manual

Demographics TabNotes Fields

Three different types of notes fields in CW:Common Notes, Provider Notes, & Case Notes.

Common Notes: shared across all providers that serve the client so should only include information that all providers need to know.

Starts on Page 36 of LaCAN Manual

Note: Changes to a clients address require a common note.Note: When entering a new common note, begin the note with the date, the name of your agency, and your first and last initials.Ex: 11/1/11 ABC Agency-TW: Updated clients address.If a common note already exists, a new note should be added above the existing one. Provider Notes: can only be viewed and entered by CAREWare users within your provider domain. Each agency can establish its own protocol for the formatting and use of Provider Notes.

To enter a Provider Note, just click on the Provider Notes tab and type in the note.

Demographics TabStarts on Page 36 of LaCAN Manual

CASE NOTESCase Notes can only be viewed and entered by case managers and clinical staff within your provider domain.Users who have permissions to enter case notes will not be able to edit or delete them.

- To enter a case note, click on the Case Notes tab and the following screen will display.

- Click Add.Demographics TabStarts on Page 67of LaCAN Manual

The Case Notes (Rapid Entry) screen will activate.

Enter the Date that corresponds to the case note. Note: the default will be todays date.

- From the Author pull down menu, select your name.

- Type in the case note in the Note field.

- Click Save to save the case note. The saved case note will appear in the list of case notes at the bottom of the screen.

- Click Cancel if you realize youve made mistake and do not want the note to be saved. Remember, you will not be able to edit or delete a case note after its been saved.

- If you would like to add information about a service(s) the client received at your agency, check the box next to Add Service and you will be taken to the Services tab after saving the case note.Purpose: To enter annual information about the clients insurance, housing situation and incomeAnnual Review TabStarts on page 47 of LaCAN Manual

Annual review fields are common or cross provider.

Values changed by one provider will be viewed-and can also be edited-by the next provider, if the same client receives services at two or more providers within the network.

You will not be able to enter any information on the Annual Review tab until youve entered at least oneservice record for a given client in the current calendar year. Note: This is to ensure that the information you enter in the Annual Review screen will only be tallied in the RSR for clients who have received at least one service in that year.

Primary Insurance Select the clients primary source of health insurance at the end of the current six-month reporting period: Medicaid MedicareNo Insurance OtherOther Public (e.g. VA)PrivateUnknown

Annual Review TabInsurance types are defined on page 48Primary HIV Medical Care: Select which setting the client receives their primary HIV medical care. Publicly-funded clinic or health department Private practiceHospital outpatient centerEmergency Room No primary source of careOther Unknown

Annual Review TabHousing /Living Arrangement:Select the response that best describes the clients housing situation at the end of the six-month reporting period. Stable/PermanentNon-permanently HousedInstitutionOtherUnknown/UnreportedUnstable

Annual Review TabLiving arrangements are defined on page 49Household Income:Enter the anticipated annual Household Income for the current year.A family income refers only to the income on which this individual can legally rely on; e.g., includes income of spouse or minor children. Remember that family income is based on the legal definition of family; e.g., if married and both people work, use both incomes. However, if two people live together and share expenses but are not legally married, do not use both incomes.If the household has an intermittent or uncertain income, have the client estimate their current monthly house hold income and multiply by twelve.If the household has no income, put a 0.Annual Review TabPage 51 of LaCAN ManualHousehold SizeIn the Household Size field, enter the number of people of any age (including the client) in the household who are legally dependent on the annual household income.

The response must always be at least 1 for the client.If the client is unclear, ask the client how many family members they are able to claim as dependents on their income taxes.Annual Review TabPage 50 of LaCAN ManualPoverty Level CAREWare will automatically calculate the Poverty Level for you based on the Household Income and Household Size.

Annual Review TabPage 50 of LaCAN ManualAnnual Review Fields for Primary Care Providers

Note: Unless specified by your funder, only agencies funded to provide primary care are required to answer these questions for the RSR. The responses to these fields will be visible to all CAREWare users across providers.Annual Review TabWas Client Counseled about HIV Transmission Risks?Only CAREWare users who are primary care providers should answer this question.Note: HRSA is specifically looking for whether the client was counseled by a primary care clinician. This question should ONLY be answered by the agencies funded to provide primary care.Annual Review TabWho Counseled about HIV Transmission Risks?This field will be activated if you select Yes for the Was Client Counseled about HIV Transmission Risks field.The response options are:Primary care clinicianCase mgr/social workerOther trained counselorUnknownNote: Select Primary care clinician only if the following definition is met: A short questionnaire was administered by a clinician to identify a patient at risk for HIV re-infection or transmission, and the clinician counseled the patient about ways to reduce their risk.

Was Client Screened for Mental Health?Indicate if the client was screened for mental health issues during the current six-month reporting period.The response options are:NoYesNot medically indicatedUnknownAnnual Review TabWas Client Screened for Substance Abuse?Indicate if the client was screened for substance abuse issues during the current six-month reporting period.The response options are:NoYesNot medically indicatedUnknownPart B Providers will continue recording mental health, substance abuse, & domestic violence referral screenings on the Clinical Encounters tab.Page 51 of LaCAN ManualCustom Annual Review Tab

Services TabStarts on Page 40 of LaCAN Manual

Used by all providersOnly apply to your agencyServices TabStarts on Page 40 of LaCAN Manual

Fields shared by all providers:

Year: Defaults to the current year. Must be changed if entering services for a different calendar year.

Vital Status: Dropdown menu field will be shared by all agencies who are serving this client. Indicates whether the client is currently alive. The option Unknown should not be used unless the client has been lost-to-follow-up & you truly dont know their vital status.

Deceased Date: If the clients Vital Status is Deceased, a date of death must be entered here. Services TabStarts on Page 40 of LaCAN Manual

Fields ALWAYS specific to your agency:

Enrl Status: Clients current enrollment status at your agency as a whole. Try not to use Unknown or Inactive/Case Closed these both show as Unknown on the RSR.

Enrl Date: The first date your client entered services at your agency. If a client re-enrolls after being out of service, DO NOT change this date.

Case Closed: If the client is no longer receiving services at your agency, enter the date that their case was closed here. It can be changed if they return to your agency.Entering ServicesStarts on Page 42 of LaCAN Manual

Every service entry has 7 components:

DateDate the service was provided Service Name Service the client received (designated by your funder)ContractWhat funding stream is paying for the service (determined by date & service name) UnitsDetermined by the contract negotiated with your funderPriceThe negotiated price per unit of serviceCostEquals Price * Cost. CAREWare calculates this for you.Custom FieldsAdditional fields required by your funder to complete the service entry (e.g., Staff or Provider Name). Vary based on service.Rapid Service EntryStarts on Page 45 of LaCAN ManualCAREWare Rapid Service EntryAccess from Main Menu -> Rapid Entry Menu -> Rapid Service Entry

Use to enter services without going into the client record

Rapid Service EntryStarts on Page 45 of LaCAN ManualCAREWare Rapid Service EntryAccess from Main Menu -> Rapid Entry Menu -> Rapid Service Entry

Client Information TabStarts on page 75 of LaCAN ManualUsed to record other client information such as who is their case manager, SSN, and mailing preferences. Fields on this tab are shared with and editable by all of the clients providers.

Emergency Contacts Tab

Starts on page 75 of LaCAN ManualAgency Specifics Tab

Fields on this tab are only visible to your agency unless otherwise requested. Contact your LaCAN Partner to have fields added. Starts on page 75 of LaCAN ManualSubformsStarts on page 82 of LaCAN ManualUsed to collect date-specific client information not included in services, referrals, or annual review.

6 Month Eligibility Review SubformHRSAs Monitoring Standards mandate that all Part A & B clients have their eligibility reassessed every 6 months.Starts on page 82 of LaCAN Manual

Entering Clinical DataClinical EncountersVital Signs, Hospital/ER Admissions, Medications, Labs, Screening Labs, Screenings, Immunizations Diagnoses and Case notesHIV C&TPregnancyStarts on page 52 of LaCAN ManualClinical EncountersThe Encounters tab holds clinical and selected assessment data. Agencies with Outpatient/Ambulatory Medical Care or who provide lab services will be able to view and report on this tab.

You must click Create Encounter to begin entering the encounter for Vital Signs, Hospital/ER Admissions, Medications, Labs, Screening Labs, Screenings, Immunizations Diagnoses. The date can be the current or a past date.

Clinical Information is NOT Shared until granted. This information will be covered in the 2nd training (Data Sharing) on November 18th

Medications and Labs will be covered in this training. Please see manual for more details.Starts on page 52 of LaCAN ManualSelecting an Encounter Date

Starts on page 52 of LaCAN Manual70MedicationsMedications are required for providers who provider Outpatient/Ambulatory Medical Care. This is where prescribed medications that a clients has started are recorded.

i.e. HAART, PCP prophylaxis, etc.

Starts on page 52 of LaCAN ManualMedicationsEnter the clients complete medication prescribing history here for antiretroviral and any other medications. For purposes of the RSR, you must enter the clients HIV antiretroviral medications. Date ART 1stPrescribed (antiretroviral therapy) defaults to the date of the first HIV medication entered into CAREWare.

Since many clients may have started ART before they came into your care, this field is editable in the medications Rapid Entry screen, and an earlier date may be entered.

Enter any medication allergies in the Allergies box. This information will carry over into future clinical encounters.

Starts on page 52 of LaCAN Manual

Entering MedicationsEnter the encounter date

Starts on page 52 of LaCAN ManualClients Not Receiving HAARTTreatment not medically indicated per guidelinesClient not ready (as determined by clinician)Client refused therapyOther extenuating circumstances

Starts on page 52 of LaCAN ManualStarting a Medication

Starts on page 52 of LaCAN ManualRegimensSlows down the data entry processOnce a regimen has been created the user can add it to all clients who are currently taking the medication.

Starts on page 52 of LaCAN ManualAdding a Medication

Starts on page 52 of LaCAN ManualStopping a Medication

Starts on page 52 of LaCAN ManualDeleting a Medication

Starts on page 52 of LaCAN ManualLab DataData can be entered manually or uploaded Upload methodsYou must consult your grantee for technical assistanceHL7 InterfaceProvider Data Import (PDI)

Starts on page 52 of LaCAN ManualEntering Lab Data

Starts on page 52 of LaCAN ManualViewing Lab Test Results

Date of testStarts on page 52 of LaCAN ManualLab data uploaded via HL7 InterfaceHL7 imports lab data directly into CAREWare from major US Laboratories. Before data are imported test and clients must be mapped.Mapping must be done with caution to ensure test results are added to the correct clients profile in CAREWare.Mapping Clients

List of clients waiting to be mapped before lab results will import into CAREWareLab data uploaded via PDIThe Provider Data Import (PDI) is designed to provide an easy intermediate step in the complicated process of importing data from other applications into CAREWare. It utilizes an Access database to provide a standard format for data that the CAREWare business tier can then use to populate the CAREWare database.Required PMC dataAgencies with Outpatient/ Ambulatory Medical Care are required to collect and report clinical data to HRSA. See where variables must be entered. TestWhere to enter data in CWCD4 counts and test datesClinical encounter: Lab tab Viral Load counts test datesClinical encounter: Lab tab PCP prophylaxisClinical encounter: Medications (where indication = OI prophylaxis and OI= PCP) Client HAARTClinical encounter: medications tab. HAART is 3 or more ARVs If No ARVs: Enter in Pre-ART Reason field on Medications tab TB Screening and datesClinical encounters, Screenings tabTST, IGRA/QuantiFeron, or Chest Radiograph Syphilis Screening and dates Clinical encounters, Screening Labs tab Hepatitis B Screening and datesClinical encounters, Screening labs tab Hepatitis B vaccine and datesClinical encounters, Immunization tab Hepatitis C Screening and datesClinical encounters, Screening labs tab HIV C&T The HIV Counseling & Testing (C&T) tab can be used to track clients who enter care through an agencys C&T program. It also allows agencies to track C&T for clients who only receive HIV C&T and not any other CARE Act eligible service. Part A uses this module to track and report client utilizing Early Intervention Services.Clients who are entered here will be included in the C&T section of the RSR, but they will not be included in the overall client counts unless they have also received an eligible CARE Act service in the reporting period. Starts on page 65 of LaCAN ManualHIV C&T record added

Starts on page 65 of LaCAN ManualHIV C&T

Starts on page 65 of LaCAN ManualPregnancyPregnancy and prenatal care by clicking on the Pregnancy tab (which only appears for female clients).The following variable are collected on this tabEstimated Conception DateDate client begin Prenatal # of prenatal visitsPregnancy OutcomeDelivery/outcome dateNewborn HIV statusART CounselingART OfferedART TakenDate ART begin

Starts on page 66 of LaCAN ManualPregnancy Tab

Starts on page 66 of LaCAN ManualNext Weeks TrainingHIPAA, Data Security, Confidentiality, & Sharing in CAREWare10AM-12PMNovember 18, 201192