louisiana careware access network user training #1: lacan & careware basics november 2011

Louisiana CAREWare Access Network User Training #1:

LaCAN & CAREWare Basics

November 2011

• LaCAN Overview

• LaCAN data policies & standards

• Accessing & navigating CAREWare

• Entering data

Today’s Topics

• Mute your phones

• We will have designated times to take questions

• Feel free to use chat for questions at any time

• A recording of the webinar will be available online

Housekeeping

HIV 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?

• One 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?

How big is LaCAN?Partner Currently Active

CW DomainsClients Served

in 2009

SHP Part B 21 6,479

NOLA Part A 11 3,400

BR Part A 9 2,128

NO/AIDS 2 1,700

Including inactive clients and agencies that are no longer funded, the LaCAN

system will start at approximately 30,000 client records.

November 2011 User Trainings:

Week of Nov 8: LaCAN Policies & CW Data Entry

Week of Nov 18: HIPAA & Data Sharing in CW

Week of Nov 29: CW Referrals & Custom Reports

Provide user documents and CAREWare manual

December 2011:

Begin importing of active domains on rolling schedule

Approximate 2 week downtime per imported agency

Current LaCAN Timeline

January/February 2012:

Complete imports

Enact services and clinical data sharing in CAREWare

Start attaching scanned client documents in CW

February/March 2012:

All LaCAN agencies and users online

Current LaCAN Timeline

LaCAN User Resources

Documents you are getting today:1. LaCAN User Manual & Policies

2. New User Forms

3. LaCAN Partner Designations (who to contact first)

Resources being developed:4. LaCAN website with all documents & web trainings

5. LaCAN Data Quality Management Manual

6. Online HIPAA & data security training for new users

LaCAN Policies & Standards

• Minimum requirements for all LaCAN sites

• Follow HRSA and grantee requirements

• Provide framework for agencies to develop internal policies

LaCAN Policies & Standards

1. Data Security & Confidentiality (2nd training)

2. Data Sharing in CAREWare (2nd training)

3. Hardware Requirements

4. Required Fields & Data Entry Timelines

5. Entering Client Identifiers & Addresses

Policy: Hardware Requirements

• Windows XP or higher

• Broadband connection

• Color screen

• Laptops by special approval only

Policy: Required Fields & Data Entry Timelines

• Providers 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) fields• Client Information tab• Emergency Contacts tab• Additional fields as required by the LaCAN Partner funding

each agency

Policy: Required Fields & Data Entry Timelines

Data Entry Timelines:• Enter new clients within 5 business days of enrollment• Enter services by 5th business day of the following month• Enter referrals & referral updates within 5 business days of

activity• Enter 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 grantee

Policy: Entering Client Identifiers & Addresses

• Provides 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

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

Management User Broad permissions:•Add and edit client information•Add and edit services•Delete services is dependent upon funder•Run all reports•Create and edit all reports•Export all reports•Set client sharing status

General User Broad permissions:•Add and edit client information•Add and edit services•Run all reports•Create and edit custom and client reports•Create and edit clinical encounters (for primary care providers)•Create and follow-up on referrals•Set client sharing status

Data Entry User Broad permissions:•View client information •Add and edit services•Add and edit clinical information if necessary•Run custom reports and other reports if necessary

CAREWare User Types

Your homework after today

• Review the LaCAN CAREWare Manual – it will provide more in-depth information than today’s 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

To Follow Today’s Training in CAREWare

If you have access to LaCAN CAREWare (formerly the Part B system):

1. Log in with your usual CW username/password

2. Select the “LaCAN Demo” domain

Basics in CAREWare

Daniel Anderson, MPHServices Data Management CoordinatorLouisiana HIV/AIDS Program

Logging In

• Click the CAREWare icon

Starts on Page 23 of LaCAN Manual

Being Locked Out

Selecting Domain

• Select Domain

Main Menu

Changing Passwords

• From the main menu click “My Settings” then “Change My Password”

CAREWare Passwords

Must not be:• User or agency name• Loved one’s name• Same as other

passwords

Must be:• 8-16 characters• Include letters and 2+

non-letters• Case sensitive• Changed every 30 days

Creating Client Records

Select “Add Client” from main menu

-Legal first, middle and last name

-Legal DOB – don’t estimate

-Legal gender unless client identifies as transgender

Legal-information from an identification card, driver’s license, birth certificate, social security card, passport, or some other official document.


Naming

• First Name Examples:

• Last Name Examples:

See policy on p7 of LaCAN Manual

Transgender Clients

• Follow 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”.


If your client is already in CAREWare



Return to possible matches w/o creating record

Confirm match & create record

If your client does not match this one

Finding Clients

Search by full name or partial name

Agency-defined ID, full or partial

HRSA-established ID, full or partial

Uncheck to include inactive clients

Wildcard (*) Search

The 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 URN

• CAREWare creates for you

Example

John Doe 01/01/1980 TransMTF

Formula: 1st & 3rd characters of first name 1st & 3rd characters of last name Birth date Gender code

JHDE0101804U

=

Finding ClientsResults matching your criteria appear

To open the client’s record, select the client and double click on the client’s name or click the “Details” button. If you want to find someone else, click the “New Search” button.

The Client RecordStarts on Page 36 of LaCAN Manual

The Client Record ContinuedStarts on of LaCAN Manual

Logging Out

Client ID: This field is provider specific.

Address, City, State, Zip Code, County, and Phone Number: Enter the client’s 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 client’s address reported.Ethnicity & Race: is based on the client’s self-identification.

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

Demographics TabStarts on Page 36 of LaCAN Manual

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 Indeterminate

Unknown


HIV Risk Factors: select all that apply


Demographics Tab

Notes 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.


Note: Changes to a client’s 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 client’s 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.


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 today’s 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 you’ve 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 it’s 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 client’s insurance, housing situation and income

Annual 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 you’ve 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 client’s primary source of health insurance at the end of the current

six-month reporting period:

Medicaid

Medicare

No Insurance Other

Other Public (e.g. VA)

Private

Unknown

Annual Review TabInsurance types are defined on page 48

Primary HIV Medical Care: Select which setting the client receives their primary HIV medical care.

• Publicly-funded clinic or health department

• Private practice

• Hospital outpatient center

• Emergency Room

• No primary source of care

• Other

• Unknown

Annual Review Tab

Housing /Living Arrangement:

Select the response that best describes the client’s housing situation at the end of the six-month reporting period.

Stable/Permanent

Non-permanently Housed

Institution

Other

Unknown/Unreported

Unstable

Annual Review TabLiving arrangements are defined on page 49

Household 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 Manual

Household Size

In 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.


Poverty Level CAREWare will automatically calculate the Poverty Level for you

based on the Household Income and Household Size.


Annual 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 Tab

Was 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 Tab

Who 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 counselorUnknown

Note: 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 indicatedUnknown

Annual Review Tab

Was 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 indicatedUnknown Part B Providers will continue recording mental

health, substance abuse, & domestic violence referral screenings on the Clinical Encounters tab.

of LaCAN ManualCustom Annual Review Tab

Services TabStarts on Page 40 of LaCAN Manual

Used by all providers Only apply to your agency


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 don’t know their vital status.

Deceased Date: If the client’s Vital Status is “Deceased,” a date of death must be entered here.


Fields ALWAYS specific to your agency:

Enrl Status: Client’s 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:

1. Date Date the service was provided

2. Service Name Service the client received (designated by your funder)

3.Contract What funding stream is paying for the service (determined by date & service name)

4. Units Determined by the contract negotiated with your funder

5. Price The negotiated price per unit of service

6. Cost Equals Price * Cost. CAREWare calculates this for you.

7. Custom Fields Additional 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 Manual

CAREWare Rapid Service Entry

1. Access 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 Manual

CAREWare Rapid Service Entry

1. Access from Main Menu -> Rapid Entry Menu -> Rapid Service Entry

Client Information TabStarts on page 75 of LaCAN Manual

Used 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 client’s providers.

Emergency Contacts TabStarts on page 75 of LaCAN Manual

Agency 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 Manual

SubformsStarts on page 82 of LaCAN Manual

Used to collect date-specific client information not included in services, referrals, or annual review.

6 Month Eligibility Review Subform

HRSA’s Monitoring Standards mandate that all Part A & B clients have their eligibility reassessed every 6 months.


Entering Clinical Data

• Clinical Encounters• Vital Signs, Hospital/ER Admissions, Medications, Labs, Screening

Labs, Screenings, Immunizations Diagnoses and Case notes

• HIV C&T

• Pregnancy


Clinical Encounters• The 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.


Selecting an Encounter DateStarts on page 52 of LaCAN Manual

Medications

• Medications 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….


Medications• Enter the client’s complete medication prescribing history here for

antiretroviral and any other medications. For purposes of the RSR, you must enter the client’s 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.


Entering Medications

• Enter the encounter date


Clients Not Receiving HAART

• Treatment not medically indicated per guidelines

• Client not ready (as determined by clinician)

• Client refused therapy

• Other extenuating circumstances


Starting a MedicationStarts on page 52 of LaCAN Manual

Regimens

• Slows down the data entry process

• Once a regimen has been created the user can add it to all clients who are currently taking the medication.


Adding a MedicationStarts on page 52 of LaCAN Manual

Stopping a MedicationStarts on page 52 of LaCAN Manual

Deleting a MedicationStarts on page 52 of LaCAN Manual

Lab Data

• Data can be entered manually or uploaded

• Upload methods• You must consult your grantee for technical assistance

• HL7 Interface• Provider Data Import (PDI)


Entering Lab DataStarts on page 52 of LaCAN Manual

Viewing Lab Test Results

Date of test


Lab data uploaded via HL7 Interface

• HL7 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 client’s profile in CAREWare.

Mapping Clients

List of clients waiting to be mapped before lab results will import into CAREWare

Lab data uploaded via PDI

• The 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 data

• Agencies with Outpatient/ Ambulatory Medical Care are required to collect and report clinical data to HRSA.

• See where variables must be entered.

Test Where to enter data in CW

CD4 counts and test dates Clinical encounter: Lab tab

Viral Load counts test dates Clinical 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 tab

TST, IGRA/QuantiFeron, or Chest Radiograph

Syphilis Screening and dates Clinical encounters, Screening Labs tab

Hepatitis B Screening and dates Clinical encounters, Screening labs tab

Hepatitis B vaccine and dates Clinical encounters, Immunization tab

Hepatitis C Screening and dates Clinical 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 agency’s 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.


HIV C&T record addedStarts on page 65 of LaCAN Manual

HIV C&TStarts on page 65 of LaCAN Manual

Pregnancy

• Pregnancy and prenatal care by clicking on the Pregnancy tab (which only appears for female clients).

• The following variable are collected on this tab• Estimated Conception Date• Date client begin Prenatal • # of prenatal visits• Pregnancy Outcome• Delivery/outcome date• Newborn HIV status• ART Counseling• ART Offered• ART Taken• Date ART begin


Pregnancy TabStarts on page 66 of LaCAN Manual

Next Week’s Training

HIPAA, Data Security, Confidentiality, & Sharing in CAREWare

10AM-12PMNovember 18, 2011