1. Louisiana CAREWare Access Network User Training #1: LaCAN & CAREWare Basics November 2011

2. LaCAN Overview LaCAN data policies & standards Accessing & navigating CAREWare Entering data Today’s Topics

3. 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

4. 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?

5. 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?

6. How big is LaCAN? Partner Currently Active CW Domains Clients Served in 2009 SHP Part B216,479 NOLA Part A113,400 BR Part A92,128 NO/AIDS21,700 Including inactive clients and agencies that are no longer funded, the LaCAN system will start at approximately 30,000 client records.

7. 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

8. 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

9. 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: 1.LaCAN website with all documents & web trainings 2.LaCAN Data Quality Management Manual 3.Online HIPAA & data security training for new users

10. LaCAN Policies & Standards Minimum requirements for all LaCAN sites Follow HRSA and grantee requirements Provide framework for agencies to develop internal policies

11. LaCAN Policies & Standards 1.Data Security & Confidentiality (2 nd training) 2.Data Sharing in CAREWare (2 nd training) 3.Hardware Requirements 4.Required Fields & Data Entry Timelines 5.Entering Client Identifiers & Addresses

12. Policy: Hardware Requirements Windows XP or higher Broadband connection Color screen Laptops by special approval only

13. 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

14. Policy: Required Fields & Data Entry Timelines Data Entry Timelines: Enter new clients within 5 business days of enrollment Enter services by 5 th 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

15. 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

16. 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

17. 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 18 th for the next training: Data Confidentiality, Security, HIPAA, & Sharing in CAREWare

18. 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

19. Basics in CAREWare Daniel Anderson, MPH Services Data Management Coordinator Louisiana HIV/AIDS Program

20. Logging In Click the CAREWare icon Starts on Page 23 of LaCAN Manual

21. Being Locked Out

22. Selecting Domain Select Domain

23. Main Menu

24. Changing Passwords From the main menu click “My Settings” then “Change My Password”

25. 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

26. 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. Starts on Page 30 of LaCAN Manual

27. Naming First Name Examples: Last Name Examples: See policy on p7 of LaCAN Manual

28. 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”.

29. Creating Client Records If your client is already in CAREWare Starts on Page 31 of LaCAN Manual

30. Creating Client Records Return to possible matches w/o creating record Confirm match & create record If your client does not match this one

31. 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

32. 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

33. Client URN CAREWare creates for you Example John Doe 01/01/1980 TransMTF Formula: 1 st & 3 rd characters of first name 1 st & 3 rd characters of last name Birth date Gender code JHDE0101804U =

34. Finding Clients Results 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.

35. The Client Record Starts on Page 36 of LaCAN Manual

36. The Client Record Continued Starts on Page 36 of LaCAN Manual

37. Logging Out

38. 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 Tab Starts on Page 36 of LaCAN Manual

39. Select one of the following options for HIV Status: HIV Status HIV Positive (not AIDS) HIV Positive (AIDS status unknown) CDC-defined AIDS) HIV Negative (affected) HIV Indeterminate Unknown Demographics Tab Starts on Page 36 of LaCAN Manual

40. HIV Risk Factors: select all that apply Demographics Tab Starts on Page 36 of LaCAN Manual

41. 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. Starts on Page 36 of LaCAN Manual

42. 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. Demographics Tab Starts on Page 36 of LaCAN Manual

43. CASE NOTES Case 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 Tab Starts on Page 67of LaCAN Manual

44. 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.

45. Purpose: To enter annual information about the client’s insurance, housing situation and income Annual Review Tab Starts on page 47 of LaCAN Manual

46. 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 one service 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.

47. 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 Tab Insurance types are defined on page 48

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

49. 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 Tab Living arrangements are defined on page 49

50. 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 Tab Page 51 of LaCAN Manual

51. 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. Annual Review Tab Page 50 of LaCAN Manual

52. Poverty Level CAREWare will automatically calculate the Poverty Level for you based on the Household Income and Household Size. Annual Review Tab Page 50 of LaCAN Manual

53. 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

54. 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 clinician Case mgr/social worker Other trained counselor Unknown 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.

55. 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: No Yes Not medically indicated Unknown 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: No Yes Not medically indicated Unknown Part B Providers will continue recording mental health, substance abuse, & domestic violence referral screenings on the Clinical Encounters tab.

56. Page 51 of LaCAN Manual Custom Annual Review Tab

57. Services Tab Starts on Page 40 of LaCAN Manual Used by all providersOnly apply to your agency

58. Services Tab Starts 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 don’t know their vital status. Deceased Date: If the client’s Vital Status is “Deceased,” a date of death must be entered here.

59. Services Tab Starts on Page 40 of LaCAN Manual 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.

60. Entering Services Starts on Page 42 of LaCAN Manual Every service entry has 7 components: 1.DateDate the service was provided 2.Service Name Service the client received (designated by your funder) 3.ContractWhat funding stream is paying for the service (determined by date & service name) 4.UnitsDetermined by the contract negotiated with your funder 5.PriceThe negotiated price per unit of service 6.CostEquals Price * Cost. CAREWare calculates this for you. 7.Custom FieldsAdditional fields required by your funder to complete the service entry (e.g., Staff or Provider Name). Vary based on service.

61. Rapid Service Entry Starts 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

62. Rapid Service Entry Starts on Page 45 of LaCAN Manual CAREWare Rapid Service Entry 1.Access from Main Menu -> Rapid Entry Menu -> Rapid Service Entry

63. Client Information Tab Starts 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.

64. Emergency Contacts Tab Starts on page 75 of LaCAN Manual

65. 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

66. Subforms Starts on page 82 of LaCAN Manual Used to collect date-specific client information not included in services, referrals, or annual review.

67. 6 Month Eligibility Review Subform HRSA’s Monitoring Standards mandate that all Part A & B clients have their eligibility reassessed every 6 months. Starts on page 82 of LaCAN Manual

68. Entering Clinical Data Clinical Encounters Vital Signs, Hospital/ER Admissions, Medications, Labs, Screening Labs, Screenings, Immunizations Diagnoses and Case notes HIV C&T Pregnancy Starts on page 52 of LaCAN Manual

69. 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 2 nd training ( Data Sharing) on November 18 th Medications and Labs will be covered in this training. Please see manual for more details. Starts on page 52 of LaCAN Manual

70. Selecting an Encounter Date Starts on page 52 of LaCAN Manual

71. 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…. Starts on page 52 of LaCAN Manual

72. 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. Starts on page 52 of LaCAN Manual

73. Entering Medications Enter the encounter date Starts on page 52 of LaCAN Manual

74. Clients Not Receiving HAART Treatment not medically indicated per guidelines Client not ready (as determined by clinician) Client refused therapy Other extenuating circumstances Starts on page 52 of LaCAN Manual

75. Starting a Medication Starts on page 52 of LaCAN Manual

76. 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. Starts on page 52 of LaCAN Manual

77. Adding a Medication Starts on page 52 of LaCAN Manual

78. Stopping a Medication Starts on page 52 of LaCAN Manual

79. Deleting a Medication Starts on page 52 of LaCAN Manual

80. 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) Starts on page 52 of LaCAN Manual

81. Entering Lab Data Starts on page 52 of LaCAN Manual

82. Viewing Lab Test Results Date of test Starts on page 52 of LaCAN Manual

83. 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 must be done with caution to ensure test results are added to the correct client’s profile in CAREWare.

84. Mapping Clients List of clients waiting to be mapped before lab results will import into CAREWare

85. 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.

86. 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. TestWhere to enter data in CW CD4 counts and test datesClinical encounter: Lab tab Viral Load counts test datesClinical encounter: Lab tab PCP prophylaxis Clinical encounter: Medications (where indication = OI prophylaxis and OI= PCP) Client HAART Clinical encounter: medications tab. HAART is 3 or more ARVs If No ARVs: Enter in Pre-ART Reason field on Medications tab TB Screening and dates Clinical encounters, Screenings tab TST, IGRA/QuantiFeron, or Chest Radiograph Syphilis Screening and datesClinical 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

87. 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. Starts on page 65 of LaCAN Manual

88. HIV C&T record added Starts on page 65 of LaCAN Manual

89. HIV C&T Starts on page 65 of LaCAN Manual

90. 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 Starts on page 66 of LaCAN Manual

91. Pregnancy Tab Starts on page 66 of LaCAN Manual

92. Next Week’s Training HIPAA, Data Security, Confidentiality, & Sharing in CAREWare 10AM-12PM November 18, 2011