CAREWare Overview Part A Training July 31, 2013

1. CAREWare OverviewPart A TrainingJuly 31, 2013 John Milberg Division of Policy and Data U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Rockville, MD

2. Presentation Goals • Provide brief history and context for development of CAREWare • Describe main features and software development model • Describe users • Discuss the role and future of CAREWare in a rapidly changing health information technology (HIT) world

3. Why CAREWare Was Developed • Concern over data quality reported to Bureau (1999-2000) • Need for a standardized tool to report on services delivered, demographics, basic clinical information • Limited resources and time to build and/or purchase their own system • Ensure that aggregate data reports were derived directly from client-level data, resulting in more reliable data

4. What It Is – What It Does • An electronic health and services information system developed by the HIV/AIDS Bureau made available for free to our grantees and providers • First released in 2000 in MS-Access; rebuilt in 2005 in VB .NET with SQL Server database • Allows providers to produce all reports required by HAB and track client demographics, services, clinical information, referrals, etc. • Contains comprehensive customizable reporting functionality, including a performance measures module to track the quality of care • Can be configured to run as a standalone or under a comprehensive wide area network administered by a state, city, or group of clinics/providers

5. What It Is Not! • CAREWare is NOT a certified EMR/EHR • It is not mandated by the HIV/AIDS Bureau. HAB only mandates what data are reported to us, not how you collect and report that data

6. Features • Collects: • Demographics • Longitudinal data on services, medications, lab, screenings, diagnoses, immunizations • Appointment scheduler • Extensive custom fields • Referrals • Reports: • HAB required outputs (client-level export, ADAP); HOPWA • Custom reports module • Performance Measures module, including pre-built HAB performance measure • Clinical encounter reports for managing HIV care

7. Features and Security Imports: • Data from EMRs/EHRs • Labs (HL7-formatted data from LabCorp and Quest) Provides security: • Standard password protection, rule-based access rights • Uses native .NET encryption • Network configurations typically use a VPN, Citrix, or other private security tools • Accommodates HIPAA security guidelines

8. Main Demographic Screen

9. Performance Measures Module

10. Performance Measures Module

11. Who Uses It? • 51 percent of all Ryan White Program-funded grantees and providers to submit their required client-level data (958 of 1870 providers in 2010) • 56 percent of outpatient ambulatory care providers • Providers in 48 states, Puerto Rico, Guam, and the U.S. Virgin Islands • In 17 states (and PR, VI, and Guam), it was used by 100 percent of providers to submit their data

12. Who Uses It/How Configured? • Configured as a centralized network in 21 States: Arizona, Connecticut, Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Maine, Minnesota, Mississippi, North Carolina, New Jersey (in process), New Mexico, Nevada, Ohio (in process), Oregon, Pennsylvania (in process), Puerto Rico, Tennessee, and Washington Cities: Denver, CO; New Haven, CT; Oakland, CA; Philadelphia, PA • 17 state grantees to manage their AIDS Drug Assistance Programs • International clinics funded by PEPFAR in Barbados, Nigeria, Uganda, and Vietnam

13. Percent of all Ryan White Program Providers/Grantees (N=1870) that used CAREWare to submit year-end data report: 2010 P.R.

14. Number of (duplicated) clients (N=800,580) reported by Ryan White Program Grantees/Providers using CAREWare: 2010

15. How Much Client Data? • 360,756 duplicated* client records were submitted from 958 CARE Act-funded providers using CAREWare in 2010 • That represents 45 percent of all client records submitted *A client can visit multiple providers and, therefore, will have a record submitted from each, hence his or her record will be “duplicated”

16. How CAREWare Fits into the Larger HIT Environment • Many agencies import data into CAREWare from other applications, primarily EMRs • Electronic download of laboratory test results from LabCorp and Quest, using data in HL7 format, active in over 20 sites • Performance measures module provides functionality to produce outcome rates with formal numerators and denominators

17. A Typical Ryan White Program Network Configuration Labs Primary care Mental Health Provider Substance abuse counselor Central Administrator (Grantee at state/city/clinic) Primary care Primary care

18. Future Issues and Developments: Internal and External Factors • Interoperability-Primary concern expressed on the CAREWare item on the Listserv • Patient-centered health information. Giving clients access electronically to their record • ICD-10 requirements and “cross-walking” with ICD-9 • Coordinate with Federal HIT initiatives and principles

19. Contact Information • John Milberg- HRSA, HIV/AIDS Bureau, Division of Science and Policy • Email: jmilberg@hrsa.gov • CAREWare Website: http://hab.hrsa.gov/manageyourgrant/careware.html