eHARS to CAREWare Pilot Project Update and Training 6/9/2015

Agenda and Objectives Review background information (purpose, benefits) Review pilot project timeline Check-in with Providers Training: Where to access the data Limitations Reports Examples Feedback, Questions, Discussion Next Steps

Background: Purpose Share Limited Surveillance Data for Clients Who Give Consent: HIV diagnosis date/AIDS diagnosis date/HIV status will be viewed by all staff in provider domains that serve the client All CD4 labs (date, type of test, result)/All viral load labs (date, type of test, result) will only be viewed by case managers and clinical staff in provider domains that serve the client Vital status and date of death Note: HIV/AIDS Surveillance System = eHARS (enhanced HIV/AIDS Reporting System)

Background: Benefits More efficient information management Case managers won’t have to spend time calling clinics for lab results Clinic staff won’t have to spend time calling case managers back with lab results Providers will have easy access to diagnosis dates Improved Client Care Easy availability of CD4 and viral load values will strengthen case managers’ ability to coordinate HIV medical care and monitor clients’ health status and quality of care Case manager access to clinical indicators will benefit client health by improving retention in care and treatment adherence support Increased Understanding Availability of diagnosis dates, CD4 and VL data will strengthen grantees’ ability to evaluate linkage and retention in care, community viral load, and missing data for those clients served by Ryan White/state funding. This could eventually impact funding for the TGA.

Timeline Date Activity November 2014 Pilot sites begin collecting ROIs from MCM clients Nov/Dec 2014 MDH does match between eHARS and CAREWare January 2015 MDH tests importing data on test site First check-in conference call with pilot sites February 2015 June 2015 Training with pilot sites on how to interpret and use the data March 2015 MDH does first import of data into MN CAREWare Second check-in conference call with pilot sites TBD MDH does second import of data into MN CAREWare In-person debrief with pilot sites July 2015 Rollout of project with all MCM sites

Check-In with Providers How is the pilot going? Struggles, successes, ideas?

Surveillance data in careware Corelle Nakamura HIV/AIDS Surveillance Student Worker Minnesota Department of Health

Training Overview HIV/AIDS Surveillance Interpreting eHARS data What is it? Why do we do it? Who is included? Interpreting eHARS data Limitations eHARS data in CAREWare Where to find it? What it looks like? Generating Reports in CAREWare

Training Overview HIV/AIDS Surveillance Interpreting eHARS data What is it? Who is included? Why do we do it? Interpreting eHARS data Limitations eHARS data in CAREWare Where to find it? What it looks like? Generating Reports in CAREWare

What is Epidemiology? Study of health and disease in populations Describe the patterns of disease occurrence Person (e.g. gender, age, race/ethnicity, etc.) Place (e.g. Minneapolis, Greater MN) Time (e.g. trends between 1990 and 2000) Analyze data to understand the causes of these disease patterns.

What is HIV/AIDS Surveillance? The on-going and systematic collection, analysis, interpretation, dissemination and evaluation of population-based information about persons infected with HIV or diagnosed with AIDS.

HIV/AIDS Surveillance System AIDS reportable since 1982 (U.S.) HIV infection reportable since 1985 (MN) Active and Passive data collection Attempt to interview all new cases Continuously updated

Who is included in the HIV/AIDS Surveillance System? All HIV- infected Persons Living in Minnesota Surveillance All tested and reported HIV-infected Persons

The Surveillance Process Continuous data collection Pool of data available for analysis Analysis Decisions

Why should we care about statistics? The number of people living with HIV/AIDS (prevalence) impacts prevention. Higher “pool of infection” among certain communities makes it more likely that transmission will occur. Looking at new cases (incidence) helps us identify emerging trends in the epidemic.

Why do HIV/AIDS Surveillance? Monitor the incidence and prevalence of HIV/AIDS Identify changes in trends of HIV occurrence Target prevention interventions Allocate funds for health and social services important changes in trends to allow investigation and intervention.  Develop information needed to design and target prevention and control programs and policies.  Develop information needed to support evaluation of disease prevention and control programs. Surveillance plays a role in research and policy by:  Collecting information about their occurrence (quantify morbidity and mortality)  Monitoring for changes (identification of risk factors or evaluation of prevention efforts)  Serving as foundation for specific research (hypothesis generation, providing data)  Providing data for use in education and health policy decisions *examples- emerging and re-emerging

How is the data used? Surveillance data is used to create the Epi profile, a yearly update that describes new HIV infections and those living with HIV/AIDS in MN. The Epi Profile helps to identify who is in need of prevention and care services, and is thus used by both the CCCHAP and the Minnesota HIV Services Planning Council in their consideration of which prevention and care services are needed. Annual report: slides, tables, narrative & webinar (archive) The Epi Profile describes the HIV/AIDS epidemic in Minnesota and identifies populations at risk for HIV infection. The EPI profile is intended to give the Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) and the Minnesota HIV Services Planning Council (Planning Council) a thorough understanding of the epidemic in our state. the epi profile helps identify the people: who are in need of prevention and care services, both those who are infected and those at risk. helps to target resources where they are most needed.

Overview HIV/AIDS Surveillance Interpreting eHARS data What is it? Why do we do it? Who is included? Interpreting eHARS data Limitations eHARS data in CAREWare Where to find it? What it looks like? Generating Reports in CAREWare

Limitations of Surveillance Data Incomplete data Differences in reporting among providers Delays of up to 3 months Reported to surveillance and entered into eHARS Potential inaccuracies in diagnosis and laboratory dates Prior to 2007 Outside of MN Manual entry Key stroke errors Delaysreporting to surveillance, getting into eHARS -Differences in reporting among providers -Labs less accurate prior to 2011 because CD4s and Viral Loads were not reported, only confirmatory labs -Labs prior to 2007 may have estimated dates (only month and year reported) and may be less accurate -Those diagnosed outside of MN may have less reliable dates of diagnosis. MN has had HIV name based reporting since 1983, but other states do not or may not have started using name based reporting until more recently. -Recent labs have more electronic reporting and less manual data entryless data entry errors

How to interpret eHARS data There is a ROI, but no labs Haven’t had labs Labs have not been entered yet Labs were not reported to surveillance ROI was not processed before the quarterly match Slight discrepancies Name and birth date Lab date and Diagnosis date Given these limitations, how should we interpret the data? There may be slight discrepancies (DOB, lab dates, diagnosis dates) -If you do not see labs, could mean they have not been reported to surveillance. Could also mean that they have not been entered yet or the individual hasn’t had a lab in that time period. -CAREWare diagnosis date is inputed by providers based on self-reported diagnosis dates from providers.

Training Overview HIV/AIDS Surveillance Interpreting eHARS data What is it? Why do we do it? Who is included? Interpreting eHARS data Limitations eHARS data in CAREWare Where to find it? What it looks like? Generating Reports in CAREWare

Where to find eHARS lab data in CAREWare?

What it looks like when there is eHARS data in CAREWare?

Training Overview HIV/AIDS Surveillance Interpreting eHARS data What is it? Why do we do it? Who is included? Interpreting eHARS data Limitations eHARS data in CAREWare Where to find it? What it looks like? Generating Reports in CAREWare

Generating an Active ROI report

Generating an Active ROI report

Generating an Active ROI report

Generating an Active ROI report

Generating an Active ROI report

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs Double click

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Generating a “No Clinical Encounter Report” for those with Active ROIs

Summary HIV Surveillance is the ongoing, systematic collection, analysis, interpretation and dissemination of HIV related data. It is important to inform public health action to reduce HIV related morbidity and mortality and to improve health. HIV Surveillance data needs to be interpreted carefully based on limitations.

For more information… Surveillance CAREWare: Corelle Nakamura: corelle.nakamura@state.mn.us Jessica Brehmer: jessica.brehmer@state.mn.us Allison LaPointe: allison.lapointe@state.mn.us CAREWare: Dennis London: dennis.london@state.mn.us

Thank you

Feedback, Questions, Discussion Questions about the training or demonstration? Overall feedback, questions?

Next Steps In order to move ahead, goal: 90% of clients to sign ROI How can we reach 90%? What strategies will increase participation?