# Presentation: 139600

## 168H CAPRI and C&P Templates

- Zachary Fain, VHIT
- Dr. Steven Brown, CPEP
- Shawn Hardenbrook, SDS

## Presentation Objectives

**CAPRI Background**
- Background & Features
- User Groups
- CPWM
**CAPRI C&P Templates**
- Goals and Objectives
- Dictation vs. Templates
- Template Use
**CAPRI Demonstration**
- Hands on

## CAPRI

**C****ompensation****A****nd****P****ension****R****ecord****I****nterchange**

## CAPRI Background

- The CAPRI application is a joint VHA-VBA IT initiative that acts as a graphical user interface (GUI) interface into the VHA VistA system
- First deployed in FY 2001, CAPRI was initially developed as the replacement for the roll-n-scroll VistA AMIE II package used by VBA
- VBA Ratings Specialists struggled using AMIE-II to access VHA Medical Center computers due to hospital system variability
- Encompasses a variety of data and functions normally found across several VistA applications
- CAPRI provides one standardized interface to these applications, regardless of differences found across VHA facilities

## CAPRI Background

- Provides access to CPRS data in read-only format
- Progress notes, orders, consults, lab data, pharmacy data, nutrition reports, problem list, discharge summaries, vitals, imaging reports
- Displays patient’s demographic, appointment and admission data
- Allows ability to directly access other VHA facilities at which the veteran has presented for care
- Includes an interface to the VistaWeb application
- Provides access to DoD data, if available
- Provides ability to electronically record compensation and pension examination results in place of costly dictation/transcription methods

## CAPRI User Groups

- CAPRI application is now a valuable tool for numerous user groups:
- Veterans Benefits Administration (VBA)
- Board of Veterans Appeals (BVA)
- VHA Office of Medical Inspector
- VHA Inspector General (IG)
- VHA OI MPI Data Quality Team
- Health Revenue Center (HRC)
- Veteran Service Organization (VSO)
- VHA C&P Departments

## CAPRI C&P Templates

- CPWM – **C**ompensation and **P**ension **W**orksheet **M**odule
- Project Objective
- Create a “Point-n-Click” examination template system that could produce standardized examination results to ensure veterans nationally receive same quality of examination
- Spring of 2002
- Work began on a system of C&P examination templates at the request of the CPEP office (Compensation and Pension Examination Program)
- Spring of 2004
- Implementation of the CAPRI C&P templates officially began

## CAPRI C&P Templates: Goals

- Standardization of VHA C&P Exams
- Standardize what information is collected
- Standardize how information is collected
- Eliminate errors of omission
- Create efficient Veteran-specific “merged” templates based on AMIE Worksheets
- Merge multiple exam types
- Ask all the “right” questions, avoid the rest
- Collaboration between CPEP, OI, C&P

## AMIE Worksheet

**October 3, 2002**
**SKIN DISEASES **(Other Than Scars)
- A.  **Review of Medical Records:**
- B.  **Medical History (Subjective Complaints):**
- Describe onset and course of disease, whether it is intermittent or constant, and whether it is progressive.
- Describe current treatment.  Specify the medication(s) used and dosage.  State whether any is a corticosteroid or other immunosuppressive drug.  State whether medications used are systemic or topical.  Describe whether intensive light therapy, UVB, PUVA, or electron beam therapy are used.
- For _each_ treatment, report the frequency of use and duration of treatment during the past 12-month period.
- Describe any side effects of treatment.
- Describe local (skin) symptoms and any systemic symptoms, such as fever or weight loss.
- For malignant neoplasms of skin, additionally describe all treatment, including date and type of last treatment.
- For benign neoplasms of skin, additionally describe any impairment of function.
- For urticaria, primary cutaneous vasculitis, and erythema multiforme, additionally describe the number of episodes during the past 12-month period, whether the episodes are debilitating, how they are treated, and whether they respond to treatment.
- C.  **Physical Examination (Objective Findings):**
- Report extent of disease - specify if any exposed areas (head, face, neck, and hands) are affected and the _percent of exposed areas_ that is affected and specify the _percent of the entire body_ that is affected.
- If there is scarring or disfigurement, follow the "Scars" worksheet in addition to this one.
- For acne or chloracne, describe whether the acne is superficial (with comedones, papules, pustules, superficial cysts) or deep (with deep inflamed nodules and pus-filled cysts), which areas of the body are affected, and, specifically, the _percent of face and neck_ affected.
- For scarring alopecia, describe the _percent of the scalp_ that is affected.
- For alopecia areata, describe whether there is loss of all body hair or whether loss of hair is limited to the scalp and face.
- For hyperhidrosis, state whether veteran is able to handle paper or tools after therapy, or is unable to handle paper or tools because of moisture and is unresponsive to therapy.
- D.  **Diagnostic and Clinical Tests:**

- If there is scarring or disfigurement, follow the "Scars" worksheet in addition to this one.

- For alopecia areata, describe whether there is loss of **all body hair** or whether loss of hair is **limited to the scalp and face**.

- Describe onset and course of disease, whether it is intermittent or constant, and whether it is progressive.

## CAPRI Template

## Dictation vs. Templates Time-Motion Study: Data Entry Time

- Dictation:
- Average: 3.4 minutes per exam
- Templates
- Average: 4.1 minutes per exam

## Dictation vs. Templates Time-Motion Study: Visit Time

- Dictation
- Average: 11.26 minutes per exam
- Templates
- Average: 14.51 minutes per exam

## Dictation vs. Templates Summary

- Templates improve quality
- Templates improve exam turnaround time
- Templates lengthen encounters by 3.25 minutes on average
- Templates lengthen documentation time by 0.7 minutes on average

## CAPRI Template Usage

## CAPRI Template Usage

| OMAHA;IOWA CITY;DES MOINES;KNOXVILLE, IOWA; | 32817 |
| --- | --- |
| TAMPA; | 22519 |
| GAINESVILLE/LAKE CITY;N. FLORIDA/S. GEORGIA VHS; | 15808 |
| ALBUQUERQUE; | 13975 |
| KANSAS CITY;COLUMBIA MO;LEAVENWORTH;TOPEKA;WICHITA; | 13815 |
| SALISBURY; | 12719 |
| NASHVILLE/MURFREESBORO; | 12582 |
| MANILA; | 10871 |
| LEXINGTON; | 10736 |
| HUNTINGTON; | 10341 |
| SAGINAW; | 8828 |
| WEST PALM BEACH; | 8544 |
| BAY PINES VA HCS; | 8485 |
| FAYETTEVILLE AR; | 8299 |
| LOUISVILLE; | 8223 |
| BIRMINGHAM; | 8173 |
| MINNEAPOLIS; | 8142 |
| NEW ORLEANS; | 8139 |
| ALEXANDRIA; | 7765 |
| SAN JUAN; | 7506 |

**Largest Site Usage Jan, 2004**
**Through**
**June, 2007**

## Template Mandate

- VA is committed to mandating template use
- Key stakeholder feedback and refinements are underway prior to mandate

## CAPRI Hands On Demonstration

- Sign On
- Access: ##VEHU
- Verify:  VEHU##

## Where to Get More Information

- CPEP Hosted Website
- Documentation:
- “http://www.va.gov/vdl/application.asp?appid=133”

## Questions?