HELP USING CARETRAK


[CareTrak] [General Information] [Patient Records] [Evaluation Tools] [Patient Reports]
[Printing and Saving Reports] [Account Information] [Forms/Help]



GENERAL INFORMATION

CareTrak offers five (5) main task categories. Each category has a number of options. Descriptions of the options are provided below.

Most tasks are completed by filling in form fields with requested information. To enter data you have to select the patient to whom the information applies. A list of the patients in the system will be provided. You can browse the list or locate the patient directly by entering your Patient ID and clicking the Search button. This will retrieve the record(s) for that patient.

The program will automatically check and verify most of the information you enter (e.g. are required fields completed, do score values add up, are there enough answers provided to calculate a score, etc.). When you have completed the required fields, you generally click a button at the bottom of the page that says Save or Finish. The program then stores the information in a database along with ID values representing your clinic and the specific patient record you were working with.

Some pages allow you to delete records for patients or delete the patient entirely from the system. You will be prompted with a warning message whenever you try to delete records. If you wish to delete the information, click the Okay button. If you do not wish to delete the information, click the Cancel button instead.

PATIENT RECORDS

This is the area where identifying information about the patient and their problem is entered. There are also links for reviewing evaluation results and editing or removing evaluations that have errors.

  • Add Patient - Enter your patient ID, the first name, last name, birth date and gender for a new patient. You can also enter diagnostic information by clicking the Next button or you can click Save and complete that portion later.

  • Add Diagnostic Data - Enter data about a problem for an existing patient. This includes the date of onset, date first seen, duration of symptoms prior to seeking treatment, prior history for this problem, diagnostic code and information about existing risk factors.

    The risk factors included are:
    • The number of prior episodes with the same or similar symptoms
    • The length of time between onset and seeking treatment
    • The presence of adversarial medico-legal issues
    • Personal problems such as financial difficulties and marital conflict
    • Pre-existing pathology - Structural pathology or skeletal anomoly directly related to new injury or condition - such as spondylolesthesis

    Any one of these factors or the presence of a high intial pain rating on the VAS (7 or above), will flag the patient as being at risk for a prolonged recovery. The presence of any risk factors will be noted on all reports on the identified problem for the patient.

    You can add more than one problem for a patient. Each problem will be tracked separately and you can add evaluation data for each on its own schedule.

  • Edit Patient - Make corrections or changes in patient identification information (e.g. birth date, spelling of name, etc.). You can also delete a patient. CAUTION: This will remove all information and evaluation records for the patient.

  • Edit Diagnostic Data - Make corrections to existing diagnostic data for a patient on an identified problem.

  • Evaluation Results - Review all current evaluation results for an existing patient on a specific problem. The results are presented in abbreviated format, listing each evaluation date, the overall score and amount of improvement. A printable version of the evaluation summary is available for the subjective questionnaires (e.g. Oswestry, NDI, Roland-Morris, etc.). This can be a convenient way to store a hard copy of evaluation data in a patient's record or to share information about overall progress with another party.

  • Edit Evaluations - Make changes or corrections in evaluations previously completed. The evaluations completed for a selected patient are displayed. Click on the date of the evaluation that needs to be edited. The data entry form will be displayed with the original data already entered. You can modify the date or change a score value and save the record with the modifications made.

  • Delete Evaluations - Delete selected evaluation records for an existing patient. NOTE: Deleting evaluations will result in changes in report contents. If there are errors in an evaluation, you can either edit the evaluation or delete the existing record and then replace it by reentering the data. Results are ordered by date of the evaluation.

  • Review Cover Letters - Cover letters previously created can be reviewed or deleted from this menu choice. You can edit a cover letter by selecting the evaluation report for which it was created (see the report menu). Letters previously written for that type of report will be available and you can edit the content by selecting the letter from the list available.

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EVALUATION TOOLS

  • Functional Rating Index - A proprietary questionnaire developed by the Institute of Evidence-Based Chiropractic and used with permission. This questionnaire combines features found in the Oswestry questionnaire (described below) and the Neck Disability Index (described below). It has ten items and is appropriate for use with patients experiencing cervical, thoracic or lumbar complaints. It takes about 1 minute to administer and can often be scored in less than ½ a minute by one of your staff.

    The questionnaire should be used at the beginning of treatment and every two weeks or six visits thereafter in most cases. An absolute change of 10% is required to demonstrate meaningful improvement. If scores do not improve across two consecutive evaluations, a change in care management should be considered.

    You can use a brief data entry screen if you have already totaled the answers for the questionnaire or a full-scale version for data entry. The program will calculate the score based on the data provided and store the results in a dated record for the patient.

  • The Bournemouth Questionnaires - Scales for assessing either low back or cervical pain are available. Each questionnaire has seven items covering the major dimensions of pain. Each item requests that the patient choose a rating from zero (0) to ten (10). A low rating indicates that pain is relatively low and having limited impact on the patient's life. A high rating indicates a significant level of negative impact.

    To score either questionnaire, add the total rating scores across all items answered. Then divide this total by the maximum value possible to get a percentage value. For example, if the patient answered all 7 items, the maximum possible score is 70. If the total ratings equal 35, then the patient has a final score of 50%.

    The questionnaires should be used at the beginning of treatment and every two weeks or six visits thereafter in most cases. A change of 10% should be observed to demonstrate meaningful improvement. If scores do not improve across two consecutive evaluations, a change in care management should be considered.

    You can use a brief data entry screen if you have already totaled the answers for the questionnaire or a full-scale version for data entry. The program will calculate the score based on the data provided and store the results in a dated record for the patient.

  • Oswestry Low Back Pain Index - A standard questionnaire for assessing the functional status of a patient with low back pain. Administer this questionnaire at the beginning of treatment and approximately every two weeks during treatment.

    This questionnaire can be scored easily by hand. When you enter evaluation results, the system will default to a brief page for entering scores you have already calculated. If you haven't calculated the raw scores or choose not to, you can click a button at the top of the page to display the full questionnaire. Using this form you can enter the answers for each item and then save the results. It doesn't matter which form you use. The reports will run properly in either case.

  • Roland-Morris Low Back Disability Questionnaire - An alternative questionnaire for assessing functional status for a patient with low back pain. This questionnaire should be used in the same fashion as the Oswestry.

    Scoring is accomplished by counting the number of "YES" answers provided by the patient. Disability is reflected in the percentage of "YES" answers relative to the total number of items (24). You can enter the number of "YES" answers in the short data entry form or click on the answer to each item in the full scale version of the questionnaire. In either case, the program will determine the percentage value and store this along with the date of the evaluation.

  • Neck Disability Index - The standard questionnaire for assessing functional status for a patient experiencing neck pain. Administer this questionnaire at the beginning of treatment and approximately every two weeks during treatment.

    This questionnaire can be scored easily by hand. When you enter evaluation results, the system will default to a brief page for entering scores you have already calculated. If you haven't calculated the raw scores or choose not to, you can click a button at the top of the page to display the full questionnaire. Using this form you can enter the answers for each item and then save the results. It doesn't matter which form you use. The reports will run properly in either case.

  • Copenhagen Neck Disability Index - An alternative to the Neck Disability Index. This is a fifteen (15) item scale that assesses the impact of cervical pain on a variety of daily activities. Each item requires the patient to answer 'YES', 'OCCASIONALLY' or 'NO'. A maximum score of 30 is possible. A disability score is calculated based on the percent of the maximum possible score obtained.

  • Headache Disability Index - The standard questionnaire for assessing functional status for a patient with headaches. Administer this questionnaire at the beginning of treatment and approximately every two weeks during treatment.

    This questionnaire can be scored easily by hand. When you enter evaluation results, the system will default to a brief page for entering scores you have already calculated. If you haven't calculated the raw scores or choose not to, you can click a button at the top of the page to display the full questionnaire. Using this form you can enter the answers for each item and then save the results. It doesn't matter which form you use. The reports will run properly in either case.

  • VAS or Visual Analog Scale - This brief questionnaire is used to assess the level of pain the patient is experiencing. It should always be used in combination with at least one of the other questionnaires (e.g. Oswestry, NDI, etc.).

    This questionnaire defaults to the single item (pain now) version. A multi-item scale is also available. The longer version asks for rating of pain now, pain at its worst and average pain. To use the longer version, click the button at the top of the page.

  • Yellow Flags Questionnaire - A thirteen (13) item questionnaire that covers the major factors that can contribute to a risk for a poor prognosis and chronic pain. The questionnaire is repeated periodically during treatment to assess whether additional attention should be paid to the factors of pain level and psycho-social functioning that can contribute to a prolonged recovery.

    This questionnaire can be scored easily by hand. When you enter evaluation results, the system will default to a brief page for entering scores you have already calculated. If you haven't calculated the raw scores or choose not to, you can click a button at the top of the page to display the full questionnaire. Using this form you can enter the answers for each item and then save the results. It doesn't matter which form you use. The reports will run properly in either case.

  • Patient Global Impression of Change - Version 1 - A 0-10 scale for patients to use in rating the degree of improvement they have experienced since beginning treatment. A two (2) point change is required to demonstrate a significant level of improvement.

    The patient's score is simply the rating value selected. A rating of zero (0) represents a great deal of improvment. A rating of ten (10) represents a significant worsening of the patient's perceived condition. A rating of five (5) indicates no perceived change.

  • Patient Global Impression of Change - Version 2 - This is a seven (7) item scale that asks the patient to rate change in status since beginning treatment at your location. Scale choices are:
    1. Very Much Improved
    2. Much Improved
    3. Minimally Improved
    4. No Change
    5. Minimally Worse
    6. Much Worse
    7. Very Much Worse
    Patient response provides an ongoing evaluation of perceived progress and satisfaction with treatment services.

  • Modified Somatic Perception Questionnaire (MSPQ) - This is a 13 item self-report scale for patients with chronic pain or disabilities. It can help identify somatic complaints that may be associated with psychological responses such as anxiety or depression. The higher the score the more marked the general somatic symptoms. The number of perceptions at each intensity level can help gauge the number of limiting symptoms. A person with significant somatic complaints would be a candidate for psychological interventions to aid coping.

    Each item is scored on a scale from zero (0) to three (3). Patients who produce a score of 12 or greater (maximum score is 39), are at risk for a prolonged recovery.

    The questionniare contains a total of 22 items, but only 13 are used to calculate the score. The remaining items are included to reduce the possibility of a response bias.

  • Modified Zung Depression Inventory - This is a twenty (20) item scale that assesses depression symptomatology. Scores above defined criterion levels can be used to determine the severity of symptoms and the urgency for referral for mental health evaluation. While it is not a diagnostic tool for depression, it is an effective tool for determining when evaluation for depression is warranted.

  • Epworth Sleepiness Scale - An eight (8) item scale that screens for sleep disorder problems. Each item describes a situation in which dozing is possible. The scale requires choosing from 4 different levels (no chance of dozing = 0, slight chance of dozing = 1, moderate chance of dozing = 2 and high chance of dozing = 3). A score greater than 9 indicates the likely presence of sleep problems and an evaluation is recommended. A score greater than 16 is considered extreme and patients getting a score in this range should be immediately referred for a sleep disorder evaluation.

  • Full QFCE - The Quantitative Functional Capacity Evaluation is a full assessment of range of motion, strength and endurance, flexibility, and any evidence of "illness behavior" as shown on the Waddell tests. The tests cover both the lower back and the neck. A pre and post test assessment of pain is also included. Results are compared with normative values. For some tests (e.g. repetitive squat test), the norms are dependent on the patient's age, gender and occupational category. You must select the norms to apply in order to enter and save data. The tests are considered to be low tech and do not require elaborate equipment or procedures. Some tests are more demanding on the patient than others. When first seeing a patient you may need to restrict the assessment to tests which are least stressful. These are marked with an asterisk on the data entry form.

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PATIENT REPORTS

All patient reports include general information about the patient and the problem being treated. Score results are presented in table format with results for each evaluation listed in order by date. A bar graph displays the results from the main questionnaire for each evaluation date (except for the QFCE reports).

You have the option of writing and printing a cover letter to accompany any report. The letters you create can be saved and edited at a future date to provide new information when you send a new copy of the report.

All of the reports are dynamic. This means that they automatically update to include all the information available and calculate improvement based on the most recent scores. Report data is not saved in the literal sense. You can recreate a report by running the report action a second time. If no new data has been added, the report will contain the same results as before

Each report includes an option for adding other information. You can do this by typing in the information or copying and pasting from another source (e.g. a word processing, treatment planning or SOAP note program).

If you copy information from another source into the editing box, it will generally preserve the original formatting and appearance of that information. If problems occur in copying information, you can often fix these by using the editing tools. The editor works much like a word processor and gives you a "what you see is what you get" (WYSWYG) display.

All reports automatically create a signature line for the Dr. listed as the provider of care for the patient. This appears only on the printer version of the report. The clinic address and phone numbers are displayed in a special section at the top of the report.

  • Functional Rating Index - Create a report showing all scores on this questionnaire. The scores are evaluated against general standards. Scores below 20% suggest a minimal level of disability. Scores between 21% and 40% represent a moderate level of impairment. Scores between 41% and 60% indicate a severe level of impairment. Scores of 61% or higher represent a very severe level of impairment. The program will label each evaluation score as to the level of severity shown. An improvement-to-date value is calculated based on an absolute scale between 0 and 100%.

    If a patient scores less than 10% on an evaluation, there may not sufficient "room" to show additional gains (a minimum of 10% change is required to show significant improvement). The program will flag a result that is below 10% and indicate that further treatment may not be warranted. Once in treatment, it is rare for patients to move to a zero (0) level of impairment and it is therefore, inappropriate to continue treatment in hopes of reaching an absence of all impairment.

    If the full-scale version has been used for data entry, the report can include a list of the item alternatives selected by the patient. This "profile" will help understand how the condition is impacting the patient.

  • Bournemouth Questionnaires - Create reports showing all scores on these questionnaires - VAS pain rating results are included, if available. Improvement is measured by comparing the baseline or first evaluation with the most recent evaluation. Improvement is represented by the percent change that has occurred. Interpretation of results is based on established guidelines.

  • Oswestry Low Back - Create a report showing all scores on this questionnaire - VAS pain rating results are included, if available. Improvement is measured by comparing the baseline or first evaluation with the most recent evaluation. Improvement is represented by the percent change that has occurred. Interpretation of results is based on established guidelines and includes reference to VAS pain ratings if available.

  • Roland-Morris Low Back Disability Questionnaire - Create a report showing the level of disability reported by the patient on each evaluation date. Improvement is measured by comparing the percent disability reported on the baseline evaluation with the current level. Interpretation is based only on whether improvement has occurred. There are no established standards at this time regarding the interpretation of the absolute number of "YES" answers provided on this questionnaire. However, this questionnaire is often described as more sensitive to changes in condition than the Oswestry.

  • Neck Disability Index - Preview and print a report on this questionnaire for a selected patient - VAS pain rating results are included, if available. Improvement is measured by comparing the baseline or first evaluation with the most recent evaluation. Improvement is represented by the percent change that has occurred. Interpretation of results is based on established guidelines and includes reference to VAS pain ratings if available.

  • Copenhagen Neck Disability Index - Reports on a fifteen (15) item scale that assesses the impact of cervical pain on a variety of daily activities. A maximum score of 30 is possible. Improvement is measured by the percent change that has occurred in the score over time.

  • Headache Disability Index - Create a report on headache pain for a selected patient - VAS pain rating results are included, if available. Improvement is measured by comparing the baseline or first evaluation with the most recent evaluation. Improvement is represented by the percent change that has occurred. Interpretation of results is based on established guidelines and includes reference to VAS pain ratings if available.

  • Visual Analog Scale - Create a report that displays pain levels reported by a selected patient. You can use either a single VAS scale (pain now) or a multi-scale evaluation that requests information on pain now, pain at its worst and average pain. Pain levels of 7 or above on a 10 point scale are considered very serious. If a high pain value is reported at the beginning of treatment, the patient is considered at risk for a prolonged recovery. If you have collected VAS data for a patient, the results will also be included with reports on functional status (Oswestry, NDI and HDI).

  • Yellow Flags - Create a report that displays baseline and current scores on the Yellow Flags questionnaire. Interpretation addresses the current level of risk for a prolonged recovery.

  • Patient Global Impression of Change - Version 1 - Create a report that displays baseline and current scores on the Patient Global Impression of Change questionnaire. If a two (2) point change has been observed, the patient's condition is described as significantly improved. Scores of 1 do not allow sufficient room to show further improvement and represent maximal measurable gains.

  • Patient Global Impression of Change - Version 2 - Create a report that displays the patient's current evaluation of progress since beginning treatment. This report can be combined with any other evaluations in the custom report option.

  • Modified Zung Depression Inventory - Create a report on the number and severity of depression symptoms being reported by the patient. Results can be used to determine when referral for mental health services may be warranted.

  • Epworth Sleepiness Scale - An eight (8) item scale that screens for sleep disorder problems. The maximum score is 24. A score greater than 9 indicates the likely presence of sleep problems. A score greater than 16 is considered extreme and patients getting a score in this range should be immediately referred for a sleep disorder evaluation.

  • Full QFCE - This report lists the results on all QFCE tests used and highlights those which are more than 15% below the normative value that applies for the selected patient. As evaluations are repeated, the progress or improvement on the tests is compared with the values for the initial assessment.

  • Custom Report - This report lets you combine the results from several different assessments into one report. When you select a patient, a list of the assessments completed with the patient is presented. By clicking the checkbox next to an assessment type you can mix a variety of results into a single report. By adding your own clinical observations, you can create a very comprehensive outcome evaluation report for insurance purposes or to share with another provider.

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PRINTING AND SAVING REPORTS

Reports are created in Adobe PDF format. When you display a report preview you will have a choice between saving the report to a file on your computer or displaying the report for immediate printing. If you choose to save the report for printing latter, the selected report will be given a file name based on the patient's name, the date of the report and the type of evaluation data included (e.g. Doe_John_12_16_2007_Oswestry.pdf). You can choose where to save the report on your computer system.

If you click Print View, the PDF will be displayed in your browser (Internet Explorer or FireFox) provided you have Adobe Reader installed. Adobe Reader is a free download from Adobe.

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ACCOUNT INFORMATION

  • Edit Account Info - Make corrections or changes to your clinic name, address, phone numbers, etc.

  • Add Provider - Create a new provider record. This provider will be added to the list for your account and you can include their name on reports for their patients.

  • Edit Provder - Make changes or delete a provider from your account.

  • Cancel Account - CareTrak is a subscripion supported service. If you choose to stop using CareTrak, you can cancel your account by clicking on this option and following the directions provided. Subscription accounts are maintained by PayPal and you must connect to their site and login to your PayPal account to cancel the subscription. Subscriptions can be cancelled at any time, but you must cancel before the next billing date to avoid any further charges for using the program.

FORMS/HELP

  • Forms - Download Microsoft Word copies of most of the questionnaires and instructions for scoring. The Functional Rating Index is used by permission and a copy of the questionnaire in PDF format is available. You will need Adobe Acrobat Reader to open and print copies of the questionnaire. You can get a free copy of Adobe Acrobat Reader at this location. Most of the questionnaires can be scored by hand and the results entered using the quick data entry option in the CareTrak application.

  • Help - A complete set of help files is maintained for the program. Each help file covers a particular topic in detail. You can select a topic from the drop down menu by first selecting or moving your mouse over the Help item. A sub menu of topics will appear. Click on a topic to see the information.

    These files are reviewed and updated regularly. As new features are added, additional help files will be provided. If you don't see an answer to your question, use the support form to contact us or review the FAQ file that is part of the help system.

    An archive of updates and changes to the program is included in the Help section. This documents in reverse chronological order, the changes and modifications that have been made to the program. New changes are also featured on the home page for the program as they occur so that you will be able to see them each time you login.

  • Support - Use this form to contact us via email. You can describe any problems you have encountered, give us a description of improvements you would like to see in the program or ask questions about how to use the program. We respond promptly to all messages.

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