LSU Health Sciences Center School of Dentistry. AxiUm Training. Faculty. Kathy Hansel

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1 LSU Health Sciences Center School of Dentistry AxiUm Training Faculty Kathy Hansel 2012

2 How to Use This Manual: AxiUm Training for Faculty Kathy Hansel, Instructor room 2305 Clinic Building View Training Videos on LSUSD website. AxiUm Tutorials- LSUSD website - Quick Links- axium Training- Training videos Introduction to Axium Tutorial, Faculty Grading & Approval & EHR Demo Video- recommended viewing a. Review this manual so that you know where the information is when you need it. 2. Complete the Training Exercise at the end of this manual. 3. Schedule a training session with Kathy Hansel so that you can be assigned an approval code. When assigned a permanent approval code, safeguard it- it is your signature in an electronic chart. If you feel it has been compromised at any time, see Kathy Hansel to change it. Log onto any clinic laptop using your LSU username and password. Click on the AxiUm icon & enter your approval code (; -4 characters-enter) to open axium in your name. Access to AxiUm page 3 Start Checks 4-5 Electronic Health Record EHR module (charting) 6-7 Faculty Approvals 8 Grading 9-10 Adding/ Editing Grade Forms 11 Selecting a patient (Rolodex) 12 Writing Notes 13 Charting Findings 14 Treatment Planning Module cheat sheet 15 Adding Planned treatment (not on initial TP) 16 Completing & Approving Tx 17 Finding Forms (consults) 18 Perio Charting 19 ****Faculty Step-by-Step Cheat Sheet for Clinic 20 Indications for Medical Consult 21 Adult Medical History ****Training Exercise for Faculty 24-32

3 Remote Access to AxiUm: Off Campus 1. Go to LSUSD Home Page 2. Quick Links drop down at top of page 3. Select Citrix - Use LSU username and password 4. Select Applications tab when Citrix Online Plug-In window appears, you should see Axium iconlog on using axium logon and password 5. To access Schick (CDR Dicom), you will have to open remote desktop connection through citrix 6. Hit Start button lower left corner of Citrix window 7. Select Remote Desktop Connection (computer name : lsusd-terminal. lsuhsc.edu) 8. Connect 9. Use LSU username and password 10. Hit Start button in this window to find CDR Dicom (Schick radiographs) program. Axium is installed on clinic and library computers only. On Campus 1. Go to LSUSD Home Page 2. Quick Links drop down at top of page 3. Select Axium Training 4. Select On- Campus Axium Access 5. Use LSU username and password in Windows Server window 6. Double click on Axium icon- use axium username and password or your approval code in username field 7. Hit Start button in this window to find CDR Dicom (Schick radiographs) program. Remote desktop download for macs: Link to Citrix for macs: Kathy Hansel Axium Administrator Room 2305 khanse@lsuhsc.edu

4 FACULTY START CHECK THE AXIUM Faculty Start-check process requires student providers to get a start check from a faculty member before proceeding with an appointment. Appointment must first be entered into student s schedule. In lower left corner of axium screen: Red provider name indicates that a start check is required and is awaiting approval. Green indicates that a start check was required and it has been approved. Yellow indicates that a start check is required for an upcoming appointment that requires approval. Start-Check Dialog The instructor left clicks on the red name field and the Appointment Start-Check Dialog is displayed. Treatments that have been approved to be performed at today s appointment will be displayed on the right side of the window. Highlight procedures from Planned Treatments window to be completed today by student and hit > button to move to Approved Treatments window- enter approval code to close window. Provider name light turns green. Hitting the View button in this window opens a Crystal report that outlines today s treatments and the future planned treatments. 4

5 Text will appear RED for those procedures that have been approved in the start check in the In Progress tab. A symbol appears next to procedures approved in the start check in the Tx History tab. If other procedures are added for this appointment, the text will appear BLUE and the Treatments have not been start checked warning window will appear when the approve/ edit window appears. If you wish to continue, just hit enter. Start-Checks and consecutive appointments At 30 minutes before (or less in case of a short notice appointment) the provider's next appointment begins a Start-Check. The provider name field background color will change from green (the color indicating a start check for the current appointment was performed) to yellow. Yellow indicates that the next appointment will require a start check but that the current appointment is ongoing and a start check may not be possible to perform immediately. A Start-Check can be performed at any time the field is red or yellow. When the current appointment is over the provider name field background color will change from yellow to red if a Start-Check is still required for the next appointment. 5

6 EHR Module- Tx History tab 1- Probing depths- last exam 2- Medical alerts- same as red alert button in status bar, automatically updates from medical history 3- Current medications automatically updates from medical history 4- Odontogram 5- Planned treatment- yellow dots in odontogram, red text at bottom of Tx history tab, P in status column 6- Tx History tab 7- Existing restorations/conditions, caries- Findings from initial exam, pink text 8- Completed treatment, approved black text, C in status column 9- Click on date column heading to sort entries by date (click on Site heading to sort by tooth #) 10- Click on up arrow to open bottom half of window to full screen Blue text- unapproved treatment, notes, forms Blue chart number button in status bar- approval needed, click on button to view unapproved items 6

7 axium charting symbols for odontogram EHR Module 7

8 Faculty Approvals Forms (caries risk assessment, denture diagnosis from, exit exam form, etc.) Click on (chart # box, at bottom of screen). Click on at bottom of Patient Approvals window. The form requiring approval will open in a new window for you to review. Hit button. Enter your approval code bringing up a Form Approval window. If the student completed more than one form, select All Pages. Enter approval code. (semicolon; - 4 character code- Enter) Approve button will grey out and your name will appear next to it. Findings, Planned and Edited Tx Click on (chart # box, at bottom of screen). You can approve all the items listed at once or you can highlight the items you wish to approve and enter your approval code. (semicolon; - 4 character code- Enter) Chart # box will turn grey when complete. Notes Students should add a note for each visit. The note will pop up for approving when approving any itens above or by itself. The note can be edited before approving. Enter approval code. (semicolon; - 4 character code- Enter) Chart # box will turn grey when complete. Tx Plan Click on,,,,. Faculty will review Tx Plan and enter approval code. (semicolon; - 4 character code- Enter) Click on Close. The student should now get patient approval. Perio Click on tab or Perio Chart module, and click on to resume entry on your chart. Click on Complete. Enter approval code. (semicolon; - 4 character code- Enter) Close Perio. See separate sheet for Completing and Approving Treatment. Kathy Hansel Axium Support Room /11 8

9 Grading for Faculty Planned treatment status should be changed from Planned to In Process or Complete. ( or, tab, double click on Tx procedure and change to I or C) Click on (chart # box, at bottom of screen). Enter approval code (semicolon; - 4 character code- Enter) to approve treatment/ notes. Grading card will appear. Enter Discipline for juniors or sophomores and proper grade form will appear. (For seniors, use SS- Fourth Year Summative Grade form for all procedures.) Procedure code and questions should appear in lower half of screen. Select a question and then double click on desired grade or type in grade for each question. Enter approval code (semicolon; - 4 character code- Enter) when finished. To view other grade forms for this procedure, click on View Other button at bottom right of grade card, All instructors- Search- select form from list- View: 9

10 For the grading scheme, a grade of a 1 or a 3 requires a comment. Type in comment and hit OK to close comment window. If answers are required for some questions, the text will turn red when attempting to approve. Go back and add grades for those questions. Enter approval code. Chart # box will turn grey when complete. If not, hit aqua chart # button and see what needs approval; it may be forms at bottom of approval window. Kathy Hansel Axium Support Room /10 10

11 Adding or Editing Grade Forms To change/edit a grade on a grade form: To Add a grade for treatment that was approved but not graded: Open patient s chart in Rolodex Go to EHR- tab- Right click on completed and approved procedure and select Add Student eval Faculty must enter approval code to access grade form. To approve and grade treatment: Open patient record in Rolodex Hit aqua chart number button at bottom of screen Faculty must enter approval code Grade form will appear- select discipline then select grade form- add grades enter approval code. Students: to view all grade forms- go to Evaluations module- Evaluations tab- set date range- Search- view grade forms Grades tab- set date range- Search- view list of individual grades Kathy Hansel /

12 Selecting a Patient Via the Rolodex 1. Click on Rolodex button. 2. In name field, type in the last name, (and as little of the first name as is necessary to pull up a reasonable list of names) You can also search by chart #, phone number (omit area code), birthdate, and first name (,Mary). If you fail to adequately narrow down your search (eg. Smith) you significantly increase search time and number of names to scroll through. 3. Click on the patient s name. 4. Make sure that the patient s name displays in the bottom name field. 5. Check the patient s demographic data to insure you ve selected the correct record and that the data is current Corrections should be made by the Business Office. 6. To hold the name in your notepad for easy selection on another day, check the box on the left If the patient s name is in the notepad, a single click will select the patient. Revised 06/12 12

13 Adding Notes to Tx History Window AxiUm offers two methods for adding notes to the Tx History window: Tx Notes & General Notes. Tx Notes Should be used in virtually all cases How 1. Highlight the tx code 2. Right mouse click, select Add Tx Note When On first visits or visits with no single tooth treatment, attach your note to the consult code. On first visits with treatments and all subsequent visits regarding that treatment, attach your note to the original treatment code. In the image above, the tx code shows the date of completion and the notes display the date of each visit, building a clear history of progress on the treatment. General Notes How Click on the General Note button on the right side of the TX History window. When writing general review notes not associated with specific tx By faculty and hygienists when writing observations or recommendations before tx is added to patient record By providers when multiple tx are put inprocess or completed on the same day. If a tx note is attached to a single tx, the note will not display if the Tx History window is sorted to a limited site view that doesn t include that tx. General Notes remain on display even with site number sorts. 13

14 AxiUm Cheat Sheet for Charting Findings (Existing Conditions and Restorations) Student Rolodex Open Patient Record Type in last name, first name, OR chart number, press enter. (You can type in just a few letters of the last name to bring up all matching patient names.) Double click so name is in bottom window. Verify proper patient through date of birth and phone number. EHR Chart Age of Teeth & Missing Teeth 1. In odontogram, click to select tooth or teeth, right click and choose Age Change or Missing. May also use right click Select Teeth to choose All Teeth or Maxillary or Mandibular Arch. Add Findings Via Chart Add Tab 2. Click on (top right of window) to open tab. In Chart Add tab, click on 3. Add Restorations Click on Restorations/Caries category to add existing restorations, sealants, temporary materials, implants and bridges. Use First tab Quick List (go to Full list if not found here) Choose type of restorationselect tooth surfaces in odontogram hit Add Finding button Text should appear at right in blue text E in status column existing restoration 4. Add Caries In same category, scroll down Quick List to find caries description, highlight it select surfaces from odontogram (red cross hatch appears) hit Add Finding button Text should appear in blue text status A existing caries red cross hatching in odontogram 5. Add Conditions (Tipped teeth, diastema, impacted, etc.) Choose Conditions categoryselect condition from Quick Listselect tooth in odontogramhit Add finding button. Text should appear at right with status A for existing condition. T o delete a finding, highlight the text, select button with red X. When finished, have faculty approve text will display as pink once approved. 05/12 14

15 4. If you completed more than one form, select All Pages. Faculty will approve. Close the EPR window. 5. Click on,,,. Faculty will review TX Plan and approve. Click on Close. TX Planning for Students (revised 02/02/10) Student Before starting Tx Plan- 1- complete pt medical history (forms AMEDHX), 2-take radiographs, 3-Add patient findings -caries, restorations,etc.- 4- add OD procedures as planned (see Charting in the Chart Add Tab sheet for instructions) Add Note Student and Faculty Create TX Plan It will not display on TX History until approved by faculty and patient. To alter unapproved Tx Plans, click on, and repeat Detailed Plan steps. Get Faculty Approvals **All forms must be approved- Caries Risk Assessment, Head & neck Exam, consults, perio exam, etc. Click on (Plans sub tab). Click on (direct right) to begin new plan. Problems sub tab: Enter plan name, Patient s Chief Concerns (in their own words) click on to add problems. Highlight problem, click on, makes sure problem(s) shows in bottom table. X to close window. Diagnosis Sub Tab: Click on to add diagnoses. Double click to add diagnosis to bottom table, click OK to exit. Diagnoses must show in bottom window. Detailed Plan Sub Tab: Click on. Double-click on diagnosis, choose Quick or Full List, choose Category, single-click on Tx choice or click on + to open folder of options and select Tx. Select tooth, teeth or surfaces if required. Click on. To delete a procedure, highlight and hit When done, highlight selected TX, right click, choose Assign, add Phase and Sequence. Both faculty and patient approval required. Click on, select Add a new Note from direct right- Code button, double click UGOD template- OK, fill in note. Note requires faculty approval. 1. Click on (chart # box, bottom of screen). Faculty will review findings and approve. 2. If you have written any notes, they will pop up. Faculty will review note and approve. 3. If chart # box is still aqua, click on it again and click on. Your patient s Medical History (and any other forms you completed) will come up for faculty to review. Make sure faculty reviews every form you completed. Hit to bring up Form Approval window. There could be up to 6 forms (Head & Neck exam, Caries Risk, etc.) Student/ Patient Get Patient Approval **Patient signs treatment plan and medical history form chart # button must be grey when finished. Go to computer with printer at front of clinic. Open patient record, in - Click, click to print patient copy and close window to bring up patient signature box. Have patient sign Treatment Plan estimate. Go to click at bottom of Medical History Form. Have patient sign medical history form. Escort patient to patient accounts window to complete billing. Student and Faculty Altering Approved Tx Plans (Must have faculty and patient approval to view tx in Tx History tab) Click on tab. Select the line of TX that needs change and double click. Click on next to Code that needs editing and make corrections or alter Tx Status. Only surfaces and materials can be modified. Other changes require a new TX Plan and patient approval. OK to exit from window. Requires faculty approval. To delete the Tx, faculty must log in and delete. All changes except deletions will be reflected in the Tx Plan tab, Detailed Plan subtab. 15

16 Adding Planned Treatment 1. Select your patient through the Rolodex. Make sure their name is showing in the message box at the bottom of the axium window. 2. Click on the Create a New Record button (top right of screen) to open the tab. 3. Select the radio button (default). 4. Select the tab (default). 5. Select the appropriate category from the list on the left. 6. Single click on Tx choice or click on the + to open folder of options. If you do not see the category or Tx you need, select the tab and repeat steps 4-6. If you want to add phasing and sequencing here, double click the selection to jump from the Codes subtab to the details subtab. Do NOT enter the sites and surfaces by typing in the code. 7. Select the tooth &/or surfaces where required by clicking on the tooth on the odontogram or selecting the quadrant when prompted. 8. Click on the Planned Tx button. Do not add Tx as Inprocess or Complete if you are going to generate a Tx Contract as it will not be included. Only Planned Tx displays on the contract. 9. To correct an error, delete the incorrect entry by highlighting the incorrect entry and clicking on the Delete Record button. Then add the correct Tx. See instructions on approving treatment and printing a treatment estimate. 16

17 Completing and Approving Treatment (Updated 06/10) 1. With patient selected, open EHR, tab. Students change View to Planned/InProcess for faculty review. 2. Select a line of planned TX and double click. 3. Move Status from Planned to In Process or to Complete. 4. Click OK. For students, the treatment will now appear in blue on the Tx History screen indicating that it requires approval. For faculty and residents, the treatment automatically is approved and goes to billing. 5. To send the treatments to billing, faculty MUST approve the change. Click on the aqua-colored chart box at the bottom of the screen. 6. This opens the Check Out Patient window. Faculty approve by entering their approval code, moving all highlighted tx to the Claim screen on the bottom, signifying that the treatment charges have gone to Billing. Faculty does not have to OK all changes. They can use the ctrl or shift key to select only those items they wish to approve. 7. Click close and the screen closes, the approved lines of treatment turn from blue to black, and the chart number box (if emptied) turns to grey. 17

18 Forms can be accessed in two places in axium: the Forms tab and the Attachments tab. This document serves to distinguish where users can find forms rather than how to complete them. Forms Tab Open EHR Click on Forms tab Click on the Create a New Record or Add Patient Form button on top toolbar. Select a form from the dropdown list. Some forms, like Medical History, will not be available in the dropdown list once data is added to the form. Rather, the form will display in the Forms on File window. Click on the form there and modify. Changes will be saved with a new date. Finding Forms Attachments Tab Open EHR and click on Attachments tab (or click on the Attachments button on the left) Default is Consent Forms Click on the Create a New Record button Click on the ellipses button Doubleclick on the desired form Click OK and then complete the form You can download PDF copies of the forms by setting your computer s default printer to PDF and then printing out the forms. 18

19 axium Treatment Entry for Perio Module- Step by Step Open patient chart in Rolodex- 1. Open the Perio Charting module you will see the most recent exam displayed. 2. Hit the create new record button Resume entry window appears. To enter a completely new chart select No, to resume an old chart click Yes. 3. Select Perio Date window appears. New: To open the Add Perio window without resuming any of the items in the list. Resume: To allow users to select an incomplete chart and resume it. This is only enabled if the selected chart is incomplete. This will display the Perio Add window with data filled in from the chart selected. Edit/Review: To allow users to select an incomplete chart, review it and possibly make corrections. When selected, displays the Perio Add window for the selected date with the title Edit Perio, the Chart Date enabled and the data filled in like when in Resume mode. Close Off : This closes off an incomplete chart so that they can no longer be edited. Re-Open: Undoes the closing off of a chart and allows it to be edited. Both Close Off and Re-Open will add another line in the list with today s date in the Audit Date column. Note :The difference between Edit and Resume is that Edit keeps the perio date as of the date it was first entered. Resume updates the perio date to today. 4. Choose Exam type from the drop down (Initial exam, complete exam. Postscaling, etc.) 5. Enter the values for each category by using the keyboard or selecting the values on the display screen, some will forward automatically, some values require choosing a site first. Defaults to beginning with Max right-max left-mand left-mand right 6. To Save: To save your work as you go along. Clear All: To clear all entries since you last saved. Clear: Clears the current cell (but does not auto advance so that the user may re-enter the proper value). Clr Tooth: To clear all 3 values for the tooth. For Yes/No conditions, resets them to their "No" value. To save and close a chart that you wish to resume at a later date To save a completed chart,does NOT allow re-entry at a later date to resume the exam Toolbar buttons: View form history, view a list of forms and see which ones are complete or incomplete, can reenter incomplete exams full mouth view of perio screen can choose to compare selected exams graphically or text only opens the medical history view attachments (referral letter, medical release letters) print exam select perio display options Kathy Hansel /Room

20 Axium- Faculty- Step-by-Step 1) Faculty -Start Check- appointment must be in scheduler first, 2) click on red student name button at lower left, review appointed treatments in right side of window, enter approval code- (semicolon; - 4 character code- Enter) 3) student name button turns green (add to or change appointed treatments by using arrow keys ) When student has completed procedures, 4) Go to In Progress or Tx History tab and change procedure from Planned to In Process or Complete (double click on procedure and change to In process or Complete) text will turn blue- needs approval 5) Faculty- approve by hitting aqua chart number button (semicolon; - 4 character code- Enter) 6) Review procedures to be approved, 7) A Treatment Note must be added for every patient visit before student leaves clinic, the note will display for approval 8) enter approval code (; semicolon before and enter button after 4 character code) 9) Is medical history signed? If button appears at bottom of med hx form, patient must sign at station at front of clinic. 10) Grades- choose grade Discipline & Form from drop down box- enter grades 11) enter approval code again (semicolon; - 4 character code- Enter) If patient does not show and student wants attendance credit- must be entered in student chart according to how many hours assisted in clinic Add as complete-c- approval is needed. Chart number button will turn grey and text of procedure turns black when successfully approved Faculty approval must be given at every appointment- a procedure (whether complete or in process) or treatment note must be entered in the chart for every patient visit and approved by faculty Approval must be done before bringing patient to cashier, charges are not entered until procedure status is changed to Complete and Approved. **To add a grade after a clinic session: When the chart number button is no longer aqua and the procedure is complete -Go to Tx History tab- select and right click on procedure needing grade- select Add Student Eval- enter approval code to open grade form- choose discipline and grade form- - enter gradesenter approval code *******Cheat Sheets and Axium Training for Faculty See LSU School of Dentistry website- Quick Links- Axium Training page has cheat sheets and training videos Kathy Hansel AxiUm Support Room 2305 khanse@lsuhsc.edu 20

21 INDICATIONS FOR MEDICAL CONSULTATION Adrenal Disorders Angina Pectoris Allergy to Local Anesthetic Anticoagulant Therapy Anemia Arrhythmias Asthma Bacterial Endocarditis Blood Dycrasias Cardiac Prosthesis Disease Cerebrovascular Disease (Stroke or Seizures) Congestive Heart Failure Chemotherapy Cirrhosis COPD (emphysema) Diabetes Mellitus Dialysis Epilepsy Hepatitis Hemorrhagic Tendencies HIV Hypertension (> 140/100) Liver Disease MAO Inhibitors Malignancies Myocardial Infarction Organic Heart Murmurs Pregnancy Prosthetic Joint Replacement Psychiatric Disorders Rheumatic Heart Disease Radiation of Head and Neck Serum Chemistries Sexually Transmitted Disease Steroid Therapy Thyroid Disease Tuberculosis 21

22 LSUHSC School of Dentistry Date: Medical-Dental Questionnaire axium No. Name: SSN: Sex: Date of Birth Race: Address: City, State, Zip: Marital Status: Home/Cell: Occupation: Office Phone Name: Relationship: In Case of Emergency, Contact: Address City, State, Zip Phone: Physician's Name: Phone: Hospital : Address: City, State, Zip: Hospital #: DENTAL HISTORY Yes No Not Sure 1 Are you presently having a toothache / dental pain? 2 Please mark your current level of dental pain: 3 Briefly explain your present dental problems or concerns: 4 Do you bleed excessively after tooth extraction? 5 Have you had pain or swelling for more than two weeks after injury or surgery to the face or jaw? 6 Any serious reactions to local or general anesthetics (ex: lidocaine, propofol), nitrous oxide? 7 Have you ever had any serious trouble associated with any previous dental treatment? 8 If yes, explain: 9 Do you have any soft tissue sores or bumps in your mouth? 10 Do you clench or grind your teeth? 11 Are any teeth sensitive to cold or sweets? 12 Has a doctor told you to take antibiotics BEFORE having your teeth cleaned or dental treatment? MEDICAL HISTORY PART 1 Yes No Not Sure 1 Are you being treated by a medical doctor now? Date of last visit: 2 Reason: 3 Are you taking any medications at the present time? List all: 4 Have you ever taken medication to relieve anxiety or depression? 5 Are you sensitive or allergic to any medication or to latex gloves/products? List: 6 Have you ever been hospitalized or had any surgical operations? 7 Have you ever had excessive bleeding from a cut or wound? 8 Have you ever had cancer? If yes, what kind? 9 Do you have pain in the chest upon exertion? 10 Do you have shortness of breath after mild exercise or exertion? 11 Do your ankles swell or do you bruise easily? 12 Do you use extra pillows to help you breathe better while sleeping? 13 Do you have to urinate (pass water) frequently? 14 Are you thirsty and/or hungry much of the time? 15 Have you lost or gained weight (more than 10 lbs) in the last year? Reason: 16 Has a doctor ever said you had infectious diseases (for example, HIV, hepatitis C, tuberculosis?) 17 Do you have difficulty with swallowing, breathing, or snoring (sleep apnea)? 18 Do you have frequent infections? 19 Do you have frequent headaches or migraines? 20 Do you currently or have you in the past used tobacco products and/or alcoholic beverages? If yes, are you interested in a tobacco cessation program? COMPLETE OTHER SIDE Ver This Medical-Dental Questionnaire is created and maintained by the Division of Diagnostic Sciences, Form P0059 Louisiana State University Health Sciences Center School of Dentistry, New Orleans, Louisiana. 22

23 Please check the appropriate box for any condition that you have now or have had in the past. (Parent or Guardian: To complete this form, indicate your dependent s health status by checking the appropriate boxes below.) 1. CARDIOVASCULAR 6. RESPIRATORY Heart Failure Heart attack or disease Angina pectoris or chest pain Acute coronary syndrome High blood pressure Heart murmur Mitral valve prolapse Rheumatic fever Congenital heart defect or lesion Artifical heart valve Irregualr heart beat Heart pacemaker or defibrillator Heart surgery or transplant Other heart problems Stroke Aneurism 2. BLOOD/ONCOLOGY Stiff joints Blood Transfusion Anemia Sickle cell disease Leukemia Clotting disorder or hemophilia Tendency to bleed longer than normal Chemotherapy Radiation treatment Chronic bronchitis Emphysema Asthma Respiratory allergies Chronic cough Sinus trouble Tuberculosis (TB) Breathing difficulties Flu-like symptoms 7. SKIN / MUCOSA / MUSCULOSKELETAL Allergy to latex (rubber gloves) Skin rash Dark mole(s) or recent changes Melanoma Fibromyalgia Sore muscles Arthritis or gout Artificial joint Osteoporosis Medicines for osteoporosis/bone cancer Intravenous (IV) bisphosphonates 8. GENITOURINARY Sexually transmitted disease (STDs): syphilis, gonorrhea, genital herpes, 3. ENDOCRINE chlamydia, HIV+ / AIDS Diabetes Thyroid disease Steroid therapy Kidney (renal) dialysis Kidney/bladder problem Urinate frequently 4. NEURAL/PSYCHIATRIC 9. ORAL MEDICINE / FACIAL PAIN Eye pain Vision Problems Glaucoma Earaches/ringing in ears Hearing loss Severe headaches Fainting or dizzy spells Epilepsy, seizures, or convulsions Nervousness Psychiatric treatment Depression Schizophrenia Bipolar Alcohol or substance abuse 5. GASTROINTESTINAL Gastritis/ulcers/reflux disease Ulcerative colitis Crohn's disease Pesistent diarrhea/constipation Hepatitis Liver disease Yellow jaundice Cirrhosis Yes No Not Sure MEDICAL HISTORY PART 2 Mouth ulcers and candidiasis White/red patches in the mouth Dry mouth (xerostomia) Pain in facial muscles TMJ (jaw joint) problems Nerve pain (neuralgias) Autoimmune disorders (Sjogren's, lupus...) 10. OTHER CONDITIONS Enlarged lymph node or gland Head and neck cancer Hyperbaric oxygen therapy Organ or cell transplant Disease, problem, or condition not listed? (Describe here:) 11. FEMALES Are you pregnant now? Do you plan to become pregnant soon? Did you have any complications during pregnancy? (If never pregnant, answer no) Do you have trouble with your period? (If you don't menstruate, answer no) To the best of my knowledge all the answers on both sides of this page are true and correct. If I have a change in my health information, I will inform my dentist at my next appointment. Yes No Not Sure Yes No Not Sure Signature of Patient (18 or older)/ Parent / Guardian Date COMPLETE OTHER SIDE Ver This Medical-Dental Questionnaire is created and maintained by the Division of Diagnostic Sciences, Form P0059 Louisiana State University Health Sciences Center School of Dentistry, New Orleans, Louisiana. 23

24 AxiUm Training Exercise 1 Postgraduate Residents Your laptop on campus: 1) Open Remote Desktop Connection to access axium: 2) Go to Start> All Programs>Accessories> Communications>Remote Desktop Connection> 3) Type in the address lsusd-terminal.lsuhsc.edu next to computer. Hit Connect. 4) Use your LSU username and password again. 5) Once the home page appears, click on the Axium icon 6) use your axium username and password in the user authentication window *Off campus- open LSUSD website- Quick Links drop down menu -Citrix connection Mac users: go to LSUSD website- Training page for remote desktop download and citrix link) Username: first letter of first name, first 5 letters of last name or LSU username Password: axium After first login, go to Tools (on toolbar)- change password To find your assigned patient: Click on Personal Planner icon Click on Assigned Patients tab and hit magnifying glass to search for the patient assigned to you. Click on name in list and right click- Select patient- will open the patient record, name appears in bottom status bar. What is your patient s chart number? To open patient s chart outside of Personal Planner: Go to Rolodex module- type in last name of your patient (Training) or chart number and hit enter. Rolodex card for this patient opens. Click on red Alert button to view medical alerts for this patient. Close window (red X). Go to EHR module: will open to Forms tab- Adult Medical History 2011 form Forms tab- Review medical history: See at the top of the form. Questions with a Yes answer in the medical history will appear here- Yes answered questions in the medical history appear in RED text What medical alerts are listed in top right next to odontogram? if you see this message in Alerts, you must open the medical release letter to see if there are any limitations to treatment: To view the med release letter, go to the second tab- Medical summary tabscroll down to see Medical Consult- click ON FILE to view letter. Any precautions listed at bottom of sheet? 24

25 AxiUm Training Exercise for Residents Go to line in Medical History- List any meds w/brand (generic) dosage Double click so that text box opens Add aspirin daily, Claritin as needed Go to next line in form, you should see updated meds in Current Medications at top right next to odontogram scroll down to view entire medical history form button appears because patient must sign medical history initially and whenever changes are made. Click on each tab in the bottom half of EHR to become familiar with info found there- In Progress- Today s Activities, Pending treatment, health summary Tx History- Existing restorations, caries, notes completed in process and planned treatment, upcoming recalls and appointments Forms- medical history, consults, Forms on File list on right Attachments- consents, medical release letters, photos Perio- perio charts Tx Plan- Phase 1 and 2 treatment plans added at initial OD for Undergrads only tab allows entry of Findings and Planned treatment click on Create new Record button on top toolbar to open Chart Add tab. Add Findings: Click on Findings button (left of screen above category) to add findings for a new patient (existing conditions & restorations) Right click on tooth # 1,16, and 32 in odontogram and mark as Missing. Indicate that #17 is impacted (conditions- impacted-choose tooth- add finding button) Add an existing amalgam restoration on Occlusal surface of tooth #30. Choose M-AMAL, then choose Occlusal surface on tooth #30 in odontogram, then add finding button Add existing composites (caries/rest) on mesial surfaces of #7 and #8. Add primary caries as a finding on Occlusal surface of tooth #2 and #14. Occlusal surface on odontogram for teeth 2 and 14- Add finding button. Right click on tooth #12 and change to primary tooth (age change). Add Planned treatment: Choose Dental Txs button to add planned treatment. Add a prophy by choosing Preventive category-adult Prophy from Quick List and Hit planned treatment button - tooth with yellow P Add 4 bitewings by choosing Diagnostics category- Bitewings, four films from Quick List, hit planned treatment button. Add an amalgam on tooth #14- Operative category-d2140- Occlusal surface on #14 in odontogram, planned treatment button 2 25

26 AxiUm Training Exercise for Residents Text for these procedures will be blue because faculty approval is needed. Chart number button in status bar at bottom of screen turns aqua also. Yellow dot on tooth surface in odontogram means planned treatment procedure. Go back to In progress and Tx history to view planned treatment. Add Treatment Notes: Clinical Notes: Add note by right clicking on a procedure in the Tx History tab - Add Tx Note- Notes can be entered as General notes (free style), Template note (must choose a template for that department), or SOAP notes. Template note- hit ellipsis button next to Code- choose a note - double click to add to bottom of window. Note guide appears in window-complete information in note. Hit OK. If no procedure was done, hit button on right toolbar to add note. Select General note- Add note Patient came to clinic in pain. took radiograph #24- sent to PG endo clinic for evaluation for endo. To add SOAP notes- select - select SOAP note- add information to all four sections of SOAP note- OK to save and close. To add a note to a tooth: right click on tooth #7 in odontogram- add note composite discolored - Note should appear in TX History Print Treatment Estimate: once planned treatment has been entered and approved, you can print a treatment estimate go to the Tx History tab- hit the button on the lower right toolbar in the Tx History tab- Select All or you can select which procedures you want and hit Ok- it displays an amount for the selected procedures. Lexi-Comp Online- Drug Database Search Go to Links (top toolbar) Axium Help Training- Go to Links (top toolbar)- link will open axium training page on LSUHSC School of Dentistry with cheat sheets and training videos 3 26

27 AxiUm Training Exercise for Residents Add a Form (consult or new medical history): Go to Forms tab- hit Add Forms button on top toolbar CNS- consult (ENDORE is for referral to PG endo, SURGRE is for referral to PG Oral Surgery) Complete the form as if you were called to undergrad clinic for a consult for your department. To open an existing form, click on date of the form or next to the form under on right. View Appointments:Go to Scheduler module Will open to your scheduling book Click on book icon in upper right hand corner of scheduler screen to select another book (if available) Click on green date button at bottom of window- calendar appears- select another date to view Find a date when you have patients in your schedule- right click on the appointment slotallows you to go to Patient card- Select patient opens the patient record. print a list of appointments or recalls in various date ranges- hit Search to run report after setting date range- will default to your provider code. Print view at bottom of window allows you to print schedule. View upcoming appointments for patient: Click on patient name in status bar at bottom of screen, appointments can be viewed at bottom of Patient Card window. 06/

28 AxiUm Training Exercise 2 New Residents Your laptop on campus: Remote Desktop connection *Clinic laptops: just click on axium icon on desktop. **Off Campus: LSUSD website- Quick Links- Citrix Go to Rolodex module- select patient from workpad list on right or type in last name or chart # and hit enter. Chart is open when name appears in status bar at bottom of screen. Go to EHR module: For a New Patient- to chart caries/restorations already there: Add Findings: click on Create new Record button on top toolbar to open Chart Add tab. Click on Findings radio button to add findings for a patient (existing conditions & restorations) Add caries and existing restorations as shown: select code from quick list select tooth surface in odontogram Add finding from toolbar 1 28

29 When complete, odontogram should match image below: When all findings have been charted, student/resident will plan treatment for patient. Adding Planned Treatment Add a planned endo on tooth #8 and 9, Practice using the Expert subtab by going to the first subtab- Expert in the Chart add tab- Select a Diagnosis- PA abscess select tooth 8 & 9 in odontogram D3310in procedures button here) Planned treatment **(do not use Add finding Add remaining planned treatment as shown: 2 29

30 Odontogram should look like this. Go back to In progress and Tx history to view planned treatment. If planned treatment is blue instead of red (approved), let Kathy Hansel know so that she can approve it. Planned treatment must appear in red, meaning that it has been approved before proceeding to next section. Some departments allow postgrad residents to automatically approve planned treatment, others require faculty approval first. Changing planned treatment to In process or Complete Go to the In Progress tab- (first tab) Under Pending Treatments, you should see planned treatments in red text. P in status column means planned treatment. Double click on crown procedures for 8 and 9 and change to In Process (I status). For each visit when fixed/removable/endo procedures are in process, status should be In process. Double click on each of the remaining planned procedures and change status to Complete. (If your planned procedures are still blue, raise your hand and I will approve them) Status column will now have I or C to indicate In Process or Complete and text turns blue (unapproved), black (approved) or brown (in process & approved). Blue text must be approved by faculty. Very Important: Charges and billing will not be complete until the status of the procedure is changed to complete and approved (black text). Add Treatment Note: Right click on the crown procedure you just changed to InProcess- Add Note- Template-Code- choose PGPROS note template- fill in note- hit OK Click on aqua chart # button to see what needs approval. 3 30

31 Go to the Attachments tab or the module on the left side of the screen- go to the Consent Forms section to see if the patient has signed an Endo Consent form- Yes or No Open and complete Forms for patient Click on Add Form button on upper right toolbar in EHR- select form with drop down arrows. Complete the following forms according to your department: PG Perio- PEREF & PATH PG Endo- ENCONS & PATH PG Pedo- PCE 2 Oral Surgery - SURGRE PG Pros and GPR- CNS & PATH Add a contact note for your patient: Patient card- hit name on status bar- contact notes icon type in wrong phone number in the Note text window- hit create new record button to save 4 31

32 Go to the Patient Care module - all records for a patient in one screentext format Change the date range to start at 01/01/10- drop down arrow next to View allows you to select records to view- hit Search All appointments, notes, treatment will display if All Records View is chosen. Production Report: Go to Info Manager - custom button select Production Report- Print- click on report type- select from drop down- click on date range- select date range- OK-view production report- completed procedures only. Send an internal message to Kathy Hansel when both training exercises are complete. Hit envelope in status bar at bottom of screen Hit create new record button - type in Hansel in the To field and Training exercise in the subject field, in the text window, type I am finished. Send 06/