Axium and Outcomes

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Axium and Outcomes

• Axium Users Meeting
• Whistler, BC
• Dec 8 10, 2003

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OHSU School of Dentistry

• Its in Oregon! Not Ohio!

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CIS team Melissa Monner, Mary Lloyd, Rose
Russell, Robert Pearson, Denice Stewart
Working Day and Night!
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Goals

• Identify common, key outcomes used by schools to
  assess patient care
• Present methods to obtain this information from
  Axium records

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Outcomes

• Student Experiences and Performance
• Quality Assurance Patient Care
• Financial

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We said we do it, what else do you need?

• Proving or showing outcomes are measured
• Completing the quality assurance cycle did the
  plan to improve or correct deficiencies work?

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External Forces

• Accreditation requirements
• OSHA, infection control
• HIPAA

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Internal Forces

• Improve efficiency
• Quality assurance

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I know its in here somewhere . .

• Or, I hope we are collecting these data . . .
  .

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I. Student Experience Performance

• A. Patient care experiences
• 1. Patient Services
• B. Competencies

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Patient Pool

• 2-11 The dental school must ensure the
  availability of adequate patient experiences that
  afford all students the opportunity to achieve
  its stated competencies within a reasonable time.
  
• 2-17 Graduates must be competent in managing a
  diverse patient population and have the
  interpersonal and communications skills to
  function successfully in a multicultural work
  environment.

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Patient pool

• 2-11 adequate patient experiences
• Info manager or Crystal report

• pts screened
• pts admitted
• pts assigned per student
• pts completed
• pts placed on recall
• Avg treatments, visits/pt

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Patient care experiences

• 2-17 diverse population
• Info manager or Crystal report

• Pts by age, gender
• Medically compromised pts
• Pts by language (custom code)
• Pts by disabilities (custom code)

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Competencies
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Critical thinking and info tech

• 2-23   Graduates must be competent in the use of
  critical thinking and problem solving related to
  the comprehensive care of patients.
• PROCESS - Describe treatment planning module and
  how it guides student
• 2-24  Graduates must be competent in the use of
  information technology resources in contemporary
  dental practice.

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Critical thinking and info tech

• 2-24  Graduates must be competent in the use of
  information technology resources in contemporary
  dental practice.
• Competency in use of Axium student must pass
  before entering clinic

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Competency in use of CIS

• Patient confidentiality
• Performance of key functions

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Competent in clinical areas

• 2-25  At a minimum, graduates must be competent
  in providing oral health care within the scope of
  general dentistry, as defined by the school, for
  the child, adolescent, adult, geriatric and
  medically compromised patient, including
• patient assessment and diagnosis comprehensive
  treatment planning health promotion and disease
  prevention informed consent anesthesia,
  sedation and pain and anxiety control
  restoration of teeth replacement of teeth
  periodontal therapy pulpal therapy oral
  mucosal disorders hard and soft tissue surgery
  dental emergencies malocclusion and space
  management and evaluation of the outcomes of
  treatment.

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Competent in clinical areas

• 2-25  competent in providing oral health care
  within the scope of general dentistry for the
  child, adolescent, adult, geriatric and medically
  compromised patient, including
• Track competency in Axium
• See 2-17 diverse patient population

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II. Quality Assurance Patient Care
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Quality Assurance

• 5-1  The dental school must conduct a formal
  system of quality assurance for the patient care
  program that demonstrates evidence of
• a. standards of care that are patient-centered,
  focused on comprehensive care and written in a
  format that facilitates assessment with
  measurable criteria
• b. an ongoing review of a representative sample
  of patients and patient records to assess the
  appropriateness, necessity and quality of the
  care provided
• c. mechanisms to determine the cause(s) of
  treatment deficiencies and
• d. patient review policies, procedures, outcomes
  and corrective measures.

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Assessable standards of care

• a. standards of care that are patient-centered,
  focused on comprehensive care and written in a
  format that facilitates assessment with
  measurable criteria

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Standards of Care

• 1.   Comprehensive care is provided.
• 2.   Care is provided in a timely manner.
• 3.   Patient care is of high quality.
• 4.   Patients report satisfaction with care
  received.
• 5.    Confidentiality of patient information is
  maintained.
• 6.    Care is delivered in a safe environment.
•  

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UNC Standards of Care

• Timeliness of Care
•  All adult patients will be assigned to a student
  within four weeks of admission.
•  Treatment plans will be developed within six
  weeks of assignment to the student.
•  All active patients will have the opportunity to
  be seen at least once per month when clinics are
  open.
• publically accessible on line

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Timeliness of Care

• Overdue Manager

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Categories to monitor timeliness of care and
ensure current information
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Source www.exanacademic.com Users area --
Manuals Overdue Conditions
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Source www.exanacademic.com Users area --
Manuals Overdue Conditions
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Set up of Overdues
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UNC Standards of Care

• Informed Consent
•  Prior to initiating care, patients will indicate
  their understanding and acceptance of the
  treatment plan by a signature on the written
  treatment plan form and the consent form.
•  Consent will include 1) a description of the
  procedures and prognoses, 2) alternative
  treatments and prognoses, 3) a description of
  foreseeable and material risks, and, 4) the
  consequences of no treatment. Each patient will
  be given an opportunity to have his/her questions
  answered.

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UNC Standards of Care

• Patient Records
•   A medical alert sticker will be placed inside
  the patient record on both the Medical Alerts and
  Problems and Plan of Care forms whenever the past
  medical history reveals any condition that may
  potentially lead to complications during dental
  treatment. If no such history exists, the word
  None will be noted.
•  Patient records will remain confidential and
  will be maintained within the physical confines
  of the School of Dentistry.

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UNC Standards of Care

• Comprehensive and Limited Care
•  Each patient will be assigned to a student with
  an emphasis on comprehensive management of the
  patient's oral health. Faculty and students will
  aspire to manage each case in a manner sensitive
  to the medical, psychological, socioeconomic, and
  behavioral characteristics of the patient.

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Record Review

• b. an ongoing review of a representative sample
  of patients and patient records to assess the
  appropriateness, necessity and quality of the
  care provided

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Record Review

• Survey form set up in Axium
• Can limit access to write vs view for staff vs
  student
• Limits students to accessing only their pts
  record reviews
• Can be updated and show changes compliance
• Can report on s and deficiencies

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(No Transcript)
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Treatment deficiencies

• c. mechanisms to determine the cause(s) of
  treatment deficiencies and

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Treatment deficiencies

• c. mechanisms to determine the cause(s) of
  treatment deficiencies
• record review items and results
• info manager or Crystal reports

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Treatment deficiencies

• c. mechanisms to determine the cause(s) of
  treatment deficiencies and

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Policies, procedures, outcomes, corrections

• d. patient review policies, procedures, outcomes
  and corrective measures.
• Assess success of corrective measures through
  outcome reports from Axium

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BLS

• 5-5  All students, faculty and support staff
  involved in the direct provision of patient care
  must be continuously recognized in basic life
  support (B.L.S.), including cardiopulmonary
  resuscitation, and must be able to manage common
  medical emergencies.

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Provider Care CPR Expiration Date
Run info manager report on status and counts use
to monitor periodically
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Radiation Safety

• 5-6  Written policies and procedures must be in
  place to ensure the safe use of ionizing
  radiation.
• Describe approval process
• Describe/show radiation exposure count

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Confidentiality

• 5-8   The school's policies must ensure that the
  confidentiality of information pertaining to the
  health status of each individual patient is
  strictly maintained.
•  

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Confidentiality

• 5-8   ensure that the confidentiality of
  information is strictly maintained.
• Describe role based access, logon and card
  security processes
•  

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Financials
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HIPAA

• Transactions and Code Sets
• Privacy
• Security

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HIPAA tracking other potential impacts

• TRACKING
• For patients
• Consent for disclosure of PHI (mechanism to
  indicate completed electronic consent for PHI or
  scan documents)
• Authorizations (ditto)
• For staff, students, faculty
• Training
• Other impacts
• Potential changes in logon process
• Code set and transactions

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Direct patient care information
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Chart Audits

• Linked to patient and student
• Direct entry
• Ability to track follow-up turnaround time and
  resolution
• All versions maintained
• Analysis for trends and against goals
• Sampling methodology (by student, by discipline,
  by active pt, by pt age, by date range)

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Chart review format
Reporting by item, by chart, by student, etc.
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• Tracking information
• Health tests and results, expiration dates
• Training OSHA, HIPAA
• Credentialing - licensure
• Direct patient care information- data collection,
  analysis and follow-up new info
• Timeliness of care
• Chart reviews
• Reports, Patient satisfaction

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Tracking
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User Health --