TOHM Review Checklist

Titanium and Sydexis Training for Third-Year Students¹

This document provides a comprehensive overview of the key functions and best practices for using the Titanium and Sydexis clinical software systems. The information is intended as a guide for third-year students to ensure proper patient management, clinical documentation, and adherence to established protocols.

IT Support Contact: For any technical issues, please contact the IT team via email at IT Team Aqua.

Navigating the Titanium Interface

Appointment Book Tips

• Expand View: To increase the viewable area (“real estate”) in the appointment book, click on the edge of the appointment book panel to expand it.

• Filter by Provider: You can filter the appointment book to show only your schedule by entering your Titanium provider ID. This will display all your appointments for a comprehensive view.

• ==Column Customization: You can click and drag the columns in the appointment book to resize them for better visibility.==

• ==Focus Management: If you click off a patient in the appointment book, the system may behave unpredictably. To reset your focus, click on a random patient first before re-selecting your intended target.==

• ==Week-by-Week View: Use the Appointment Slot Search feature to generate a week-by-week viewing of your scheduled appointments, which is helpful for long-term planning.==

Finding Your Appointments

If you are unable to see your scheduled appointments or chair assignments in the main view, use the search function:

1. Click the Search button.
2. Enter your provider number (e.g., 8761).
3. The system will display a week-by-week view of your appointments for the next six weeks, including dates, times, and booking details. This provides a quick way to locate your rostered sessions without having the ability to book patients directly.

==Alternatively, in the “My Appointments” section, go to Select Book and input your specific S-number (e.g., S-XXX). This filters the view so you only see your own assigned appointments.==

Note: For appointments where you are assisting another clinician, this view will not be sufficient. It is recommended to cross-reference with Herman or other scheduling tools.

Patient Profile Linkage Bug²

There is a known bug in Titanium that can prevent patient information from transferring correctly from the appointment book to the patient profile screen.

• Symptom: When you click on a patient in the appointment book, the patient profile fields may appear blank.

• Workaround: To establish the link, select any patient from your patient history dropdown menu in the profile section first. After doing this, clicking on a patient in the appointment book will correctly load their data into the profile.

• If a course of care glitches or is closed, you can find patient history by clicking the small 'H' icon in the toolbar located under the odontogram.

Patient Profile Management

Checking Patient Eligibility

Before commencing any clinical activity, including contacting the patient for an appointment, it is crucial to verify their eligibility status. The status is indicated by the color of the banner at the top of their patient profile.

• Blue Banner: The patient is eligible for treatment. The profile will show no outstanding debt and a valid eligibility expiry date. You may proceed with the appointment and treatment.
• Red Banner: The patient is ineligible for treatment. You cannot enter any treatment or charting information into the profile.

Procedure for Ineligible Patients (Red Banner):

1. Recognize that you cannot proceed with the patient.
2. Do not attempt to diagnose the reason for ineligibility (e.g., debt, expired healthcare card, etc.).
3. Refer the patient back to reception to resolve the issue.
4. Best Practice: Check the patient’s eligibility status before calling them to book an appointment to avoid wasting time and prevent difficult clinical scenarios.

Final Check

Before calling a patient from the waiting area, perform a final check on their profile's top banner. This is to verify their eligibility (e.g., Centrelink status) is still valid immediately before commencing treatment.

Managing Medical Alerts

Alerts are used to communicate critical patient information to all clinicians.

• Adding an Alert:

  1. Click the Add button in the alerts section at the top of the patient profile.
  2. Select the type of alert (e.g., Medical, Medications, Special Needs).
  3. Enter the relevant information (e.g., “Blood disorder,” “Requires translator”).

  ==Alternatively, you can navigate via the main menu: Toolbar > Add > Set Alert. This is used to document allergies or other critical health conditions.==

• Viewing Alerts: Active alerts will appear as a flashing icon in the patient’s profile. These alerts are vital for clinical safety and should be reviewed at the start of every session.

• Cancelling Alerts: Alerts can be cancelled, but this should be done with extreme caution as it has significant clinical implications. Note that all actions related to alerts are recorded in an audit trail.

Clinical Workflow in Titanium

1. Medical History³

A medical history must be completed and reviewed as per clinical protocols.

• Process:

  1. Click the question mark symbol (?) in the patient profile.

  2. Select New Medical History.

  3. Go through the questionnaire with the patient.

• Pre-population: For returning patients, the form will pre-populate with answers from their most recent medical history.

• Frequency: Confirm with your student coordinators the required frequency for taking a new medical history (e.g., every appointment, only for new patients, or if changes are reported).

• Printing: Medical history forms, once completed, are stored in the Documents tab as PDFs and can be printed from there.

Internal Resources

==Internal resources and templates can be found via the OCHWA SharePoint site (uniwa.sharepoint.com/sites/ochwa), which should be bookmarked for quick access.==

2. eForms: Consent and Lab Slips

eForms are used for various documentation needs, including patient consent and lab requests.

• Treatment Consent:
  • This form must be completed for new patients or patients new to you.
  • Review the form with the patient and obtain their signature.
  • Use the Save and Complete option. This makes the form indelible and prevents future edits.
    • ==Use the Calculator icon at the bottom of the screen to generate an estimate. This module allows for the digital capture of patient signatures for informed consent.==
• Complex Forms (e.g., Periodontics):
  • These forms may require information gathered over multiple appointments.
  • Use the Save option to save your progress without finalizing the form. You can return to it later to add more information.
• Lab Slips:
  • The only editable fields are the dates.
  • You must print the form to mark the tooth on the odontogram and specify lab requirements.
    • Use the integrated LabMagic system for managing laboratory prescriptions and slips.

3. Charting: Baseline vs. Treatment

It is essential to distinguish between charting existing conditions (baseline) and charting planned treatments.

• Baseline Charting:

  • This is performed in the Baseline section of the odontogram.

  • It documents all conditions and existing restorations observed in the patient’s mouth before you begin your treatment.

    • ==To access, click the “Base” tab at the bottom right of the screen.==
    • To record findings, right-click on the odontogram.

  • Correcting a Missing Tooth: If a tooth was incorrectly marked as missing, you can restore it by selecting “Missing” from the charting options and clicking on the tooth again in the baseline chart - The “Missing Tooth” button acts as a toggle; to add a tooth back, select the empty spot and click the button again..

  • Charting Over Existing Work: Do not delete previous clinicians’ baseline observations. Chart new findings over the top. The odontogram may become congested, but hovering over the tooth will reveal a chronological history of all charted items.

• Treatment Charting:

  • This is performed in the main charting area (above the baseline).

  • It documents the treatment you plan to perform today or in the future.

  • Left-Click vs. Right-Click:

  • Left-Clicking surfaces individually charts them as separate conditions (e.g., a carious lesion on the mesial, another on the occlusal).

  • Right-Clicking and dragging across surfaces charts them as a single, continuous condition (e.g., one carious lesion spanning the mesial-occlusal-distal surfaces).

4. Course of Care Management⁴

A Course of Care (CoC) groups all treatment items for a specific plan.

• Creating a CoC:

  1. Right-click on the desktop and select Add Appointment.
  2. When creating the CoC, ensure the payer is set to DMD. Do not use other options like DMD 3 & 4 unless specifically instructed.
     • You must also set the Clinic Code to "Undergrad".
  3. Select the appropriate information category (e.g., GP Dentist).

• Managing Long Courses of Care:

  • CoCs with over 20 items can become buggy and may cause duplication errors.

  • Best Practice: Keep CoCs concise. Close a CoC once a phase of treatment is complete and open a new one for the next phase

    new episode for entirely new treatment cycles..

    Create a

  • Recommendation: Use separate CoCs for different treatment types (e.g., one for perio, one for restorative). This keeps treatment plans and estimates specific to that specialty.

  • To close a CoC, use the handshake button.

• Viewing Past Treatments:

  • Even after a CoC is closed, you can view all historical treatments using the History tab in the patient’s chart.
  • Alternatively, use the Clinician Activity Report (see Reporting section). - ==To do this, access SQL Server Reporting Services via SharePoint (OCHWA Internal Sites > Titanium Reports > Students).==

5. Treatment Plans, Estimates, and Worksheets

• Estimates:

  • Use the calculator icon to generate an estimate for any treatment plan that includes items with a fee.
  • The estimate document includes consent declarations that the patient must read and sign.
  • The signed estimate is saved in the Documents tab, providing a record for any future fee disputes.

• Treatment Plans and Worksheets:

  • Worksheet: Used for simpler treatment plans to show a tutor for approval.

    • These are generally used for routine tasks at the start of an appointment.

  • Treatment Plan: Used for complex, multi-stage treatments (e.g., dentures) that span several appointments. This requires signatures from both the student and the tutor/coordinator.

    • Other examples of complex procedures include indirect restorations (e.g., Onlays) and endodontics.
    • If a session involves a variety of different procedures, they should also be organized under a Treatment Plan rather than a simple worksheet.

  • If a treatment plan changes, a new plan should be created. All versions will be stored chronologically under the treatment plan tab.

6. Tutor Approval and Charging⁵

• Approval:

  • All planned treatment items will have a red asterisk.
  • Before starting treatment, a tutor must approve the items.
  • Select the items (hold Shift to select multiple) and the tutor will enter their PIN.
  • Approved items will have a blue asterisk.

• Charging Through:

  • At the end of the session, all completed work must be charged through.
  • This is critical for two reasons:
    1. Student Credit: You will not receive credit towards your quotas unless the items are charged.
    2. Clinic Revenue: The clinic is reimbursed by the Department of Health for completed services.
  • The tutor will typically check the “Completed” box for the appointment or individual items before the final charge is processed.

7. Handling Sterilization Batch Numbers

• When documenting sterilization batch numbers in the corresponding eForm, use Save and Complete.
• Common Error: If you use Save and then attempt to charge the item, you will receive an error because the form is not complete.
• Correction: If this happens, the tutor must un-approve the item. You can then go back to the eForm, click Save and Complete, and have the tutor re-approve and charge the item.
• Tip: You can use a comma to enter multiple batch numbers from the same sterilizer in a single field.

Reporting and Data Management

Clinician Activity Report

This powerful report provides a complete history of all activity you have performed and charged through. It is an invaluable tool for tracking progress and filling out logbooks.

Info

Students should monitor their own activity and progress through the reporting tools available on the OCHWA SharePoint site. This ensures all procedures are captured and credited correctly.

• Access:

  1. Navigate to the Aqua SharePoint site.
  2. Go to Aqua Internal Sites > Titanium Reports > Students.
  3. Select Clinician Activity with Notes.

• Usage:

  1. Enter your student provider number (e.g., S8777).
  2. Click View Report.
  3. The report will list every patient, item code, and clinical note associated with your provider ID.
  4. You can export this report to Excel, allowing you to filter by patient and copy information for your logbook or treatment planning.

Sydexis Imaging Software⁶

**Accessing Patient Profiles in Sydexis

• Ensure the patient is active in Titanium before launching Sydexis to ensure the bridge correctly links the patient's digital records.**

• Launch Sydexis by clicking the tooth icon in Titanium.

• The patient’s profile should load automatically. Note that the Sydexis card number is different from the patient’s UMRN in Titanium.

• Known Bug: The system may incorrectly default every patient’s gender to female. This is a known issue being addressed.

Image Acquisition and Processing

• For Phosphor Plates (ScanX):

  • At the computer adjacent to the ScanX unit, you must use the Image Bridge icon (a small blue icon at the bottom right).
  • Do not use the “Exposure” tab to acquire plate images. Doing so will result in warped, unusable images and will require retakes.

• For Importing Photos (e.g., extra-oral, intra-oral camera):

  • Use the Exposure tab to import images from other sources. You can import multiple images at once.

• Standard protocols for digital X-rays apply; ensure images are saved and correctly oriented within the Sydexis interface before ending the session.

• Downloading Images: There is an option to download images from Sydexis, which can be located within the software’s interface.

Academic Module and Referrals

Making Referrals

The process for referring a patient depends on the specialty.

• Oral Medicine and Oral Surgery: These referrals must be made through the reception desk. Walk the patient to reception to have the referral created.
• All Other Disciplines (Perio, Endo, etc.):
  1. Create a Waitlist Entry: Referrals are made by creating an entry in the Waitlist area of the Academic Module.
  • ==Navigate to Waitlist/Referral.==
  • ==Click on a Waitlist Entry.==
  • ==Use the Waitlist Dropdown to select the destination/specialty.==
  • ==Subclass: It is suggested to select “CONSULT”.==
  • ==Notes: Ensure you provide detailed clinical notes explaining the reason for the referral.==
  2. Add Notes in CoC: In the patient’s Course of Care, add a referral item and detailed notes explaining the reason for the referral.
  3. Seek Tutor Assistance: It is highly recommended to create the waitlist entry with a tutor to ensure the patient is placed in the correct subcategory (e.g., Perio-Consult vs. Perio-Scale and Clean). This prevents delays and ensures the patient is seen by the appropriate clinician.

Managing Assigned Patients⁷

Viewing All Assigned Patients

To view a comprehensive list of all patients assigned to you, it is necessary to adjust the default filter settings.

• Process: When you open the Academic Module, it may filter by a date range. To see all your assigned patients, remove the start and end dates from the filter. This field should be removed to display your entire patient roster, rather than just those within a specific timeframe.

Requesting Patients and Treatment

• Requesting Patients: You can request new patients through the module by listing treatment needs in the notes section.
• Students must proactively manage their patient list. If a patient requires a specific procedure not currently on their plan, a treatment request must be initiated.
• Procedure for “Pronuna” Requests:
  1. List the specific treatment needs in the Notes section for the relevant patient.
  2. Send the request through the system.
  3. The request will then be processed and assigned accordingly.
• Post-Request Management: Once a request has been completed, you can use the system’s filtering tools to remove it from your active request list, ensuring your dashboard remains organized and up-to-date.

Discharging Patients

The system allows users to request that a patient be discharged from their care.

• Process: A discharge can be requested directly through the platform.
• Important Clarification: First seek clarification from a coordinator to ensure the patient’s treatment is truly complete and no follow-up is required. It is crucial to confirm the nature of the discharge. A patient marked as “discharged” may not be permanently removed from the system. They could be returned to the general patient pool for future follow-ups (e.g., a six-month check-up) and may be reassigned later.

This process is essential for maintaining an accurate active patient list.

Filtering and Organizing Patients

To maintain an organized and efficient workflow, the system provides robust filtering capabilities.

Filtering by Patient Status⁸

You can filter your patient list based on their current status. For example, setting the filter to exclude patients marked as “Complete” will hide them from your primary list. This allows you to focus solely on active cases that require attention.

• Utilize the status filters to distinguish between patients who are "Ready for Care," "In Progress," or "Completed."

Creating Filter Shortcuts

For frequently used views, you can create shortcuts. This allows you to quickly apply a pre-set filter, such as one that displays only your active cases, to streamline your workflow.

• Custom filters can be saved to quickly access specific patient groups (e.g., those requiring specific procedures like endo or pros).

Treatment Requests

Procedure for “Pronuna” Requests

When submitting a request for treatment (referred to as a “Pronuna” request), follow these steps:

1. List the specific treatment needs in the Notes section for the relevant patient.
2. Send the request through the system.
3. The request will then be processed and assigned accordingly.

Post-Request Management

Once a request has been completed, you can use the system’s filtering tools to remove it from your active request list, ensuring your dashboard remains organized and up-to-date.

• After submitting a request or referral, monitor the status in Titanium to ensure the patient has been triaged or added to the appropriate specialist waitlist. Check the "Interactions" or "Documents" tab for updates from senior staff.

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Questions to Answer

• Odontogram Legend

• Episode Colour Legend

• Templates for clinical notes?

• Sharepoint access

• Referral

• Finding assisting sessions

• tohm docs

Sidexis

LabMagic

Referral

General Tips

• You can click columns in appointment book to make it bigger
• in my appointments you can go to select book > input S-XXX > you only see your own S number
• If you click off a patient in appointment book, you have to click a random patient first or else its random
• you can do an appointment slot search and get a week by week viewing of when your appointments are
• When patients arrive you have to make sure that the patient profile hasn’t expired you can do this by:
  • looking at the top bar colour (i.e. red bar across the top)
  • Before you call the patient, check if they’re eligible
    • centrelink and stuff
• uniwa.sharepoint.com/sites/ochwa (saved in bookmarks)
• Documents Tab is interactions with the patient
• You can add a medical alert (i.e. for allergies and stuff)
  • toolbar > add > set alert
• Baseline charting
  • click in the base tab at the bottom right > right click on odontogram
• How to add a tooth back
  • just select the empty spot, then click missing tooth in the base charting (it works like a toggle)

Creating Episodes

• Select DMD Payer
• Clinic code should be “Undergrad”
• Fill information about the first appointment
• create a new epidsde for new treatments

Treatment Approval

• Red asterix means its not approved
• shift select all to be approved and approve them

Estimate

• Click the calculator at the bottom
  • it gives you estimate and consent with the ability to sign

Treatment Plan vs worksheet

• worksheets happen at the start of the appointment
• treatment plan is for more complicated procedures
  • indirects, onlays , endos
• if you have a mix of stuff, it goes under tx plan

Finding patient history after closing course of care when glitched

in tool bar under odontogram click the tiny H to see the patinet history!

Course of Care too long

When it gets too long, you have to close the course of care

• go to history tab to see the old course of care
• you can also see it under SQL SERVER Reporting Services
  • Sharepoint > ochwa internal sites > titanium reports > students

Multiple Batch Numbers

If under the same sterilizer you can use a comma and add them

Referral

• go to waitlist/ referral
• click a waitlist entry
• then under the waitlist drop down pick who you’re referring to
  • subclass (CONSULT is suggested)
  • Fill notes on why you are giving the referral

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