# Titanium and Sydexis Training for Third-Year Students 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. ## 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. **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 Bug 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. 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.** #### Appointment Book Optimization - **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. #### Locating Scheduled 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. *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 Bug 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. # 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. ## 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"). - **Viewing Alerts**: Active alerts will appear as a flashing icon in the patient's profile. - **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 History A medical history must be completed and reviewed as per clinical protocols. - **Process**: 1. Click the question mark symbol (?) in the patient profile. #### Patient History Link Workaround To establish the link between the appointment book and the profile section: - 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. 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. #### Eligibility Status Indicators - **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. **Best Practice**: Check the patient's eligibility status *before* calling them to book an appointment to avoid wasting time and prevent difficult clinical scenarios. #### Managing Medical Alerts Alerts 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"). - **Viewing Alerts**: Active alerts will appear as a flashing icon in the patient's profile. - **Cancelling Alerts**: Alerts can be cancelled, but this should be done with extreme caution as it has significant clinical implications. All actions related to alerts are recorded in an audit trail. #### Clinical Workflow: Medical History A medical history must be completed and reviewed as per clinical protocols. - **Process**: 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. ## 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. * **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. ## 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. * **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. * **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:**  1. Select **New Medical History**. 2. Go through the questionnaire with the patient. #### Medical History Guidelines - **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 are stored in the **Documents** tab as PDFs and can be printed from there. #### 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 to make the form indelible and prevent future edits. - **Complex Forms (e.g., Periodontics)**: - These forms may require information gathered over multiple appointments. - Use the **Save** option to save 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. Text-based procedure diagram outlining the workflow for eForms (Consent and Lab Slips). The diagram details steps for Treatment Consent (reviewing and obtaining signature), Complex Forms (saving progress over multiple appointments), and Lab Slips (printing to mark tooth on odontogram). **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 Management 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. 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. - **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). ## 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. - *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. - If a treatment plan changes, a new plan should be created. All versions will be stored chronologically under the treatment plan tab. 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. - Documents all conditions and existing restorations observed *before* treatment begins. - **Correcting a Missing Tooth**: If a tooth was incorrectly marked as missing, select "Missing" from the charting options and click on the tooth again in the baseline chart to restore it. - **Charting Over Existing Work**: Do not delete previous clinicians' baseline observations. Chart new findings over the top. 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). - Documents the treatment planned for today or the future. - **Left-Clicking**: Charts surfaces individually as separate conditions (e.g., separate carious lesions on mesial and occlusal). - **Right-Clicking and Dragging**: Charts surfaces as a single, continuous condition (e.g., one MOD carious lesion). A Course of Care (CoC) groups all treatment items for a specific plan. #### Creating and Managing a CoC 1. Right-click on the desktop and select **Add Appointment**. 2. Set the payer to **DMD**. Do not use other options like DMD 3 & 4 unless instructed. 3. Select the appropriate information category (e.g., GP Dentist). #### CoC Best Practices - **Size Limits**: CoCs with over 20 items can become buggy. Keep CoCs concise. - **Phasing**: Close a CoC once a phase of treatment is complete and open a new one for the next phase using the **handshake button**. - **Specialization**: Use separate CoCs for different treatment types (e.g., one for perio, one for restorative) to keep estimates specific to that specialty. #### Viewing History and Estimates - **Viewing Past Treatments**: Use the **History** tab in the patient’s chart or the Clinician Activity Report. - **Estimates**: Use the **calculator icon** to generate an estimate for treatments with fees. The signed estimate is saved in the **Documents** tab. - **Worksheets**: Used for simpler treatment plans to show a tutor for approval. - **Treatment Plans**: Used for complex, multi-stage treatments (e.g., dentures). Requires signatures from both student and tutor. New plans should be created if treatment changes; all versions are stored chronologically. # 6. Tutor Approval and Charging * ### 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. * ### 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. #### Approval Process - 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) for the tutor to enter their PIN. - Approved items will display a blue asterisk. #### Charging Through At the end of the session, all completed work must be charged through for two reasons: 1. **Student Credit**: You will not receive credit towards quotas unless items are charged. 2. **Clinic Revenue**: The clinic is reimbursed by the Department of Health for completed services. #### Sterilization Batch Numbers - Document sterilization batch numbers in the corresponding eForm using **Save and Complete**. - **Error Correction**: If you only use "Save" and cannot charge the item, the tutor must un-approve the item. You must then set the eForm to **Save and Complete** before the tutor re-approves and charges it. - **Tip**: Use a comma to enter multiple batch numbers from the same sterilizer in a single field. #### Clinician Activity Report This report provides a complete history of all activity performed and charged through. - **Access**: Aqua SharePoint > Aqua Internal Sites > Titanium Reports > Students > Clinician Activity with Notes. - **Usage**: Enter your student provider number (e.g., S8777) and click **View Report**. - **Data Management**: The report can be exported to Excel to filter by patient and copy information for logbooks. # Sydexis Imaging Software ## Accessing Patient Profiles in Sydexis * 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. * **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. 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.  #### Accessing Patient Profiles - Launch Sydexis by clicking the **tooth icon** in Titanium. - The patient's profile should load automatically. Note that the Sydexis card number differs from the Titanium UMRN. - **Known Bug**: The system may incorrectly default patient gender to female. #### Academic Module Referrals - **Oral Medicine and Oral Surgery**: Referrals must be made through the **reception desk** by walking the patient there. - **Other Disciplines (Perio, Endo, etc.)**: 1. Create a **Waitlist** entry in the Academic Module. 2. Add a referral item and detailed notes in the patient's Course of Care (CoC). 3. Seek tutor assistance to ensure the correct subcategory (e.g., Perio-Consult) is selected. #### Phosphor Plates (ScanX) - Use the **Image Bridge** icon (small blue icon at the bottom right) at the computer adjacent to the ScanX unit. - **Warning**: Do not use the "Exposure" tab for plate images; this causes warped, unusable images. #### Importing and Downloading - **Importing**: Use the **Exposure** tab to import images from other sources (e.g., intra-oral cameras). Multiple images can be imported at once. - **Downloading**: An option to download images is available within the software interface. Procedural diagram illustrating the workflow for 'All Other Disciplines' (Perio, Endo, etc.) within the Academic Module. The visual flow consists of three sequential steps: 1) 'Create a Waitlist Entry' in the Waitlist area; 2) 'Add Notes in CoC' (Course of Care); and 3) 'Seek Tutor Assistance' to ensure correct subcategorization (e.g., Perio-Consult vs. Perio-Scale and Clean). The text explicitly states that using a tutor prevents delays. # **Managing Assigned Patients** * **Viewing All Patients:** 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. * **Requesting Patients:** You can request new patients through the module by listing treatment needs in the notes section. * **Discharging Patients:** You can request to discharge a patient, but first seek clarification from a coordinator to ensure the patient's treatment is truly complete and no follow-up is required. ## **Guide to Patient Management in the Academic Module** This document outlines key procedures for managing patient lists, statuses, and treatment requests within the academic module. ## **Managing Your Assigned Patient List** ### **Viewing All Assigned Patients** To view a comprehensive list of all patients assigned to you, it is necessary to adjust the default filter settings. The system initially applies a start and end date filter. This field should be removed to display your entire patient roster, rather than just those within a specific timeframe. ### **Requesting Patient Discharge** 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:** 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. # **Filtering and Organizing Patients** To maintain an organized and efficient workflow, the system provides robust filtering capabilities. #### Viewing Assigned Patients - When opening the Academic Module, remove the start and end dates from the filter to see all assigned patients rather than just a specific date range. #### Requesting New Patients - Request new patients through the module by listing specific treatment needs in the notes section. #### Discharging Patients - You can request to discharge a patient through the platform. - **Coordinator Consultation**: Seek clarification from a coordinator before discharging to ensure treatment is complete. - **Status Note**: A "discharged" patient may be returned to the general pool for future follow-ups (e.g., six-month check-ups) and could be reassigned later. #### Filtering and Organizing - Use the system's filtering capabilities to maintain an efficient workflow, such as excluding patients marked as "Complete" to focus on active cases. Filtering by Patient Status 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. 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. Submitting 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. #### Patient Status Filtering You can filter your patient list based on current status. For example, setting the filter to exclude patients marked as "Complete" will hide them from your primary list, allowing focus on active cases. #### Creating Filter Shortcuts For frequently used views, you can create shortcuts to quickly apply pre-set filters, such as a view displaying only active cases. #### Submitting Treatment Requests (Pronuna) 1. List specific treatment needs in the **Notes** section for the relevant patient. 2. Send the request through the system for processing and assignment. #### Post-Request Management Once a request is completed, use the filtering tools to remove it from your active request list to keep the dashboard organized. 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