1.5 The SDM Electronic Oral Health Record (EOHR) Overview

Appendix 1.5
The SDM Electronic Oral Health Record (EoHR) Overview
The School of Dental Medicine has developed its own Electronic Oral Health Record
(EoHR) to support patient care, education, and financial management. The system,
commonly referred to as Picasso, began operation on July 7th 1998. The Picasso
design has, at its heart, the management and evaluation of student dentists and
residents. The functions to perform patient and financial management were
incorporated into the design, but the design was driven by the need to capture
detailed data about every student-patient-faculty encounter. It is currently being
developed in to a high quality, fully interoperable EoHR. It will allow the School to
operate in a paperless environment and also share and access patient health
information with other systems, like the Western NY Regional Health Information
Organization, known as HEALTHELink.
Evaluation Methods:
Picasso provides two methods of faculty evaluation. The first method is Clinical
Practical Examinations (CPEs). There are eighteen CPEs that must be successfully
completed by predoctoral dental students. The faculty records their assessment of
the CPE on an optical scan card. These cards are read and stored in the Picasso
database. The second method is through periodic evaluation. Each semester is
divided into two evaluation periods. The first period is a formative evaluation; the
second is the summative evaluation of student development relative to course goals.
In each period Picasso totals the number of clinic supervisions by each faculty
member for every student. If the number of encounters is over the threshold set an
evaluation is needed. The faculty logs into Picasso during evaluation week and
assess their list of students, as below.
Appendix 1.5
Periodic Evaluation
Students are evaluated (Honors, Satisfactory, Unsatisfactory) in twelve specific skill
areas and given an overall evaluation. The faculty also enter a textual comment on
the student's development or accomplishments during the evaluation period. The
faculty evaluator saves the assessment and proceeds to the next student in their list.
Once the evaluation entry week is complete Picasso produces an Evaluation
Summary to the student. The summary displays the student's grades and the
Appendix 1.5
faculty's comments. The summary does not identify the faculty members individually.
At the conclusion of the summative evaluation period Picasso generates a Student
Grade Report for the course director. This report calculates the semester grade
based upon all of the factors defined in the course syllabus and identifies any
missing or incomplete required elements, such as an incomplete CPE.
Appendix 1.5
Student/Resident Accomplishments
In addition to the evaluations, Picasso tracks the progress and accomplishments
associated with every clinical patient encounter. This data is available to the
student/resident, the faculty course director and/or program director. The detailed
view below may be sorted by date, patient, procedure, or clinic.
CPU Detail Report
The same data is summarized and analyzed in support of different management and
patient care objectives. One widely used report is the Production Summary report.
This report, seen overleaf, totals the "in progress" and completed dentistry by
category. Each student's accomplishments are listed in a single line on this report.
The left number represents the procedures in progress the right number the
completed procedures. Different column headings are used for predoctoral students
and advanced education residents. The first example is the predoctoral format.
Predoctoral Production Summary Columns
Appendix 1.5
Each advanced education program has defined a different Production report format
and the Periodontics program has defined two: Surgical and Non-Surgical. The
columns defined for the surgical report of the Advance Education Program in
Periodontics is shown below.
PG Production Detail Columns Perio (Surgical)
Basic Elements
Picasso provides many elements of any practice management system: Patient
Demographics, Appointment Scheduling. Treatment Planning, Patient Ledgers,
Billing, and Recall, Secure Messaging, Referrals, Digital Imaging, Electronic
Remittance and Chair-side Access. One important design consideration for Picasso
was to maximize the "hands on" time for students and residents to ensure that they
have experience using a practice management system.
Financial
Picasso provides a cashier's interface for the entry of treatment progress for each
appointment. Progress is recorded on the pre-printed Activity Tracking Form. From
this input new charges are posted to the patient ledger. Self-pay patient charges are
automatically differentiated from those, which need to be billed to Medicaid.
Discounts and payments are entered and the patient is provided with a payment
receipt. Among the financial reports available are Revenue and Payments and
Adjustments. Picasso generates Patient Billing and an electronic claim submission
for New York State Medicaid. Several reports are provided in support of Patient
Billing, Medicaid Billing, Department of Health Costing, and Collections. Activity
Tracking Forms are printed for every appointment.
Appendix 1.5
Account Ledger
The Activity Tracking Form is printed with the individual patient's updated treatment
plan. At the end of each appointment the student updates data and presents it to the
faculty for signature. This approach reduces coding errors and since the treatment
plan is phased and sequenced the faculty are provided with visual feedback on the
progress of treatment.
Diagnosis & Treatment Planning
Students and residents are required to create and maintain diagnosis data and
treatment plans for each assigned patient.
Diagnosis & Treatment Plan of a Perio Patient
Appendix 1.5
Treatment progress is automatically update each time an Activity Tracking Form is
processed. When an unplanned procedure is performed the cashier's entry is placed
on an adjunctive treatment tab. The student is required to integrate the procedure
into the treatment plan in the appropriate phase sequence.
Appointment Scheduling
Students and residents are required to schedule their own appointments via Picasso.
Faculty are scheduled by discipline and supervision load. Students may schedule
appointments form a School of Dental Medicine computer or from their own notebook
computer. Students may use the wireless network or connect from home to
schedule, cancel, or modify an appointment. Students are limited to viewing and
scheduling their own appointments. Once an appointment has been scheduled the
patient's chart and the appropriate instruments are ordered automatically. Staff and
faculty can view all appointments for a given clinic and a sample view is provided
below.
Appointment Schedule
Color is used to indicate the status of the appointment and the Activity Tracking
Form:
Red -form printed not processed; Green -form processed, Orange –appointment
cancelled; Violet - patient disappoint; and Blue -appointment scheduled form not
Appendix 1.5
printed.
Multi -Disciplinary Recall
A patient may be associated with several different types of recalls. Each recall allows
a different interval, protocol, and rules (recurring/non-recurring). The patient may
also have a Watch list and Recall instructions. When then appointment is scheduled
the scheduler combines all recalls due and Watch list items.
Recall Scheduler View
Digital Imaging
The School of Dental Medicine offers students and residents the opportunity and
educational experience of using digital imaging in their supervised patient care. A
variety of imaging modalities are currently in use at the School and include: digital xrays (both direct and indirect digital sensors), digital pan/ceph, digital cone beam CT,
intraoral and extra-oral photography. The School has made significant efforts and
investments to store these images, back them up, display them, link them to patient
records, print them as needed, and expand access to the digital images at the point
of care (chair-side). The imaging system is comprised of a standards based state of
the art digital imaging System, (MiPACS from Medicore Technologies) which has
been fully integrated into the Schools own electronic oral health record (Picasso).
Appendix 1.5
Digital Imaging Software
Point of Care (POC) computers
As part of the School's efforts to modernize the clinics, almost 400 point-of-care
(PoC) computers have been installed at all operatories within Squire and Foster.
These computers provide access to Picasso allowing students to access patient
data, digital imaging, schedule appointments, access medical, dental, and
pharmacological reference materials, and monitor their clinical accomplishments or
competencies. The computers also allow faculty to easily approve radiographs and
referrals to other clinics. Computers at the point of care offer exciting new
opportunities and advantages that enhance the educational experience, improve the
quality and efficiency of patient care, and can help boost not only the quantity but
also the quality of clinical data, which can then subsequently be used for research or
public health studies. The computers are designed to also support future
technologies, such as simulation and others. In addition to the point-of-care
computers, approximately thirty shared workstations are available in the patient care
areas.