Drm Plus Administrator Manual V6 9
User Manual: Pdf
Open the PDF directly: View PDF 
.
Page Count: 315
| Download | |
| Open PDF In Browser | View PDF |
Dental Record Manager Plus (DRM Plus) Administrator Manual Version 6.9 May 2018 May 2018 DRM Plus Administrator Manual v6.9 1 © 2018 Document Storage Systems, Inc. All rights reserved. Document Storage Systems (DSS) is a privately held corporation and has been the premier provider of health information and document imaging distribution and storage systems to Veterans Affairs facilities for over seventeen years. DSS is located at 12575 US Highway One, Suite 200, Juno Beach, Florida 33408. World Wide Web: www.dssinc.com Dental Record Manager Plus is a trademark of Document Storage Systems, Inc. Outlook, Internet Explorer, and Windows are trademarks of Microsoft Corporation. VistA is a trademark of the Department of Veterans Affairs, Software Services, and Computerized Patient Record System. No portion of this manual or software may be reproduced without the prior written consent of Document Storage Systems, Inc. May 2018 DRM Plus Administrator Manual v6.9 2 Table of Contents Introduction ............................................................................................................................................. 9 Document Storage Systems, Inc. ................................................................................................... 9 From the Department of Veterans Affairs ...................................................................................... 9 Introduction .................................................................................................................................. 9 Quality Improvement/Performance Measures and Benefits .......................................................... 10 Customer Support ....................................................................................................................... 10 Dental Record Manager Plus User and Administrator Requirements .................................................... 11 DRM Plus User Requirements .................................................................................................... 11 Administrator Option .................................................................................................................. 12 Accessing DRM Plus .............................................................................................................................. 13 Access ........................................................................................................................................ 13 Using the DRM Plus Drop-Down Menus ............................................................................................... 17 File ............................................................................................................................................. 17 Refresh Patient Chart ..................................................................................................... 17 File Administrative Time ................................................................................................ 17 File Fee Basis ................................................................................................................ 18 Print ............................................................................................................................... 19 Spell Check .................................................................................................................... 20 Save Unfiled Data .......................................................................................................... 21 Exit ................................................................................................................................ 22 Edit ............................................................................................................................................. 23 Copy .............................................................................................................................. 23 Cut ................................................................................................................................. 23 Paste .............................................................................................................................. 23 Select All ........................................................................................................................ 23 Dental Encounter Data ................................................................................................................ 24 Create New PCE Visit .................................................................................................... 24 View Scheduled Appointments and Historical Visits ........................................................ 25 Treatment & Exam...................................................................................................................... 28 Show Configuration ........................................................................................................ 29 Add/Edit Personal QuickList .......................................................................................... 40 Add Medical Codes to ADA Table .................................................................................. 41 Edit Code Information in the ADA Table ........................................................................ 43 Edit Procedure Costs...................................................................................................... 44 Filter View ..................................................................................................................... 45 Clean Slate ..................................................................................................................... 46 Undo Clean Slate ........................................................................................................... 51 All Planned Care to Clipboard ....................................................................................... 52 Tools .......................................................................................................................................... 53 Windows Calculator ....................................................................................................... 53 Windows Explorer .......................................................................................................... 53 Windows Notepad........................................................................................................... 53 User Inquiry ................................................................................................................... 54 User Options .................................................................................................................. 56 Administrative Toolbox................................................................................................... 73 Panel Add/Edit ............................................................................................................... 87 Provider Add/Edit .......................................................................................................... 89 Ancillary Tool Functions – ADA Website ........................................................................ 91 Reports ....................................................................................................................................... 92 May 2018 DRM Plus Administrator Manual v6.9 3 Reports........................................................................................................................... 92 Service Reports ............................................................................................................ 115 Data Warehouse Reports .............................................................................................. 117 Adverse Events Report .................................................................................................. 119 Device Tracking Report ................................................................................................ 122 Extract History File ...................................................................................................... 125 Queued Extract History File ......................................................................................... 127 Help .......................................................................................................................................... 130 Contents ....................................................................................................................... 130 Version Release Notes .................................................................................................. 131 Last Broker Call ........................................................................................................... 132 VA Intranet Website...................................................................................................... 132 Find your DRM Plus Administrators............................................................................. 132 Have a Question, Comment or Suggestion about DRM? ............................................... 132 About ........................................................................................................................... 133 DRM Plus Banner ............................................................................................................................... 135 Patient Information ................................................................................................................... 135 Visit Information ...................................................................................................................... 136 Dental Provider Information...................................................................................................... 137 Vitals Button............................................................................................................................. 138 Adverse Events Button.............................................................................................................. 138 To add an adverse event: .............................................................................................. 139 To edit a filed Active adverse event:.............................................................................. 140 To delete a filed adverse event: ..................................................................................... 140 Device Tracking Button ............................................................................................................ 142 To add completed procedure device identifiers: ............................................................ 144 To add non-transaction device identifiers: .................................................................... 145 To remove filed device identifiers for a transaction or non-transaction: ........................ 147 To delete the filed device identifiers for a transaction or non-transaction: .................... 148 Dental Class Information .......................................................................................................... 149 Clean Slate................................................................................................................................ 150 Icons ......................................................................................................................................... 150 General Coding Standards ........................................................................................... 150 Patient Flags ............................................................................................................................. 150 Clinical Reminders ....................................................................................................... 150 Consult......................................................................................................................... 151 Exam Quality Indicator ................................................................................................ 151 Fluoride Quality Indicator............................................................................................ 152 Alerts ........................................................................................................................... 153 Cover Page ........................................................................................................................................... 155 Dental Eligibility ...................................................................................................................... 156 Dental Class................................................................................................................. 156 Service Connected Teeth/Service Trauma ..................................................................... 156 Adjunctive Medical Condition(s) .................................................................................. 157 Eligibility Expiration Date............................................................................................ 158 Anticipated Rehab Date ................................................................................................ 158 Demographics ........................................................................................................................... 159 Case Management ..................................................................................................................... 159 Status ........................................................................................................................... 159 Suggested Recare Date ................................................................................................. 159 Recent Dental Activity .............................................................................................................. 160 May 2018 DRM Plus Administrator Manual v6.9 4 Fluoride Indicator Prescription Date .......................................................................................... 160 Dental Alerts............................................................................................................................. 161 Notes ........................................................................................................................................ 161 Filed Planned Care .................................................................................................................... 162 Clinical Record .................................................................................................................................... 163 Problems ................................................................................................................................... 165 Consultations ............................................................................................................................ 165 Notes ........................................................................................................................................ 166 Adding a New TIU Progress Note ................................................................................. 167 Adding a New TIU Progress Note Addendum................................................................ 169 Dental History ...................................................................................................................................... 170 Viewing Dental Information by Tooth ....................................................................................... 171 Viewing Other Dental History Information................................................................................ 171 Viewing All Dental History Information ................................................................................... 171 Viewing Dental History Information by Episode of Care ........................................................... 172 Episode in Date Range .............................................................................................................. 172 Deleting an Encounter ............................................................................................................... 172 Chart/Treatment – Treatment & Exam ............................................................................................. 174 Diagnostic Findings .................................................................................................................. 176 Editing Diagnostic Finding Descriptions ...................................................................... 177 Deleting a Diagnostic Finding ...................................................................................... 177 Treatment Plan.......................................................................................................................... 178 Entering a Treatment Plan ........................................................................................... 178 Editing a Treatment Plan Description........................................................................... 180 Deleting a Treatment Plan ............................................................................................ 181 Completing a Treatment Plan ....................................................................................... 181 Completed Care ........................................................................................................................ 182 Entering Completed Care ............................................................................................. 182 Editing Completed Care Description ............................................................................ 183 Deleting a Completed Care .......................................................................................... 183 Include “Completed”/Include “Findings and Completed”/Include “Findings” ............................ 184 Perio Buttons Icon .................................................................................................................... 185 Seq Plan/Sequencing Button ..................................................................................................... 186 Plan a Treatment Sequence .......................................................................................... 187 Complete a Planned Treatment in the Sequencing Screen ............................................. 187 Deleting a Planned Treatment in the Sequencing Screen ............................................... 188 Chart Hx (History) Button......................................................................................................... 188 Summary Button ....................................................................................................................... 189 H&N Button ............................................................................................................................. 190 PSR Button ............................................................................................................................... 193 OHA (Oral Health Assessment) Button ..................................................................................... 194 TMJ Button .............................................................................................................................. 196 Occl (Occlusion) Button ........................................................................................................... 197 Habits (Parafunctional) Button .................................................................................................. 199 Social Hx (Social History) Button ............................................................................................. 200 Multiple Filings to Same Modal on Same Day .............................................................. 201 Chart/Treatment – Periodontal Chart ................................................................................................ 203 History and Compare Buttons ................................................................................................... 204 Summary Button ....................................................................................................................... 205 H&N Button ............................................................................................................................. 205 PSR Button ............................................................................................................................... 205 May 2018 DRM Plus Administrator Manual v6.9 5 Stats Button .............................................................................................................................. 206 OHA (Oral Health Assessment) Button ..................................................................................... 206 Notes Button ............................................................................................................................. 207 Entering Periodontal Information .............................................................................................. 208 Other Tools ............................................................................................................................... 209 Exam .................................................................................................................................................... 210 Exam Elements ......................................................................................................................... 212 Presentation/Chief Complaint Element ......................................................................... 212 Vitals Elements............................................................................................................. 213 PMH (Past Medical History) and Medications Element ................................................ 214 Social History Element ................................................................................................. 215 H&N (Head and Neck) Findings Element ..................................................................... 216 Radiographic Findings Element.................................................................................... 217 Diagnostic Findings Element ........................................................................................ 218 Periodontal Assessment Element .................................................................................. 219 Parafunctional Habits Element ..................................................................................... 222 TMJ Findings Element.................................................................................................. 223 Occlusal Findings Element ........................................................................................... 224 Salivary Flow Element.................................................................................................. 225 Removable Prostheses Element..................................................................................... 226 Assessment/Plan Element ............................................................................................. 227 Patient Education Element ........................................................................................... 228 Disposition Element ..................................................................................................... 229 Import Previously Filed Data Screen ............................................................................ 230 Completing the Encounter .................................................................................................................. 232 Potential Duplicate Transactions Screen .................................................................................... 236 File Data Option Screen ............................................................................................................ 237 File to PCE/DES with Code.......................................................................................... 237 File to DES-Only Data ................................................................................................. 238 Filing Options Screen................................................................................................................ 238 Filing Options .............................................................................................................. 238 Visit Date/Time ............................................................................................................ 238 Encounter Dental Class ................................................................................................ 239 Disposition ................................................................................................................... 239 Suggested Recare Date ................................................................................................. 239 Primary PCE Diagnosis & Send Dx to CPRS Problem List ........................................... 240 Service Connection ....................................................................................................... 240 Additional Providers/Additional Signers ....................................................................... 241 Station.......................................................................................................................... 242 Progress Note Screen ................................................................................................................ 242 Viewing/Importing DRM Object/Progress Note ............................................................ 243 Viewing/Importing CPRS Templates ............................................................................. 243 Importing VistA Medical Information ........................................................................... 243 Other Options in the Import Menu ................................................................................ 244 Accessing Dental CNTs ................................................................................................ 244 Electronic Signature ..................................................................................................... 244 Progress Note Addendum ............................................................................................. 245 CNT Navigator ......................................................................................................................... 246 Navigating Within CNTs ............................................................................................... 247 Consult Notes ........................................................................................................................... 249 Resident Filing as Cosigners or Distributed Providers ............................................................... 251 May 2018 DRM Plus Administrator Manual v6.9 6 Appendix A – Glossary of VA Terms ................................................................................................. 253 Appendix B – Common Application Functions .................................................................................. 257 Appendix C – Hints and Notes ............................................................................................................. 259 Save Unfiled Data ..................................................................................................................... 259 Dental Class Displayed on Banner ............................................................................................ 259 Diagnostic Findings .................................................................................................................. 259 Treatment Plan.......................................................................................................................... 259 Multi-Add Screen ..................................................................................................................... 260 Ranged Codes ........................................................................................................................... 260 Speed Codes ............................................................................................................................. 260 Tx Planning/Sequencing Screen ................................................................................................ 260 Completed Care ........................................................................................................................ 261 Periodontal Chart ...................................................................................................................... 261 Completing the Encounter ......................................................................................................... 262 Reports – Non-Clinical Time by Provider.................................................................................. 264 Code Boilerplates...................................................................................................................... 264 Last Broker Call........................................................................................................................ 264 Recent Dental Activity .............................................................................................................. 264 Appendix D – Icon Definitions ............................................................................................................. 265 Diagnostic Findings .................................................................................................................. 265 Treatment Plan.......................................................................................................................... 268 Completed Care ........................................................................................................................ 270 Special Descriptions – Bridge Icon............................................................................................ 272 Special Descriptions – Conn Bar Icon ....................................................................................... 273 Special Descriptions – Notes Icon ............................................................................................. 273 Appendix E – Create Reports in MS Excel and Access ....................................................................... 274 Developing Excel Reports ......................................................................................................... 274 Creating Custom Reports Using Excel ...................................................................................... 277 Deleting Columns or Rows ........................................................................................... 278 Expanding Columns or Rows ........................................................................................ 278 Field Formatting Options ............................................................................................. 278 Creating a Header for a Report .................................................................................... 281 Sorting Data................................................................................................................. 283 Subtotaling Data .......................................................................................................... 284 Pull Down Options ....................................................................................................... 286 Importing the DRM Plus Extract Text File into an Access Report.............................................. 287 Importing the DRM Plus Extract Excel File into Access Database ............................................. 294 Appendix F – Using the Keyboard to Enter Periodontal Data ............................................................ 299 Overview .................................................................................................................................. 299 Navigating the Periodontal Screen ............................................................................... 299 Arch Views ................................................................................................................... 299 Cursor Movement ......................................................................................................... 299 Entering Data............................................................................................................... 300 Special Buttons............................................................................................................. 300 Other Functions ........................................................................................................... 300 Appendix G – Ranged Codes ............................................................................................................... 301 Appendix H – Active-Inactive Maintenance Control .......................................................................... 302 Appendix I – Option to Set Dental Patients to Inactive Status .............................................................. 304 Appendix J – How to Map Dental CNTs .............................................................................................. 305 Appendix K – Recommendations for Coding of Prosthetic Appliance ............................................... 307 Appendix L – Business Use of DRM Plus ............................................................................................ 309 May 2018 DRM Plus Administrator Manual v6.9 7 Local Policy and Practice .......................................................................................................... 309 National Policy and Practice Coding Standards ......................................................................... 309 Appendix M – Data Security ............................................................................................................... 310 Appendix N – madExcept Application................................................................................................ 312 Periodontal Keyboard Shortcuts Tear-Out.......................................................................................... 315 May 2018 DRM Plus Administrator Manual v6.9 8 Introduction Document Storage Systems, Inc. DSS, Inc. specializes in the computerization of patient medical charts. Our core specialty within the medical market is building Windows Graphical User Interface (GUI) applications; which insert, update and retrieve patient data held in a MUMPS (M) data repository, or SQL database system. DSS offers an array of GUI products, which allow for the electronic documentation of TIU progress notes and other significant parts of medical records, scanning and viewing of clinical and administrative documents and automated medical record coding through simple points and clicks. From the Department of Veterans Affairs Dental Record Manager Plus (DRM Plus) captures specific dentally-related information elements NOT readily available in CPRS. These elements include: oral cavity/tooth related diagnostic findings, dentalspecific care plans and a superset of completed care information. DRM Plus aids the provider in the entry of dental diagnostic information, coding and crediting dental procedures, completing TIU progress notes, and planning and tracking dental patient care. DRM Plus is adjunctive to CPRS and is NOT designed to replace CPRS for dental users. While some information from CPRS is available, and can be accessed in DRM plus, providers should use all the available tools in the VistA suite of applications. These tools include: VistA Imaging, I-Med Consent, and any clinical system applications specific to the local sites. DRM Plus is a Dental Graphical User Interface front end for data input into the VistA Dental files, as well as the Patient Care Encounter (PCE), Text Integration Utility (TIU) and CPRS Problem List packages. Introduction The DRM Plus program is designed to provide dental health care facilities with an intuitive, user-friendly Windows interface for end-users to create encounter information, evaluate patient dental conditions, and develop and maintain the treatment plan. The DRM Plus program is an application that uses RPC Broker technology, which permits the facility users to store and retrieve clinical data within the VistA System. DRM Plus supports the Veterans Health Administration, Office of Dentistry, continuous quality improvement initiatives by providing added value to the clinical and administrative management of the patient’s electronic dental record. The enhanced methods of data capture included in this application continue to eliminate unnecessary paperwork and administrative functions through the automation of clinical dental data. The use of DRM Plus results in more accurate insurance billing for dental visits, consults and procedures. This application supports the filing of Dental Encounter System (DES) within the guidelines established by the Veterans Health Administration, Office of Dentistry. May 2018 DRM Plus Administrator Manual v6.9 9 Some features of DRM Plus are summarized in the following: Entry of dental conditions, plans and completed procedures through the use of graphic icons with extensive use of color schemes. Upper/Lower/Full Views with full color coded graphics. Sequencing of Treatment Plan procedures Dental History with date-change capability Quadrant or Tooth summaries Head/Neck Findings availability Periodontal charting Full Mouth Plaque Index with definitions ADA/Local/Quick Codes Creation and maintenance of tooth-specific and general patient notes. Quality Improvement/Performance Measures and Benefits DRM Plus supports the VA Administration, Office of Dentistry’s continuous quality improvement initiatives by providing added value to the clinical and administrative management of the patient’s electronic dental record. The efficient data capture methods included in this product eliminates unnecessary paperwork and administrative functions. Additional quality improvement benefits and sample performance measures include: Performances Measures Reductions in operating cost and improved services through better integration of VHA resources and data. Supports high level job satisfaction by providing clinicians with feedback regarding quality of care and promotes a culture that places a high value on individual and collective accountability through reporting. Promotes a VHA culture of ongoing quality improvement that is predicated on providing excellent health care value. Accuracy and usefulness of data increases based on the reduction of data entry points and decreased potential for error. Enhanced capability to measure quality of care consistent with the VA Dentistry GPRA Performance Plan. Customer Support DRM Plus is supported in the same manner as any other nationally supported software product. Problems should be reported to the local site ADPAC and/or Help Desk, who in turn utilize the Computer Associate’s Service Desk Manager (CA SDM) system to log and track problems. Help desk support is provided from 8:00 AM to 7:00PM Eastern Standard Time, Monday through Friday. Documenting problems provides a means to find and disseminate solutions to those involved in any area of DRM Plus or VistA. May 2018 DRM Plus Administrator Manual v6.9 10 Dental Record Manager Plus User and Administrator Requirements DRM Plus User Requirements 1. DRM Plus users must have a valid Person Class in VistA file 200 (New Person File) to file data in DRM Plus. a. ALL residents and fellows must have one of the following Person Classes: V030300, V115500, or V115600, and this requires the resident to select a distributive provider (attending) as the primary provider when filing to DES and PCE. b. DRM Plus users must have a Person Class (different than the three listed above) to file data in DRM Plus. DRM Plus users that do NOT have a Person Class will receive an “!”-screen (Informational) stating the user is required to have an active Person Class to file data in DRM Plus. Please contact IT support for assignment of Person Class. c. DRM Plus users without a Person Class assigned may file an unsigned encounter for another provider or save unfiled data for another provider. 2. Dental Residents and Fellows using DRM Plus must have a valid User Class in VistA TIU if they require a cosigner. Please refer to the Authorization/Subscription Utility (ASU) User Manual to insure that Dental Residents are prompted for cosignature on all Progress Notes and Consults. This is typically done by a Clinical Coordinator, IT Staff, ADPAC or other manager using the Document Parameter Edit option on the TIU Parameters Menu on the IRM Maintenance Menu. The USERS REQUIRING COSIGNATURE field within the Document Parameter Edit option indicates which groups of users (i.e., User Classes) require cosignature for the type of document in question. 3. All DRM Plus users filing TIU progress notes must have an electronic signature in VistA file 200 (New Person File). 4. All DRM Plus users must have a default division (station number) in VistA file 200 (New Person File) for the station number to appear as the default (preselected) when filing an encounter. 5. All DRM Plus users must have the secondary menu option DENTV DSS DRM GUI assigned to access DRM Plus. 6. All DRM Plus users filing encounters should have their initials defined in the new person file (200) so that they will appear in the DRM Plus transaction tables. 7. All DRM Plus users (except Cover Page Only users) must have an active 8-Digit Dental Provider ID in the VistA Dental Provider File (220.5) to open DRM Plus and file data. DRM Plus users that do NOT have an 8-Digit Dental Provider ID will receive a “Red X”-screen (Stop) stating that they are required to have an active Dental Provider ID and will be denied access to DRM Plus. Note to DRM Plus application administrators: Use the DRM Plus option Provider Add/Edit on the Tools menu to enter this information. Select the New button if the user name does NOT display in the list. 8. Dental Students should NOT be assigned a Person Class in VistA; they only need an 8-digit Provider ID and require a User Class in VistA TIU (student). The User Class allows them to access CPRS. The dental student may file data for another provider. 9. DRM Plus users that have Cover Page Only access require the secondary menu option DENTV DSS DRM GUI assigned and no other requirements to access DRM Plus. Cover Page Only access must be granted by a DRM Plus application administrator. Note: DRM Plus users must have permission to write and modify to-and-from the DOCSTORE folder. May 2018 DRM Plus Administrator Manual v6.9 11 Administrator Option All DRM Plus application administrators must be DRM Plus users. Enter VistA in Programmer Mode by typing D ^XUP at the VistA prompt and get to "Select Option". 1. At Select Option Name, type: DENTV XPAR EDIT PARAMS. 2. At the Select PARAMETER DEFINITION NAME, type: DENTV DRM ADMINISTRATOR. 3. At the Select NEW PERSON NAME, type in the name of the person to be made a dental administrator. 4. Set the value to YES. May 2018 DRM Plus Administrator Manual v6.9 12 Accessing DRM Plus Access To access DRM Plus, first open CPRS and select the desired patient. Open the Tools menu in the CPRS tool bar, and select DRM Plus submenu from the available submenus. Figure 1: Access DRM Plus through CPRS DRM Plus opens with the patient information loaded and, unless changed by the user, the Chart/Treatment tab as the default opening screen. Note: Users may be required to re-enter Access/Verify codes when opening DRM Plus. The default opening settings of DRM Plus is the Treatment Plan screen on the Chart/Treatment tab, unless changed by the user. Note: The proper ways to close DRM Plus are listed: 1. Selecting the [X] button in the upper right corner of the DRM Plus screen; or 2. Selecting File menu Exit submenu; or 3. Selecting Task Manager Application tab highlight Dental Record Manager Plus task End Task button. May 2018 DRM Plus Administrator Manual v6.9 13 Figure 2: DRM Plus Chart/Treatment Tab The “!”- screen (Informational) displays when a DRM Plus user does NOT have an active VistA Person Class. This user will need to contact the local Help Desk and request an active VistA Person Class. One of the requirements to file data in DRM Plus is to have an active VistA Person Class. However a DRM Plus user with NO VistA Person Class may file an unsigned encounter for another provider or save unfiled data for another provider. Figure 3: “!”-screen (Informational) The “Red X”- screen (Stop) displays when a DRM Plus user does NOT have an active 8-Digit Dental Provider ID. NO access will be allowed to open DRM Plus by the user. A DRM Plus Administrator may create an active 8-Digit Dental Provider ID from the Provider Add/Edit submenu from the Tools menu in DRM Plus. One of the requirements to file data in DRM Plus is to have an active 8-Digit Dental Provider ID. May 2018 DRM Plus Administrator Manual v6.9 14 Figure 4: “Red X” –screen (Stop) Note: No informational warning screen displays to a user with Cover Page tab access only. The following informational screen will display when someone opens a DRM Plus patient’s chart that someone else has open. The informational screen displays the name of the user who first opened the patient’s chart. The informational screen also asks the user to only view the chart until the first user accessing the patient chart closes it, nothing should be entered, edited or deleted. The user receiving the warnings should refresh the patient’s chart or close and reopen DRM Plus after the other user has finished. There can be issues in DRM Plus when filing entries such as unfiled data or patient’s TIU progress notes when more than one person is accessing the same patient chart. Figure 5: Warning Informational Screen May 2018 DRM Plus Administrator Manual v6.9 15 In the following pages, the various parts of DRM Plus are highlighted and the functionality of the program is explored. The main screen is broken into three distinct parts. The drop-down menus allow the user to access various menus throughout the program, regardless of which tab is in use. Some drop-down menu functions are NOT available with every different tab. In this case, the menu function is disabled when the tab is open. Figure 6: DRM Plus Drop-Down Menus The banner contains patient, visit/location, provider/patient information and limited vitals entry. There are also the adverse events button, device tracking button, dental class button, coding standards and alerts icons on the banner. Figure 7: DRM Plus Banner The tabs are the heart of DRM Plus. They allow the user to create a new exam template, new treatment plan, view the dental history of a patient, view clinical records, and create a text note or a text note addendum. All providers may perform myriad tasks by simply clicking through each of the tabs and adding the pertinent information that is allowed in the appropriate place. Figure 8: DRM Plus Tabs The following chapters explore the functionality of each of the areas of the program in detail. May 2018 DRM Plus Administrator Manual v6.9 16 Using the DRM Plus Drop-Down Menus The DRM Plus drop-down menus consist of seven menus: File, Edit, Dental Encounter Data, Treatment & Exam, Tools, Reports and Help. Figure 9: DRM Plus Drop-Down Menus File The File menu contains seven submenus: Refresh Patient Chart, File Administrative Time, File Fee Basis, Print, Spell Check, Save Unfiled Data and Exit. The Spell Check is only active in the note and note addendum screens. Figure 10: DRM Plus File Menu Refresh Patient Chart The Refresh Patient Chart submenu allows DRM Plus users to refresh the patient’s chart while working in DRM Plus. File Administrative Time When the File Administrative Time submenu is selected from the File menu, the File Administrative Time screen displays. May 2018 DRM Plus Administrator Manual v6.9 17 Figure 11: File Administrative Time Screen 1. Use the drop-down menu near the top of the screen to select the desired Station Number. 2. Click the appropriate radio button to select the type of administrative time. 3. Use the up and down arrows next to the hours and minutes text boxes to adjust how much time is recorded. Note that the minutes can only be adjusted in 15 minute increments. 4. Click the OK button. The screen closes and files that administrative time for report usage. Note: This filing of administrative time is for local use only and does NOT file to the VA-MCA Labor Mapping Access Database Program. File Fee Basis When the File Fee Basis submenu is selected, the Dental Record Manager Fee Basis screen displays. Figure 12: Dental Record Manager Fee Basis Screen May 2018 DRM Plus Administrator Manual v6.9 18 1. 2. 3. 4. Use the Report Date drop-down menu to select a date to edit/delete a previous fee basis entry. Choose the station by clicking the appropriate radio button. Click the Dental Category drop-down menu to choose a Dental Class. Click the Date Authorized for Payment drop-down menu to display a calendar. The user may toggle through this calendar to choose the authorized date for payment. 5. Enter the Total Cost in the text box. 6. Click the Finish button. 7. A screen displays stating that a Fee Basis record has been added. Click the OK button. End-user criteria required to allow entering fee basis data within DRM Plus includes: Does need to be in the Dental Provider file (8-digit provider ID). Does NOT need a Person Class in VistA. Does need access to CPRS. Does need access to DRM Plus (DENTV DSS DRM GUI secondary menu option). Does NOT need DRM Plus administrative access. Note: DRM Plus Administrators can run all Fee Basis reports. Patient care provided by fee should be entered in DRM Plus as Diagnostic Findings. Note: Fee basis data entered in DRM Plus is only available for local reports created in DRM Plus. Print Select the Print button to view the Print screen. Figure 13: Print Screen Select the check boxes that correspond to what is to be printed. May 2018 DRM Plus Administrator Manual v6.9 19 Spell Check Select Spell Check to correct possible spelling errors. This feature is only active in note and note addendum screens. Figure 14: Spelling Screen The program goes through the text and highlights words that may have been misspelled and suggests possible correct spellings. Use the buttons to Ignore, Change or Add words. Click the Options button to select various options, pick a language/dictionary or add a custom dictionary. Figure 15: Spelling Options Screen May 2018 DRM Plus Administrator Manual v6.9 20 Click the check boxes beside the desired options located on the Spelling tab. Select the language and dictionaries from the Language tab and click the OK button. The Spelling Options screen closes. Save Unfiled Data Select the Save Unfiled Data submenu. The Save DRM Plus Data screen displays. Click the Yes button to save the unfiled data to the listed provider. A screen displays. Click the Yes button again to confirm. Figure 16: Save DRM Plus Data Screen To change the save unfiled data to another provider, click the Provider... button. Figure 17: Search for Provider Screen 1. Enter the name or partial name of the desired provider in the search criteria text box. 2. Press thekey. 3. Click the needed provider from the list of results. May 2018 DRM Plus Administrator Manual v6.9 21 4. Click the OK button to change the provider. The Save DRM Plus Data screen displays. 5. Click the Yes button to save the unfiled data to the new provider. When a dental provider is saving unfiled data and assigning it to another dental provider for a selected patient who has previously saved unfiled data that has NOT been filed, the following screen displays. Figure 18: Provider Already Has Unfiled Data If the user clicks the Yes button, previously saved unfiled data originally saved by another dental provider, or this provider, is overwritten. Only one unfiled data entry may be maintained by a single provider, per patient. Exit Exit the program by selecting the Exit submenu from the File menu. The CPRS main screen displays. May 2018 DRM Plus Administrator Manual v6.9 22 Edit The Edit menu consists of four submenus: Copy, Cut, Paste and Select All. Figure 19: Edit Menu Copy To copy, highlight the desired text and choose Copy. Cut To cut, highlight the desired text and choose Cut. The selected text is removed. Paste To paste, move the cursor to the area where the copy or cut text is to be replaced. Select the Paste submenu to add the text to the chosen area. Select All Select All highlights all the text visible on the screen which can be copied and/or cut. Use the Copy or Cut submenus to complete the desired task. May 2018 DRM Plus Administrator Manual v6.9 23 Dental Encounter Data The Dental Encounter Data menu has two submenus: Create New PCE Visit and View Scheduled Appointments and Historical Visits. Figure 20: Dental Encounter Data Menu Create New PCE Visit Select the Create New PCE Visit submenu to display the Provider and Location for Current Activities screen. Note: This submenu is only available if the DRM Plus Administrator allows new PCE visits to be created in the DRM Plus application. The opening default tab is the New Visit tab. Figure 21: Provider and Location for Current Activities Screen The Encounter Provider field should default to the correct end-user that is signed into VistA. Select the Encounter Location if the Default Location parameter is NOT set in advance. The Default Location parameter is explained in the Treatment System section in the Using the DRM Plus Drop-Down Menus chapter of this manual. May 2018 DRM Plus Administrator Manual v6.9 24 Visit Date/Time defaults to the present date/time for a new visit in the New Visit tab. The date and time may be changed if desired. Figure 22: New Visit Tab To record a new visit other than the present date/time: 1. DRM Plus defaults to the present provider; however, a different provider may be selected using the Encounter Provider list. 2. Select the clinic location from the scroll menu if the Default Location is NOT set. 3. Use the drop-down arrow to toggle through the calendar screen and select a date. 4. Use the up and down arrows to adjust the Visit Time. 5. Check the Historical Visit check box, if applicable. 6. Click the OK button to create the new PCE visit. Note: Future date appointments may NOT be created in DRM Plus. Note: Creating a new PCE visit in DRM Plus does NOT update Appointment Manager in VistA. View Scheduled Appointments and Historical Visits The My Clinic Visits tab lists the patient visits for the selected clinic. This tab only displays if a default Dental Location parameter is selected. When no default Dental Location parameter is selected, the Dental Visits tab displays. To record the scheduled appointment for the patient: 1. DRM Plus defaults to the present provider; however, another provider may be selected from the Encounter Provider list. 2. If there is only one scheduled visit, it is automatically defaulted. 3. Select the correct scheduled visit in the bottom window, if it is NOT defaulted. 4. Click the OK button and the provider/location is set for the scheduled visit. May 2018 DRM Plus Administrator Manual v6.9 25 Figure 23: My Clinic Visits Tab The Dental Visits tab lists all the dental clinic visits. Figure 24: Dental Visits Tab May 2018 DRM Plus Administrator Manual v6.9 26 The All Visits tab lists all dental visits and admission(s) if the selected patient is an inpatient. Figure 25: All Visits Tab The Admissions tab lists the admissions for the selected patient. Figure 26: Admissions Tab May 2018 DRM Plus Administrator Manual v6.9 27 Treatment & Exam The Treatment & Exam menu has nine submenus: Show Configuration, Add/Edit Personal QuickList, Add Medical Codes to ADA Table, Edit Code Information in ADA Table, Edit Procedure Costs, Filter View, Clean Slate, Undo Clean Slate and All Planned Care to Clipboard. Note: The Add Medical Codes to ADA Table, Edit Code Information in ADA Table, Edit Procedure Costs, Clean Slate and Undo Clean Slate are DRM Plus administrative submenus. Figure 27: Treatment & Exam Menu May 2018 DRM Plus Administrator Manual v6.9 28 Show Configuration Select the Show Configuration submenu to display the Charting Configuration screen. Figure 28: Charting Configuration Screen Use the various tabs to configure the chart. The tabs are: TX & Exam, Periodontal, Report, Voice, H&N, Statistics, Suggestion Links and Speed Codes. The parameters on each tab are a user specific function; changing it does NOT impact other users. When finished, click the OK button. May 2018 DRM Plus Administrator Manual v6.9 29 Tx & Exam Use the Tx & Exam tab to change the default view screen that displays when DRM Plus is first opened. The original default view screen is the Treatment Plan view. The Sequencing screen displayed upon entry is NOT selected as a default parameter; however, showing a warning box when adding duplicate transactions on a tooth for each view chart is a default parameter. Use the check boxes to change these user specific parameter functions. Use the functions on this tab to fine tune the Display Defaults; choose Graphical Displays or Transaction Lists to display check boxes based on the screen being viewed. Figure 29: Tx & Exam Tab May 2018 DRM Plus Administrator Manual v6.9 30 Periodontal Choose the Periodontal tab to set pocket depth warning and choose the colors that display as pocket warnings and normal pockets on the Periodontal Chart screen. Other submenus on this tab include Show MGJ Trace and Exam Sequence. Figure 30: Periodontal Tab To change the exam sequence: 1. Click the Edit button. 2. The Edit Perio Sequence screen displays. May 2018 DRM Plus Administrator Manual v6.9 31 Figure 31: Edit Perio Sequence Screen 3. Click each Section in the order in which the perio exam sequence should be performed. 4. Click the OK button to save the new exam sequence. To go back to the original settings, which appeared when this screen was first displayed, click the Reset button. Once the exam sequence has been changed and the user has clicked the OK button on the Periodontal tab, this becomes the permanent default exam sequence. May 2018 DRM Plus Administrator Manual v6.9 32 Report Use the functions on the Report tab to select certain pieces of information, which appears on individual reports when using the Print option under the File menu. The Chart check box selection prints the graphic chart, displayed on the last view screen of the Chart/Treatment tab, prior to the chosen Print submenu. The Transactions check box selection prints the transaction table, displayed on the last view screen of the Chart/ Treatment tab, prior to the chosen Print submenu. Patient Notes and Tooth Notes check box selections print the entries entered using the Notes icon. Figure 32: Report Tab Voice Voice is NOT enabled in DRM Plus. May 2018 DRM Plus Administrator Manual v6.9 33 Speed Codes Use the Speed Codes tab to set/create individual icons in DRM Plus for frequently used procedure codes entered using the Treatment Plan or Completed Care viewing screens. Figure 33: Speed Codes Tab To add a Speed Code: 1. Click the Add button. The Edit Speed Code screen displays. 2. Add a new Name, which cannot exceed 10 characters. 3. Entering a description is optional. Two symbols; semicolon (;) and up-carrot (^) may NOT be added or used in the description text. 4. Use the search function, ADA Codes, to look up a procedure code(s) and add it to the new speed code. 5. Entering an icon is optional. 6. Click the OK button to begin finalization. May 2018 DRM Plus Administrator Manual v6.9 34 Figure 34: Edit Speed Code Screen To edit or delete the speed code, highlight the desired name in the Speed Codes tab and click the Edit or Delete button. Provide appropriate entry in the subsequent screens; otherwise, click the OK button to complete this part of the process. To complete the speed code process: 1. Move to the Completed Care or Treatment Plan view of the Treatment & Exam screen. 2. Click one of the undesignated icon squares. The Configure Button screen displays. Figure 35: Configure Button Screen 3. Click the drop-down arrow, highlight and click the desired Speed Code name. 4. Click the OK button and the speed code is linked to that icon. The Perio Mode check box on the Configure Button screen designates the viewing preference when the Perio Buttons icon is clicked. The Perio Buttons icon is used as a toggle for displaying another 19 available icon buttons. Clicking the Perio Buttons icon displays any 19 Speed Code icons that have been designated in the Perio Mode (check box clicked) while hiding any non-perio mode Speed Code icons from the display. Clicking the Perio Buttons icon again reverses the display. This option allows for a total of 38 Speed Code icons to be created. The 19 non-perio mode speed codes are the default Speed Code icons when DRM Plus is initially opened. Please see the Perio Buttons Icon section, in the Chart/Treatment – Treatment & Exam chapter of this manual, for more information. May 2018 DRM Plus Administrator Manual v6.9 35 Suggestion Links Use the Suggestion Links tab to enter code suggestions, when entering one procedure code which is linked to another procedure code(s), without having to use an icon to find the other code. A screen displays asking if other linked codes should be added providing an opportunity to decline the entry of suggested linked codes. Figure 36: Suggestion Links Tab To add a suggestion link: 1. Click the Add button. 2. A screen displays featuring a list of all DRM Plus procedure codes. Click the desired primary procedure code that other procedure codes are linked to, and then click the OK button. May 2018 DRM Plus Administrator Manual v6.9 36 Figure 37: Suggestion Links Code List 3. A screen requesting the linked codes to the primary procedure code displays. Figure 38: Linked Codes Screen 4. Click the Add button to add the first linked code. The list of all DRM Plus procedure codes displays again. 5. Choose the second code to be linked with the primary procedure code and click the OK button. 6. Add as many linked codes to the primary procedure code as desired. To finish and return to the tab, click the OK button. Note: As many codes as necessary can be linked. Simply continue clicking the Add button on the Linked codes screen and choosing more codes from the list. To edit the suggestion link: 1. Select a suggestion link to be edited and click the Edit button. The Linked codes screen displays. 2. Click the Add button for another procedure code, and the list of procedure codes displays. Click the OK button. 3. To remove a linked code entry, click the Delete button and then the OK button. To delete the suggestion link, select the suggestion link and click the Delete button. May 2018 DRM Plus Administrator Manual v6.9 37 Statistics Choose the Statistics tab to set the warning level for pocket depth, free gingival margin, mucogingival junction, furcation and mobility found in the Stats screen on the Periodontal Chart. Figure 39: Statistics Tab To change the warning level: 1. Double-click the box containing the Warning Level to be changed. 2. A screen displays. Enter the new warning level in the text box and click the OK button. Figure 40: Adjust the Warning Level 3. The Warning Level is changed on the tab. May 2018 DRM Plus Administrator Manual v6.9 38 H&N The H&N tab allows the provider to use the Add and Delete buttons to add/delete head and neck findings listed on the H&N screen located on both the Treatment & Exam and Periodontal Chart screens. Figure 41: H&N Tab To add an H&N finding: 1. Click the Add button. 2. A DRM screen displays. Enter the finding in the text box. Figure 42: DRM Description Screen 3. Click the OK button. The finding is added. May 2018 DRM Plus Administrator Manual v6.9 39 To delete a finding, click the desired H&N finding in the list and then click the Delete button. The finding is removed from the list. Note: All administrative descriptions added or deleted for head and neck findings are permanent for all users in the local DRM Plus server. Add/Edit Personal QuickList Select the Add/Edit Personal QuickList submenu to manage a Quick List of codes for personal use. For additional convenience, enter frequently used procedure codes that have multi-add functionality associated with the code, into the Quick List. The Manage Personal QuickList screen displays. Figure 43: Manage Personal QuickList Screen To add to the Quick List: 1. 2. 3. 4. Type the search criteria into the Find text box. Search by words or numbers. A matching list displays on the left side of the screen. Click one of them to select it. Click the right arrow button to move the selected code to the Quick List. Click the OK button to end and close the screen or repeat to add another code to the Quick List. To remove from the Quick List: 1. Select an entry from the Quick List on the right side of the Manage Personal QuickList screen. 2. Click the left arrow button to remove it from the list. A screen displays confirming that the entry is to be deleted. Click the Yes button to continue. Note: Codes entered into a Quick List are accessed through the Quick Code icon. May 2018 DRM Plus Administrator Manual v6.9 40 Add Medical Codes to ADA Table A DRM Plus Administrator may select this submenu to add medical CPT procedure codes to the ADA mapping table. Each medical CPT procedure code must have at least one designated diagnosis code entered with it. Once a diagnosis code has been designated, it may be changed at any time. These changes apply only to the local VistA system for specific facilities. Figure 44: Dental Code Editor Screen To add a medical procedure code to the ADA mapping table: 1. 2. 3. 4. Type a word or medical CPT procedure code into the yellow drop-down box. Press the key. Search results display in the drop-down menu. Select the correct result. Once a new medical CPT procedure code is selected, several fields display on the Dental Code Editor screen. May 2018 DRM Plus Administrator Manual v6.9 41 Figure 45: Dental Code Editor Screen when Adding Procedure Code 5. Choose the VistA DES code from the VA-DSS Product Line drop-down menu. Enter the VA Cost to perform and the Equivalent Private Cost information in the respective text boxes. The VA-DSS Product Line field is required; the cost fields are optional. 6. The RVU Value in the text field is always zero for any local medical CPT procedure code added to the ADA mapping table. 7. Add the diagnosis code using the Diagnosis Code Search, by typing into the corresponding text box and pressing the key. 8. Select the correct diagnosis code from the Diagnosis Code Search drop-down menu and click the green icon [+] button. The diagnosis code is added to the Prioritized List of Diagnosis Codes. Repeat this step until all necessary diagnosis codes are added. 9. To change the position of any diagnosis code on the list, first select the diagnosis code, and then use the blue Up arrow to move the diagnosis code up. Repeat until all diagnosis codes are in the correct order. 10. To remove a diagnosis code from the list, click the red [X] button. 11. Add an Administrative Note in the corresponding text box (optional). 12. When finished, click the OK button. Note: Local DRM Plus Administrators can enter text freely in the Administrative Note text box to complement the local medical CPT procedure code. This field is NOT mandatory to save a local medical CPT procedure code. Note: All locally-added medical CPT procedure codes are monitored nationally, and may be added in a future DRM Plus patch, with an appropriate RVU value set. May 2018 DRM Plus Administrator Manual v6.9 42 Edit Code Information in the ADA Table Select this submenu to edit all CPT dental and medical procedure codes on the ADA mapping table from the local server. Diagnosis codes may be added onto the existing national list of diagnosis codes; however, the existing national list of diagnosis codes may NOT be edited. Figure 46: Dental Code Editor Screen when Editing Procedure Code To edit a code in the ADA Master Database List: 1. Type in the search term in the yellow drop-down box. Only those codes which are in the ADA master database list display. 2. The VA-DSS Product Line, RVU Value and Coding Standards cannot be edited. 3. Type in the fields that are to be edited; the VA Cost to Perform, Equivalent Private Cost, Prioritized List of Diagnosis Codes and the Administrative Note fields can be edited. 4. To add a list of local diagnosis codes, see the previous Add Medical Codes to ADA Table section and follow steps (7-10). 5. When finished, click the OK button. Note: When any diagnosis codes are added to a CPT procedure code, a line appears dividing the list into the preset national list of diagnostic codes above the line, and the added local diagnostic codes below the line. Note: The VA Cost to Perform, Equivalent Private Cost and Administrative Note text boxes are optional. May 2018 DRM Plus Administrator Manual v6.9 43 Edit Procedure Costs Select this optional submenu to add or edit procedure code costs. Figure 47: Edit Procedure Costs Screen To add/edit a procedure code cost: 1. Scroll through the list to find the desired ADA/CPT procedure code. 2. Select the cost to be added or edited. Both VA Cost to Perform and Equivalent Private Cost can be added or edited. RVU cannot be edited. 3. Type the cost value into the appropriate cell. 4. Press the key or use the up/down arrow keys so that the new cost is saved. Left or right arrow keys do NOT save the cost value. 5. Click either Save to Excel, to view in Microsoft Excel, Print or Close. May 2018 DRM Plus Administrator Manual v6.9 44 Filter View Use the Filter View submenu to choose which encounters display on the Chart/Treatment tab of DRM Plus. Figure 48: Filter View Submenus Current Episode of Care Select this filter to show only those treatments that have been completed for all visits during the current disposition or patient status. All Episodes of Care Select this filter to show all treatments completed for all visits. This is the default setting. Select Episode of Care Select this filter to see all the treatments completed for all visits during a previous specific disposition or patient status. When this submenu is selected, a screen listening all previous dispositions or patient statuses associated with a given patient displays. Figure 49: Select Episode of Care Screen To select a previous disposition, click the desired one from the list and click the OK button. May 2018 DRM Plus Administrator Manual v6.9 45 Date Range Select this filter to show treatments that have been completed within a specified date range. When this filter is selected, a screen displays. Use this screen to select a date range. Figure 50: Select Date Range Screen To filter by date range: 1. Use the drop-down menu to select the needed dates. Click the OK button. 2. The treatments completed in the entered date range display on the screen. If no entries were made during the selected date range, DRM Plus displays as a clean slate. Clean Slate The Clean Slate submenu functionality clears the graphical portion of the Treatment & Exam screen, and deletes all planned treatment for the selected patient. The new clean slate can be restored for this patient at any time until a new encounter has been filed on this patient’s chart. The deleted planned treatment may never be recovered, only re-entered and filed on the patient’s chart. Clean slate also inactivates all saved unfiled data entered during this session and all previous unfiled data saved by all providers for this patient. Clean slate removes all graphics on the three Treatment & Exam screens, but leaves the historical transactions in both tables of the findings and completed screens. The submenus of Clean Slate and Undo Clean Slate are found under the Treatment & Exam menu. Only end-users who have the DRM Plus Administrative parameter option for clean slate are allowed to use this function. Figure 51: Clean Slate Submenu May 2018 DRM Plus Administrator Manual v6.9 46 The following dialog displays the planned treatment for the selected patient. This patient has extensive findings and completed treatment which have been filed previously on the DRM Plus patient chart. Figure 52: Patient Chart before Clean Slate Selecting the Clean Slate submenu under the Treatment & Exam menu displays a screen informing the DRM Plus Administrator that planned treatment is deleted permanently. All current graphics are removed from the exam (findings) and completed treatment screens. All transactions entered during this session are saved as inactivated unfiled data. All unfiled transactions from all providers saved on this patient are inactivated. May 2018 DRM Plus Administrator Manual v6.9 47 Figure 53: Clean Slate Information Screen The next screens may or may NOT display to the DRM Plus Administrator. The first screen, Dental Record Manager Plus, only displays if there was any unfiled data that was saved for this patient by any provider in the past. The unfiled data is inactivated if a DRM Plus Administrator completes the clean slate. Figure 54: No Data Saved Otherwise, the Save DRM Plus Data screen displays, which allows the DRM Plus Administrator to save new transactions as unfiled data. However, these transaction will be inactivated when completing the clean slate. When the No button is selected on the Save DRM Plus Data screen, the user must again click the No button on the same screen after clean slate has recycled. Figure 55: Save DRM Plus Data May 2018 DRM Plus Administrator Manual v6.9 48 The next screen, which always displays, has a message asking if the DRM Plus Administrator would like to print the planned treatment. Select the Print button if concerned about re-entering the planned treatment, because the planned treatment is deleted and cannot be recovered. When this is another provider’s treatment plan, it should be printed and given to that provider to follow-up on the planned treatment for this patient. That provider must re-enter and file the planned treatment on this patient’s chart. Figure 56: Print Planned Care Notes The following screen displays to inform that Clean Slate was successful, click the OK button. Figure 57: Clean Slate Successful The chart displays no graphics for completed treatment and exam findings. All the historical transactions in the tables for both the completed treatment and exam findings are still present. The next dialog displayed shows that the Seq Plan button is no longer active, because all planned treatment has been deleted; both graphical and transactional. May 2018 DRM Plus Administrator Manual v6.9 49 Figure 58: Patient Chart after Clean Slate The following screen displays when a DRM Plus Administrator saved unfiled data during the clean slate process. It also displays for any provider opening this patient’s chart after the clean slate has been completed, and there was previously saved unfiled data for this patient by that provider. It informs the provider that the patient now has inactive unfiled data. The provider may delete the unfiled data using the screen by selecting the Delete button, or selecting the View button and then clicking either to View or Delete the inactive unfiled data from the Unfiled Data report. Figure 59: Load DRM Plus Data Screen Clean slate displays an icon in the banner showing the last clean slate date performed on this patient’s chart. This icon is permanently on this patient’s chart; however, it could be updated when another clean slate is performed on this patient’s chart. Figure 60: Clean Slate Banner Icon May 2018 DRM Plus Administrator Manual v6.9 50 Note: The Clean Slate submenu may NOT be used for any filed completed transaction corrections, or any encounters filed incorrectly on a dental patient. These still have to be deleted by the DRM Plus Administrator using the line item deletion function or the complete encounter deletion function. Undo Clean Slate The Undo Clean Slate submenu allows the DRM Plus Administrator to undo the last clean slate action taken on a given patient. All historical graphics of completed treatment and findings are returned to the chart, assuming only one clean slate has been performed. If it is the second time, it only returns the historical graphics created following the first clean slate. To utilize the undo clean slate function: 1. Select the Undo Clean Slate submenu from the Treatment & Exam drop-down menu. The following screen displays. Figure 61: Undo Clean Slate Message Screen 2. Click the Yes button to reveal another screen, which confirms that Clean Slate is undone. Figure 62: Clean Slate Undone While the DRM Plus patient’s chart is refreshing, if inactive unfiled data exists, which had NOT been deleted, another screen displays. The options presented are the same that are provided when loading saved unfiled data into the patient’s chart. May 2018 DRM Plus Administrator Manual v6.9 51 Figure 63: Previously Saved Inactive Data Message The correct date range of completed treatment and findings graphics imports into the patient’s chart, as shown below. Figure 64: Completed Treatment Graphics Recovered Note: Saved unfiled data for a patient may be recovered if the DRM Plus Administrator performs a Clean Slate for this patient and immediately uses the Undo Clean Slate submenu, before the inactive unfiled data is deleted. All Planned Care to Clipboard All Planned Care to Clipboard is a submenu located as the last header on the Treatment & Exam menu. This submenu when selected will allow the user to copy all planned data; filed and unfiled planned treatment from the Seq Plan screen with extra planned details that occur on the cover page. This copy may be pasted on any word document, text document or any application window if allowed. Select the All Planned Care to Clipboard submenu and place your curser in the word document, text document or any application window where you would like the planned data pasted. May 2018 DRM Plus Administrator Manual v6.9 52 Tools The Tools menu has 9 submenus: Windows Calculator, Windows Explorer, Windows Notepad, User Inquiry, User Options, Administrative Toolbox, Panel Add/Edit, Provider Add/Edit and Vitals. The ADA Website submenu is an ancillary application that the DRM Plus Administrator may customize for all users. The DRM Plus Administrator may customize up to 10 ancillary application submenus. Note: Administrative Toolbox, Panel Add/Edit and Provider Add/Edit are DRM Plus administrative functions. Figure 65: Tools Menu Windows Calculator Select this submenu to open Windows Calculator. Windows Explorer Select this submenu to open Windows Explorer. Windows Notepad Select this submenu to open Windows Notepad. May 2018 DRM Plus Administrator Manual v6.9 53 User Inquiry Select this submenu to view and change the VistA fields or to view the VistA fields of other users. The VistA User Inquiry screen displays. Figure 66: VistA User Inquiry Screen 1. Type the User Name into the input text box and press the key. 2. The results display on the left side of the screen. 3. Select a User Name to view. The user’s information displays on the right side of the screen as shown in the next figure. May 2018 DRM Plus Administrator Manual v6.9 54 Figure 67: VistA User Inquiry Screen with User Information Displayed Select the User Tool Box button to change the personal fields in VistA. Click the User Tool Box button at the bottom of the screen and the User’s TBox screen displays. Figure 68: User’s TBox Screen May 2018 DRM Plus Administrator Manual v6.9 55 4. 5. 6. 7. Select the desired User Profile Fields by clicking the corresponding radio button. Edit the new text in the text box. Click the Update Field button. Click the Finished button. The VistA User Inquiry screen displays again. User Options Adjust various user settings in this submenu. The screen contains five tabs: General, Printing, Progress Note, Treatment System and Exam Settings. Figure 69: User Settings Screen The Broker Call History icon opens the broker calls screen. Please see the Last Broker Call section, in the Using the DRM Plus Drop-Down Menus chapter of this manual, for more information. May 2018 DRM Plus Administrator Manual v6.9 56 General The default General tab allows the provider to change Date Range defaults, Other Settings and File Location folders. Figure 70: General Tab The Delete User Settings button located on the lower left corner of the screen displays in all the tabs. This button allows the user to delete any new changes in this session before the parameter is saved. Note: The Delete User Settings function only applies to the user that is currently logged in. Other users are NOT affected if one chooses to delete user settings. To change the default date ranges: 1. Click the Date Range Defaults button. 2. The Date Range screen displays. May 2018 DRM Plus Administrator Manual v6.9 57 Figure 71: Date Range Screen 3. Use the up and down arrows to set the desired date range. 4. Click the OK button to return to the User Setting screen. To change other parameter settings: 1. Click the Other Parameters button. 2. The Other Parameters screen displays. Figure 72: Other Parameters Screen 3. Use the Tabs drop-down menu to set the initial tab and chart display in DRM Plus. 4. Use the Note Boilerplate check box to indicate whether the program should prompt for the boilerplate insert associated with the VistA TIU progress note title selection. May 2018 DRM Plus Administrator Manual v6.9 58 To change the file folder location: 1. Click the Set default folder button. 2. The Select Default Folder screen displays. Figure 73: Select Default Folder Screen 3. Navigate to and click the desired folder. 4. Click the OK button to select it. Note: This option allows the importing of information stored as a .txt file into the TIU progress note. To set the extract folder location: 1. Click the Set extract folder button. 2. The Select Extract Folder screen displays. May 2018 DRM Plus Administrator Manual v6.9 59 Figure 74: Select Extract Folder Screen 3. Navigate to the desired folder and click it. 4. Click the OK button to select the folder. A confirmation screen displays. 5. Click the OK button. Extract History reports are saved to this location. May 2018 DRM Plus Administrator Manual v6.9 60 Printing Use the Printing tab to set print margins, orientations, etc. Figure 75: Printing Tab To change the page configuration: 1. Click the Page Setup button. 2. The Page Setup screen displays. May 2018 DRM Plus Administrator Manual v6.9 61 Figure 76: Page Setup Screen 3. 4. 5. 6. 7. Use the up and down arrows to adjust the margins. Use the Orientation radio buttons to change the orientation of the printed document. Use the Page Number check box to indicate whether page numbers are to be included. Use the Ellipsis buttons to choose fonts for the Page Text, Header Text and Page Number. Click the OK button to return to the User Settings screen. May 2018 DRM Plus Administrator Manual v6.9 62 Progress Note Use the buttons in the Progress Note tab to configure progress note data objects, configure note data sequence and configure code boilerplates. Figure 77: Progress Note Tab To configure progress note data objects: 1. Click the Progress Note Data button. 2. The Progress Note Data Objects screen displays. May 2018 DRM Plus Administrator Manual v6.9 63 Figure 78: Progress Note Data Objects Screen 3. Use the various check boxes to include or exclude desired progress note data objects. 4. Click the OK button to return to the User Settings screen. Note: The Code Boilerplate check box activates the automatic importing into the TIU progress note of any code boilerplate created in DRM Plus. To configure the note data sequence: 1. Click the Set Note Sequence button. 2. The Note Object Sequence screen displays. May 2018 DRM Plus Administrator Manual v6.9 64 Figure 79: Note Object Sequence Screen 3. Select the note object to be moved in the list. 4. Use the up and down arrows on the right side of the screen to change the sequence of the note object on the list. 5. Click the OK button to return to the User Settings/Progress Note tab screen. To configure the code boilerplate: 1. Click the Configure Code Boilerplate button. 2. The Code Boilerplate screen displays. Figure 80: Code Boilerplate Screen May 2018 DRM Plus Administrator Manual v6.9 65 To add a new code boilerplate: 1. Click the Add New button. 2. The New Boilerplate screen displays. Figure 81: New Boilerplate Screen 3. Enter the name in the text box and click the OK button. 4. The Code Boilerplate Text screen displays. Figure 82: Code Boilerplate Text Screen 5. Click the Add Code button to add a code to the boilerplate. 6. The Find CPT Code or CPT Description Text screen displays. May 2018 DRM Plus Administrator Manual v6.9 66 Figure 83: Find CPT Code Screen 7. Type in the CPT code. A partial number is acceptable. Press the key. 8. The search results display in the screen. Select one and click the OK button. 9. The selected code displays on the Code Boilerplate Text screen. The provider may add more than one CPT code to this code boilerplate. 10. To delete that code, click the Delete Code button in the Code Boilerplate Text screen. 11. Type the desired associated text into the right side of the Code Boilerplate Text screen. 12. Click OK. A confirmation screen displays. Click OK to return to the Code Boilerplate screen. To edit a code boilerplate: 1. Select the code boilerplate to be edited from the Code Boilerplate screen. 2. Click the Edit button. 3. The Code Boilerplate Text screen displays. Figure 84: Code Boilerplate Text Screen May 2018 DRM Plus Administrator Manual v6.9 67 4. From here, type in the right side of the screen to add or delete text from the boilerplate. Use the Add Code and Delete Code buttons to add or delete codes form the boilerplate. 5. Click the OK button. An information screen displays. Click the OK button to return to the Code Boilerplate screen. To delete a code boilerplate: 1. 2. 3. 4. Select a code boilerplate from the list on the Code Boilerplate screen. Click the Delete button. A confirmation screen displays. Click the Yes button to delete the boilerplate. An information screen displays. Click the OK button to return to the Code Boilerplate screen. Treatment System The Treatment System tab allows access to additional options. Figure 85: Treatment System Tab Use the check boxes to choose whether to prompt for a diagnostic code when adding a planned item, or select the default tree view to display DRM Plus note objects on the Progress Note screen. May 2018 DRM Plus Administrator Manual v6.9 68 To choose a default location: 1. Click the Ellipsis (...) button next to the Default Location text box. 2. The Select Location screen displays. Figure 86: Select Location Screen 3. 4. 5. 6. 7. Type the location into the text box and press the key. Search results display on the Select Location screen. Choose the desired location and click the OK button. Select the OK button from the informational screen and the location is saved. Use the Clear button if the location should be removed, then the OK button on the informational screen. 8. The user may also change the default location by using the Select Location screen. 9. Always select the OK button from the informational screen to save any changes. 10. Select the Done button at the bottom of the screen to close the User Settings screen. May 2018 DRM Plus Administrator Manual v6.9 69 Exam Settings The Exam Settings tab provides the user with several options. These include: Canned Statements, Next/ Back Button and Requirements. Figure 87: Exam Settings Tab The Canned Statements parameter allows adding of additional pre-defined statements by the end-user to four elements. All local providers are end-users when utilizing this function from the User Options submenu, whether or not they are DRM Plus administrators. Any changes made from the User Settings screen affect only the individual end user. Pre-defined statements are broken into five categories: Radiographic, Assessment Summary and Treatment Plan (located in the same element), Patient Education and Disposition. There is a maximum of twelve pre-defined statements allowed per category. The local DRM Plus Administrator has priority when entering these statements system-wide, utilizing the administrator settings parameter (NOT displayed here). When any of these element categories are maxed out with pre-defined statements, the DRM Plus Administrator may add another. This can be done by utilizing the administrator settings parameter. This hides the last pre-defined statement entered by any end-user, and only affects those end-users with twelve entered and displayed in the given category. May 2018 DRM Plus Administrator Manual v6.9 70 To add a pre-defined statement (admin or non-admin) from the User Settings screen: 1. 2. 3. 4. Select one of the five pre-defined statement buttons, such as Assessment Summary. Type or copy/paste a pre-defined statement in the lower text box. Click the green Add (+) button. Click the OK button to confirm the new pre-defined statement addition. Figure 88: Assessment Summary Screen The end-user may highlight any of the pre-defined statements that were entered from their User Settings screen and either delete that statement or move the statement’s position in the list. This deletion or rearranging of the order only affects the end-user’s list of pre-defined statements and NOT any entered by the DRM Plus Administrator or any national pre-defined comment that was kept by the DRM Plus Administrator; these are listed at the top. The Next/Back Button parameter setting allows end-users, when selecting the Next or Back buttons located on any Exam tab element screen, to go directly to the next proceeding or previous required element screen for that exam code and skip all optional element screens. Note: There is no Back button on the first Presentation/Chief Complaint element screen and there is no Next button on the last Disposition element screen. Figure 89: Next/Back Button Parameters May 2018 DRM Plus Administrator Manual v6.9 71 Both options are unchecked by default. When unchecked, the Next button skips any element that is optional or has been completed from new data entered during this session and opens the next required element. When checked, the Next button opens the very next element regardless of whether it is optional or completed during this session. The Back button when unchecked skips any element that is optional but opens all previous required elements that are completed or NOT. When checked, the Back button opens the previous element regardless of whether it is optional or required. The user is required to complete any optional or required element when selecting the Next button when trying to move forward. Selecting the Back button does NOT require the element to be completed to open a previous element. Note: When this parameter has been formatted in the User Settings screen, these selections only affect the end-user’s profile and follows that end-user to any computer when loading DRM Plus with their VistA access/verify codes. The first requirements parameter, Configure Requirements Display, allows the end-user to keep the requirements display open when selecting any element from the Exam tab or the definitions from the OHA and Occlusal screens. The second requirements parameter, Configure Radiographs Requirement, allows the end-user to require a Radiograph Finding entry with any exam/consult code entered as completed care and requires data entered into the Exam tab. Figure 90: Requirements Parameters The Configure Requirements Display parameter is checked by default and displays the element’s requirements whenever an element screen is open. When unchecked, the end-user must select the Done button and then close/reopen DRM Plus to activate. This parameter change requires the end-user to open the Element Requirements Panel manually. The Element Requirements icon located in the upper right corner of the element screen when selected displays the Element Requirements Panel. Figure 91: Presentation/Chief Complaint Element Screen May 2018 DRM Plus Administrator Manual v6.9 72 The Configure Radiographs Requirement is unchecked by default and only requires radiographs for the D0150 and D0180 exams. When checked, the end-user must select the Done button and then close/reopen DRM Plus to activate. This parameter change requires the end-user to enter data from the Radiographic Findings element with any exam/consult code entered as completed care and requires data entered into the Exam tab. Note: The ADA exam codes D0145, D0171, D0190 and D0191 are NOT included with the DRM Plus Exam tab functionality when entered in DRM Plus by a provider. Administrative Toolbox The Administrative Toolbox submenu serves to change various administrative settings. It includes six tabs: General, Printing, Progress Note, Ancillary, Alerts and Exam Settings. The Delete Admin Settings button restores all default administrative settings present when DRM Plus was originally installed. Changing the parameter settings for a non-DRM Plus Administrator in the clinic requires a DRM Plus Administrator to select the Double Heads icon on the Administrative Settings screen. The DRM Plus Administrator must enter and select the user’s name which opens the User Settings screen for the selected user. A non-DRM Plus Administrator may overwrite any parameter change(s) entered by a DRM Plus Administrator when setting parameters through their User Options submenu. Note: A non-DRM Plus Administrator may NOT overwrite canned statements used with the Exam tab elements entered by a DRM Plus Administrator. Figure 93: Administrative Settings Screen May 2018 DRM Plus Administrator Manual v6.9 73 The three icons found in the upper left corner allow access to other functions. Click the Double Heads icon to select another end-user, allowing the DRM Plus Administrator to become that end-user. The admin end-user screen displays the five tabs normally found with the user settings of this provider and a sixth named Security tab. The DRM Plus Administrator may also grant full or partial administrative privileges to the provider using the Security tab. The other five tabs allow the administrator to change parameters for the end-user, which supersedes current user options settings. To change administrative privileges or parameters for another end-user: 1. Click the Double Heads icon. The Select User screen displays. Figure 93: Select User Screen 2. 3. 4. 5. 6. 7. Enter the search name for the provider in the text box. Press the key. Select the desired user from the results. Click the OK button. The screen displayed then is the User Settings for: Provider’s Name screen. Select the Security tab, click the appropriate check boxes to grant this provider any administrative parameter(s) required. May 2018 DRM Plus Administrator Manual v6.9 74 Figure 94: Security Tab with the Administrative Toolbox 8. Check the Grant full Administrator privilege check box to grant full administrative permission. 9. Check the Allow history extract (Excel) check box to allow the designated user to save Extract History reports to be used in Excel/Access. 10. Check the Allow user to change Primary/Secondary Providers check box to allow the user to change the patient’s primary and secondary provider. 11. Check the Allow user to edit Dental Eligibility (on the Cover Page) check box to allow the designated user to edit the patient’s dental eligibility information. 12. Check the Allow user to clean slate dental graphics check box to allow the designated user to clear all of the graphics in the three Treatment & Exam view screens. 13. Check the User has access to the Cover Page ONLY check box to allow the user to view/edit only the Cover Page tab of DRM Plus. 14. The User TBox Access drop-down menu is provided to allow users the option to customize their profiles. a. The default for all users is E – Edits allowed, some VA facilities may prefer to deny this permission. b. The N – No Access Allowed option allows no editing of the user’s profile. c. The D– Display Only setting allows the user to view their profile setting. 15. Check any other tab to change this provider’s User Settings parameters. Click the Key May 2018 icon to return back to the main Administrative Settings screen. DRM Plus Administrator Manual v6.9 75 The Broker Call History icon opens the broker calls screen. Please see the Last Broker Call section in this chapter, for more information. General General tab parameters set by a DRM Plus Administrator can only be set for one user at a time. If a DRM Plus Administrator is setting General tab parameter(s) for another DRM Plus user, then the DRM Plus Administrator must select the Double Heads icon on the Administrative Settings screen. The DRM Plus Administrator must enter, select the user’s name which opens the User Settings screen for the selected user and enter the parameter setting(s) or change(s). This process needs to be repeated for each user requiring General tab parameter setting(s) or change(s). The General tab parameter settings entered by a DRM Plus Administrator will be the default settings until that user resets or changes those parameter settings from their User Options submenu. Figure 95: General Tab To change the date range defaults, please see the User Options section of this chapter. Note: Date range defaults should NOT be changed unless the DRM Plus Administrator first checks with local IT support. Increasing these values can degrade overall network/systems performance. May 2018 DRM Plus Administrator Manual v6.9 76 To change other parameter settings: 1. Click the Other Parameters button. The Other Parameters screen displays. Figure 96: Other Parameters Screen 2. Use the first Tabs drop-down menu to change the tab that displays when the program first opens. Use the second drop-down menu to choose Treatment & Exam or Periodontal Chart for the default view of the Chart/Treatment tab. 3. Click the Note Boilerplate check box, defaulted as checked, to choose whether to be prompted for a TIU boilerplate insert. The TIU boilerplates reside in VistA and are tied to a TIU progress note title. The parameter when selected displays a screen asking the user if they would like to import a note boilerplate after they select a specific TIU progress note title. 4. Click the System Setting check box to determine if PCE visit creation within DRM Plus is allowed in the local dental clinic. 5. The System Setting allows the number of days for the Exam Quality Indicator to display for the entire local dental clinic. This option is unavailable in the User Options settings. 6. The System Setting also allows the Report Package Size value to be changed for Adverse Events and Device Tracking reports. The number represents the returns per package of report data retrieved from the VistA database. Note: Please do NOT change the Report Package Size value unless you are having difficulty, errors or connection loss, with retrieving either of the two reports. The time required to retrieve the report data is usually NOT an issue with this setting and if the report package size is changed it will probably NOT improve the time in retrieving the report. To set the default file folder, please see the User Options section of this chapter for more information. The Set Extract Folder allows the DRM Plus Administrator, or users with the administrative parameter option for Extract History reports, to set the directory/file location where the extraction of the dental history file is stored. May 2018 DRM Plus Administrator Manual v6.9 77 To set the extract folder location: 1. 2. 3. 4. Click the Set extract folder button. Use the Select Extract Folder screen to navigate to the desired folder. Click the OK button. A confirmation screen displays with the new file location. Click the OK button. To set the Web Locations, hyperlinks: The General Coding Standards hyperlink located on the banner and on the Diagnosis Code selection screen may be updated by a DRM Plus Administrator by changing the VA Office of Dentistry web address if needed. The same functionality has been established for the Dental Definitions hyperlink which is located in the OHA modal screen and the Occlusion modal screen. This hyperlink should be changed by the DRM Plus Administrator when instructed to do so by the VA Dental Informatics and Analytics Director. 1. Click the General Coding Standards Set hyperlink button. 2. Copy and paste the correct web address in the field. Figure 97: General Coding Standards hyperlink Screen 3. Click the OK button to save the new hyperlink default sent by the VA Office of Dentistry. Figure 98: Confirmation Message 4. Click the OK button to close this informational screen. The same process is used for the Dental Definitions hyperlink parameter. 1. Click the Dental Definitions Set hyperlink button. 2. Copy and paste the correct web address in the field. May 2018 DRM Plus Administrator Manual v6.9 78 Figure 99: Dental Definitions hyperlink Screen 3. Clicking the OK button saves the new hyperlink default sent by the VA Office of Dentistry. Figure 100: Confirmation Message 4. Click the OK button to close this informational screen. The Primary/Secondary Warehouse Reports XML hyperlinks will connect to specific reports as maintained by the Office of Dentistry. These hyperlinks should be changed by the DRM Plus Administrator when instructed to do so by the VA Dental Informatics and Analytics Director. The same process is used for the Primary Warehouse Reports XML and the Secondary Warehouse Reports XML hyperlink parameters. 1. Click the Primary Warehouse Reports XML Set hyperlink button. 2. Copy and paste the correct web address in the field. Figure 101: Primary Warehouse Reports HML File Hyperlink 3. Clicking the OK button saves the new hyperlink default sent by the VA Office of Dentistry. May 2018 DRM Plus Administrator Manual v6.9 79 Figure 102: Confirmation Message 4. Click the OK button to close this informational screen. Figure 103: XML file retrieval timeout (0-60) Adjusting the first XML file retrieval timeout (0-60) field allows the retrieval timeout to be adjusted by the DRM Plus Administrator for Data Warehouse Reports. A setting of 0 seconds does NOT mean there will NOT be a delay. Also a setting of 0 seconds may NOT allow your site time enough to connect and get the submenu, so use with caution. A setting of 5 seconds is the default. This may need to be adjusted (lengthened or shortened) based on your site’s internet/network connectivity. The National Library of Medicine GUDID hyperlink will allow a connection and retrieval of a UDI (unique device identification) value. The hyperlink should be changed by the DRM Plus Administrator when instructed to do so by the VA Dental Informatics and Analytics Director. Figure 104: National Library of Medicine GUDID hyperlink Adjusting the second XML file retrieval timeout (0-60) field allows the retrieval timeout to be adjusted by the DRM Plus Administrator for a UDI value. A setting of 0 seconds does NOT mean there will NOT be a delay. Also a setting of 0 seconds may NOT allow your site time enough to connect and get the submenu, so use with caution. A setting of 3 seconds is the default. This may need to be adjusted (lengthened or shortened) based on your site’s internet/network connectivity. May 2018 DRM Plus Administrator Manual v6.9 80 Printing Printing tab parameters set by a DRM Plus Administrator can only be set for one user at a time. If a DRM Plus Administrator is setting Printing tab parameter(s) for another DRM Plus user, then the DRM Plus Administrator must select the Double Heads icon on the Administrative Settings screen. The DRM Plus Administrator must enter, select the user’s name which results in the opening of the User Settings screen for the selected user and enter the parameter setting(s) or change(s). This process needs to be repeated for each user requiring Printing tab parameter setting(s) or change(s). The Printing tab parameter settings entered by a DRM Plus Administrator is the default settings until that user resets or changes those parameter settings from their User Options submenu. Progress Note Setting the parameters in the Progress Note tab cannot be changed using the Administrators Toolbox. The DRM Plus Administrator may configure code boilerplates from the Progress Note tab located on the Administrative Settings screen. Every end-user planning to access these code boilerplates must enter the exact name of the code boilerplate created by the DRM Plus Administrator. After entering the exact name of the code boilerplate in their User Settings screen and clicking the OK button, the administrative code boilerplate automatically imports. Treatment System Treatment System tab parameters set by a DRM Plus Administrator can only be set for one provider at a time. If a DRM Plus Administrator is setting Treatment System tab parameter(s) for another DRM Plus provider, then the DRM Plus Administrator must select the Double Heads icon on the Administrative Settings screen. The DRM Plus Administrator must enter, select the provider’s name which results in the opening of the User Settings screen for the selected provider and enter the parameter setting(s) or change(s). This process will need to be repeated for each provider requiring Treatment System tab parameter setting(s) or change(s). The Treatment System tab parameter settings entered by a DRM Plus Administrator will be the default settings until that provider resets or changes those parameter settings from their User Options submenu. Ancillary Use the functions in the Ancillary tab to add options to the tool menu. Use the check box to enable MiPACS. To add an application, type the name and website directly into the table, or use the browse function. The location for these application executables may require IT assistance. May 2018 DRM Plus Administrator Manual v6.9 81 Figure 105: Ancillary Tab The DRM Plus Administrator may customize up to 10 ancillary applications or websites to launch from the Tools menu. May 2018 DRM Plus Administrator Manual v6.9 82 To add an executable: 1. Click the Browse to Add Option button. The Microsoft Open browse screen displays. Figure 106: Microsoft Open Browse Screen 2. 3. 4. 5. 6. 7. Navigate to the desired executable file and click the Open button. The .exe file appears on the list. Name the option by typing in the corresponding Option Name field. Click the Set button to confirm the changes. A confirmation screen displays. Click the OK button. The option now appears in the Tools menu. To delete an executable: 1. 2. 3. 4. 5. Highlight the desired executable in the table. Press the key. Highlight the desired option name. Press the key. The option is removed from the Tools menu. May 2018 DRM Plus Administrator Manual v6.9 83 Further guidance is available within the program. Click the red question mark [?] icon and the Help for Customizing Tools Options screen displays. IT can help with parameter passing, since this is similar to setting up CPRS Tools menu options. Figure 107: Help for Customizing Tools Options Screen This page contains examples and definitions of allowable parameters that DRM Plus understands and can convert to real values. Note: These are examples for illustration and some options might NOT be available at the user’s facility. May 2018 DRM Plus Administrator Manual v6.9 84 Alerts Use the functions on this tab to add or delete DRM Plus alerts. These alerts permanently saved by the DRM Plus Administrator may be entered by any user with the Alert icon, located on the banner. When entered, the alerts display on the Cover Page tab. Figure 108: Alerts Tab To add an alert: 1. Click the Add button. The Add Dental Alert screen displays. Figure 109: Add Dental Alert Screen 2. Type the alert name into the text box. 3. Click the OK button. The alert appears on the list. May 2018 DRM Plus Administrator Manual v6.9 85 To delete an alert: 1. Highlight the alert to be deleted. 2. Click the Delete button. 3. The alert is removed from the list. Exam Settings This Administrative Settings parameter allows the DRM Plus Administrator to add/delete, system wide, all the national and local administrative pre-defined statements. This parameter may be accessed from the Tools menu → Administrative Toolbox → Exam Settings tab, only by DRM Plus Administrators. Figure 110: Exam Settings Tab These parameters allow DRM Plus Administrators to create pre-defined statements that import to all enduser accounts using the local VistA system. The five pre-defined statement buttons are Radiographic, Assessment Summary, Treatment Plan, Patient Education and Disposition. There are two to four national pre-defined statements pre-developed for these five categories. There is a maximum of twelve pre-defined statements allowed per comment field by any end-user. The DRM Plus Administrator has priority for entering pre-defined statements at any time and may add/delete a national or local admin pre-defined statement by following the same steps described when entering with the User Settings. The DRM Plus Administrator may only view the national pre-defined statements or those entered by the DRM Plus Administrator with this parameter. The pre-defined statements entered by any enduser’s User Settings parameter are NOT viewable in this screen, which includes DRM Plus Administrator entries from their own User Settings parameter. May 2018 DRM Plus Administrator Manual v6.9 86 The DRM Plus Administrator may delete or rearrange the sequencing of any national or administrator predefined statements entered by this parameter. Highlight the pre-defined statement and use one of the two buttons on the left side of the screen to delete or rearrange the sequence of this pre-defined statement. The end-user may NOT delete or rearrange any of these admin pre-defined statements; they are always listed at the top in every user’s list. The Next/Back Button and the Requirements parameter from the Administrative Settings screen do NOT affect the entire local VistA system or any other end-user functionality, but only result in changing the admin end-user functionality. This action results in the same outcome when editing the User Settings screen. Note: DRM Plus Administrators must use either User Options or the Double Head icon (selecting themselves) to enter end-user/personal pre-defined statements NOT intended for use by other providers in the clinic. Panel Add/Edit Use this submenu to change the primary/secondary physician’s panel to a different provider. This administrative panel changes all patients associated with the original primary provider to any new primary provider for that block of patients. It works the same for any secondary providers completed together or separate. Selecting the Panel Add/Edit submenu displays the following screen. Figure 111: Change Provider Panel Screen May 2018 DRM Plus Administrator Manual v6.9 87 1. Highlight the original PDP from the Active Dental Providers list and select the green [+] icon. 2. Highlight the new PDP from the Active Dental Providers list and select the green [+] icon. 3. Select the OK button. Figure 112: Panel Change Confirmation Message 4. It is highly recommended that a list of patients be printed if the user is planning on merging two panels. 5. Select the OK button if the panel of patients should be switched to a new provider. Note: All patients listed on the print-out are changed to the new primary provider. If there are any patients listed on the print-out that should NOT be changed to the new primary provider, then the DRM Plus Administrator must make a decision to either change all patients listed to the new primary provider using this batch-change functionality and manually change the ‘exception’ patients one at a time back to the original provider after the batch change has been implemented, or change all patients listed on the print-out manually. Manually changing providers one patient at a time requires the change to be made from the Designated Dental Providers screen located in the DRM Plus banner in each patient’s chart. May 2018 DRM Plus Administrator Manual v6.9 88 Provider Add/Edit Use this submenu to add a new provider, or to edit a provider’s 8-digit dental provider ID in DRM Plus. Dental providers may also be inactivated using this function. Inactivated providers cannot be selected for reports. Figure 113: Dental Provider Edit Screen Dental Provider Menu This menu auto-fills with entries from the VistA dental provider file. Once a new provider is added to the dental provider file; they may NOT be deleted by the DRM Plus Administrator. Checking the Inactive check box does NOT allow the provider to be selected for any reports. Provider Type Menu This menu displays a list of provider types and includes a two-digit code used to build the new eight digit dental provider ID. Provider Specialty Menu This menu displays a list of provider specialties and includes a two digit code used to build the new eight digit dental provider ID. Provider Seq # This is the next available four digit sequenced number that is computer generated to build the new eight digit dental provider ID. This number can be edited if desired; however, editing is NOT required. May 2018 DRM Plus Administrator Manual v6.9 89 Dental Provider Number This displays the new 8-digit dental provider ID, which is a read only field. The first two digits are the two digit code from Provider Type. The next two digits are the two digit code from Provider Specialty. The last four digits are the Provider Seq # automatically generated or manually entered. Old Provider ID Old Provider IDs may be filed with old four digit IDs from previous provider numbers; however, this field is NOT required for new DRM Plus users. Person Class The VistA Person Class displaying at the bottom of the screen will be view only and flagged if there is some basic discrepancy between the 8-digit dental provider ID and the Person Class. The flag will be displayed in a red typed message as in the following dialog. Figure 114: Provider Number/Person Class Flag Note: All dental providers must have an 8-digit dental provider ID to open and file data in DRM Plus. To add a new provider: 1. Click the New button. 2. The Search for Provider screen displays. May 2018 DRM Plus Administrator Manual v6.9 90 Figure 115: Search for Provider Screen 3. Enter the search terms in the text box and press the key. The search results display. 4. Select the desired provider and click the OK button. 5. The provider is added, and their name displays on the Dental Provider Edit screen. To edit either a new or existing provider’s information: 1. 2. 3. 4. 5. 6. 7. 8. Select the provider from the dental provider drop-down menu. Select the Provider Type from the next drop-down menu. Select the Provider Specialty from the next drop-down menu. Enter the Provider Sequence number in the text box. (Populates automatically if new) Select the Inactive check box, if appropriate. The Dental Provider Number is listed. Click the OK button. A confirmation screen displays. Click the OK button. Ancillary Tool Functions – ADA Website This American Dental Association website is only available if the DRM Plus Administrator formats this in the administrator’s Ancillary applications and parameters. Some users may NOT have permission to access the internet or have to enter/re-enter a user name/passcode. May 2018 DRM Plus Administrator Manual v6.9 91 Reports The Reports menu has the seven following submenus: Reports (DRM canned reports), Service Reports (old DAS reports), Data Warehouse Reports, Adverse Events, Device Tracking, Extract History File (for small date range extract reports), and Queued Extract History File (for large date range extract reports). Reports When this submenu is selected, the Report Selection screen displays. Figure 116: Report Selection Screen This screen has three tabs: General, Patient and Planning. May 2018 DRM Plus Administrator Manual v6.9 92 General Tab Figure 117: General Tab To create a report: 1. Choose the desired report type radio button. 2. Select the Fiscal Year or the Start Date and End Date. 3. Use the check box to indicate whether the provider name and the distributed provider totals should be included in the report. 4. Choose a Patient Status. 5. Indicate what the Transaction Status is. 6. Select the Report Category Type. 7. Choose the date type that is to be represented on the report. 8. Click the OK button to generate the report. The report screen displays. May 2018 DRM Plus Administrator Manual v6.9 93 Figure 118: DRM Report Screen This screen has options to save an Excel file (Save to Excel button) or close. Some of the options may NOT be available with every report type. Eight report types are accessible through this tab: Provider Summary: Summary counts of procedures by Station/Provider and Dental Classification. Clinic Summary: Summary counts of procedures by Station and Dental Classification. Visits by Provider: Detailed listing of procedures by Station/Provider. Visits by Clinic: Detailed listing of procedures by Station. Non-Clinical Time by Provider: Total days by provider for time applied to Education, Administration, Research and Fees. Fee Basis/Detailed Fee Basis: Total amount authorized and number of cases by Dental Classification (for local dental use only). Encounters/Visits by Patient Type: Summary counts of encounters/visits by patient type. Recare Report: List of patients with recare dates. May 2018 DRM Plus Administrator Manual v6.9 94 Click the corresponding radio buttons to select the desired report types. Use the check boxes to customize these reports. There are seven check box options: All Stations: This selection shows all stations of the parent facility. All Providers: This selection shows the report for all providers using provider ID numbers. Use Provider Name on Reports: This selection shows the report using provider names. Include Distributed Provider Totals: This selection adds Distributed Provider workload totals to the two provider reports. Completed: This selection includes completed care in the report. Planned: This selection includes planned procedures in the report. Deleted: This selection includes deleted completed care procedures in the report. Clinic Summary, Visits by Clinic and Fee Basis reports do NOT offer provider selection. Provider Summary, Visits by Provider and Non Clinical Time by Provider do allow provider selection. Deselecting the All Providers check box displays a list of providers to choose from. One or more is selectable within the list for Provider Summary and Visits by Provider reports. Start Date/End Date selections display a calendar on the drop-down. The dates default to the current date. Future dates are NOT allowed in these fields. The Fiscal Year allows selection to auto-select the date range for that fiscal year. The station defaults to All Stations. This can be changed by selecting a single optioned station. Patient Status allows the user to select either Active, Inactive, Maintenance, Active/Maintenance or All Statuses. Distributed provider workload may be viewed on the Provider Summary or Visits by Provider report. When All Providers is checked for these provider reports, and Include Distributed Provider Totals is checked, the distributed provider workload is included. The report may contain providers who are NOT in the dental provider file. This could occur because the distributed provider is auto-defined when the resident selects a cosigner for the note in DRM Plus. If the co-signer is NOT a dental provider, possibly from a wrong selection, the report contains the name of the distributed provider enclosed in parentheses, i.e., (DOCTOR, ATTENDING). Note: The report names Encounters by Provider and Encounters by Clinic have been changed to replace the word Encounters with Visits. These reports (as well as the Summary reports) display the Total Visits at the bottom. The number of encounters in DRM Plus is NOT truly indicative of the times the provider has seen a patient. Note: Selecting multiple reports from the General tab while the Report Selection screen is displayed always requires the selection of the report radio button first, followed by the selection of the Fiscal Year, even if the same fiscal year is desired for multiple reports. May 2018 DRM Plus Administrator Manual v6.9 95 Provider Summary The Provider Summary report replaces the DENTREATPROV RPT in VistA. The optional third page prompted in VistA report displays as total values at the end of the columns. ADA/CPT Codes, listed under the date range, that are included in this report, come from the selection of either the Visit Date or the Create Date designated on the General tab. Figure 119: Provider Summary When creating a Provider Summary report, select one or more providers by pressing and holding the and keys, or select all providers by using the All Providers check box. Use the same function to either show all rows/columns or to show just those rows/columns that contain data. The report information may be saved to an Excel spreadsheet by clicking the Save All to Excel or Save to Excel buttons. Print the selected information displayed for an individual provider, or select Print All to print for all providers. Note: Checking the Include Distributed Provider Totals check box adds distributed provider workload totals, located at the bottom of each column in the two provider reports. May 2018 DRM Plus Administrator Manual v6.9 96 Clinic Summary The Clinic Summary report replaces the DENTREATCLINIC RPT in VistA. This report is essentially the same as the Provider Summary report, except that the entire station is displayed (all providers). ADA/CPT codes, listed under the date range, which are included in this report, come from the selection of either the Visit Date or the Create Date designated on the General tab. Figure 120: Clinic Summary May 2018 DRM Plus Administrator Manual v6.9 97 Visits by Provider The Visits by Provider report replaces the DENTTREATSITPROV RPT in VistA. Each transaction is displayed, making this a potentially enormous report. Treatment dates included in this report come from the selection of either the Visit Date or the Create Date, designated on the General tab. Data is displayed chronologically. Figure 121: Visits by Provider To create a Visits by Provider report, select one or more providers by pressing the and keys, or select all providers by checking the All Providers check box. Click the Save All to Excel or Save to Excel buttons to save the current data to an Excel spreadsheet. The print options are the same as those for the Provider Summary report. On Visits by Provider reports, the items marked Distributed are those that were filed by a resident to this attending provider. The unmarked entries are the items filed by the attending provider. Note: Total sittings are equal to the number of history file entries for the selected date range. If the report is large, and the number of rows displayed is greater than 65,000, the system does NOT allow a save to Excel. A message displays prompting the user to change the date range. May 2018 DRM Plus Administrator Manual v6.9 98 Visits by Clinic The Visits by Clinic report replaces the DENTTREATSIT RPT in VistA. This report is essentially the same as the Visits by Provider report, except that the entire station is displayed (all providers). Treatment dates included in this report come from the selection of either the Visit Date or the Create Date, designated on the General tab. Figure 122: Visits by Clinic Note: This report may be very large and takes a considerable amount of time to process. May 2018 DRM Plus Administrator Manual v6.9 99 Non-Clinical Time by Provider Report The Non-Clinical Time by Provider report replaces the DENTNCLINTIME PROV in VistA. The data on the Non-Clinical Time by Provider report only accounts for any non-clinical time entered in DRM Plus. This option is for local use only. Figure 123: Non-Clinical Time The entry option allows the user to record Administrative, Fee Basis, Education and Training and Research time in hours and minutes (15 minute increments) for local reporting only. The Non-Clinical Time by Provider report displays an approximate numerical unit of days (1 day = 8 hours). The accumulation of less than four hours results in rounding down to the nearest whole number day. The columns for Research, Education, Fee and Admin are summed independently in total days. The Total column includes the sum of all four categories combined together for its entry in total days. Note: Filing non-clinical time in DRM Plus is for local DRM Plus reporting only. Workload credit for nonclinical time should be entered in Labor Mapping, which is accessed through the Macro Cost Accounting (VA-MCA) office. Contact the local VA-MCA office to obtain further information on Labor Mapping. May 2018 DRM Plus Administrator Manual v6.9 100 Fee Basis/Detailed Fee Basis Report The Dental Fee Basis (type 5) report replaces the Applications and Dental Fee (type 5) report DENTFEE RPT in VistA. These two reports never have the same data, since they are from two different options (one in VistA, the other in DRM) and two separate VistA files. The Dental Fee Basis (type5) report displays data from the File Fee Basis submenu available from the File drop-down menu. Figure 124: Dental Fee Basis Note: Fee basis data entered in DRM Plus is only available for local reports created in DRM Plus. May 2018 DRM Plus Administrator Manual v6.9 101 Encounters/Visits by Patient Type Report The Encounters/Visits by Patient Type report has been created to display data from DRM Plus in an easily readable format of providers and patients by inpatient and outpatient categories. Figure 125: Encounters/Visits by Patient Type May 2018 DRM Plus Administrator Manual v6.9 102 Recare Report The Recare report is available to list patients with recare dates in the selected date range. Patient demographic and recent dental activity data are displayed on the report. Maintenance and Active/Maintenance were added as selectable statuses on various reports. Maintenance status is the default status on the Recare report. Note: The Recare report is accessible for all provider working at the dental clinic to run the report. Figure 126: Recare Report A list of elements in Recare reports include: Recare Date, Patient Class, Home Phone, Work Phone, SSN, Patient Name, Address 1, Address 2, City, State, Zip, Sex, Last Visit, Last Provider, Primary Provider, Secondary Provider, Dental Alerts, Next Appointment, Next Appointment Clinic, Last Comp Exam, Last Brief Exam, Last Perio Exam, Last Pano X-ray, Last Full Mouth X-ray, Last BW X-ray and Last Prophy. May 2018 DRM Plus Administrator Manual v6.9 103 Patient Tab Use the Patient tab to run a report on any patient and view a list of visits. The patient is only used for report generation; changing patients in DRM Plus is NOT allowed. Figure 127: Patient Tab 1. Click the Patient Selection button to select a patient. The program automatically defaults to the patient whose record is currently opened in DRM Plus. May 2018 DRM Plus Administrator Manual v6.9 104 2. The Patient Selection screen displays. Figure 128: Patient Selection Screen 3. 4. 5. 6. Type a patient name into the text box and press the key. Partial names are acceptable. Select the desired patient from the results box and click the OK button. The selected patient’s name now displays on the Patient tab. Choose the date and select other information to be included or excluded using the check boxes on the Patient tab. 7. Click the OK button. 8. The DRM Report screen displays. Save to an Excel file, print or close. May 2018 DRM Plus Administrator Manual v6.9 105 Planning Tab Use the options in the Planning tab to run planned reports, active patients by provider report or unfiled data by provider report. Figure 129: Planning Tab 1. 2. 3. 4. 5. Select the type of report from the five radio buttons. Use the check boxes to indicate provider information. Choose a Patient Status except for the Unfiled Data by Provider report. Click the OK button. The selected report screen will display. Print, close or save the results to Excel. Note: The Primary/Secondary provider option is utilized for these reports: Provider Planning, Planned Items List, Planned Non-VA Care and Active Patients by Provider. The following reports are available from the Planning tab: Provider Planning, Planned Items List, Planned Non-VA Care, Active Patients by Provider and Unfiled Data by Provider. May 2018 DRM Plus Administrator Manual v6.9 106 Provider Planning The Provider Planning report contains the Provider, Patient Name & Last 4 SSN, Patient Last Visit and Patient Category, Planned Procedures, Next Appointment/Location and Qty/RVU/Cost data. Figure 130: Primary Provider Planning Note: The cost is included if it has previously been entered locally by a DRM Plus Administrator. May 2018 DRM Plus Administrator Manual v6.9 107 Planned Items List The Planned Items List report contains most of the same information as the existing Provider Planning report. However this report is in a sortable list format. Clicking the first three headers Provider, Patient Name & Last 4 SSN or Planned Procedures allows the provider to re-sort these columns. The Provider Planning report contains the Provider, Patient Name & Last 4 SSN, Planned Procedures, and Qty/RVU/Cost data. The Planned Items List report will also contain a column listing the planned Non-VA care quantity procedures. Figure 131: Planned Items List Note: The cost is included if it has previously been entered locally by a DRM Plus Administrator. May 2018 DRM Plus Administrator Manual v6.9 108 Planned Non-VA Care Report The Planned Non-VA Care report contains most of the same information as the existing Planned Items List report with a sortable list format. Clicking the first three headers Provider, Patient Name & Last 4 SSN or Planned Procedures allows the provider to re-sort by these columns. The Planned Non-VA Care report contains the Provider, Patient Name & Last 4 SSN, Planned Procedures, and Qty/RVU/Cost data. However the report will only return planned Non-VA care procedures that have been filed to the VistA server the local dental clinic is using. Figure 132: Planned Non-VA Care Note: The cost is included if it has previously been entered locally by a DRM Plus Administrator. May 2018 DRM Plus Administrator Manual v6.9 109 Active Patients by Provider Report The Active Patients by Provider report displays a list of patients with active dental encounters for providers. It displays by Primary and/or Secondary provider. The report also only lists the patient one time per provider. This report may display many more patients than the provider truly has with an active status, due to the default filing flag in DRM Plus. The default is Active, and most users do not change this. There are two areas in DRM Plus to address this issue: 1. The most recent dental encounter may be updated by the user through the Case Management Status field on the Cover Page. 2. Users are prompted to change the status of the patient when completing the encounter when they click the Finish button. The provider is prompted because the patient no longer has any planned items. Figure 133: Active Patients by Provider May 2018 DRM Plus Administrator Manual v6.9 110 Unfiled Data by Provider Report The Unfiled Data by Provider report displays a list of patients who have unfiled data for providers. Unfiled data is data that resides in a temporary scratch pad-type area, and is only visible by the provider the data is saved to. This data is NOT part of the patient’s chart record, and should be filed to completion in a timely manner. Unfiled data becomes inactive after eight calendar days; the unfiled saved data is viewable but no longer available to be filed. Figure 134: Unfiled Data by Provider After selecting an Unfiled Data by Provider report, the provider needs to select the View data button which allows the user to display the data that was saved as unfiled data on that patient. The TX Note Preview screen opens and displays the save unfiled data. This displays the unfiled data saved by this provider or by some other provider who sent it to this provider on a specific patient. The provider may print this unfiled data, especially if the data was made inactive either by the unfiled data now saved over the 8-day limit, or if a DRM Plus Administrator used the Clean Slate submenu option on this patient’s chart. An example of inactive unfiled data would have a Yes listed in the Inactive column. Because DRM Plus is unable to reload this inactive data back into the patient’s chart, the provider is required to re-enter the data manually with another encounter. May 2018 DRM Plus Administrator Manual v6.9 111 The provider may delete any unfiled data by selecting the check box under the Provider column and then selecting the Delete Checked button. The Check Inactives/Uncheck Inactives button allows the provider to select/unselect all the inactive unfiled data reports. The Check All/Uncheck All button allows the provider to select/unselect all the check boxes in the Unfiled Data by Provider report. The following dialog is an example of unfiled data saved on a patient. The user may print the unfiled data by selecting the Print button or close the screen by clicking the OK button. Figure 135: TX Note Preview Non-administrative end-users are able to delete, view and print the active/inactive unfiled data for all their respective patients when accessing this report. The Unfiled Data by Provider report only allows a nonadministrative provider to view their own saved unfiled data and NOT of other providers. The following dialog is the screen that allows the provider to Load, View (non-load) or Delete any unfiled data when opening the DRM Plus chart for a patient. The Delete button allows the provider to delete unfiled data before it is loaded into this patient’s chart. The provider is NOT able to view the unfiled data when they select the Delete button from this screen. May 2018 DRM Plus Administrator Manual v6.9 112 The Load DRM Plus Data screen informs the provider the name of who saved the unfiled data to them. The name listed at the beginning of the statement on the screen is the person who saved the unfiled data to the user opening the patient’s chart. Figure 136: Load DRM Plus Data Screen There are two ways to view the unfiled data before the provider deletes this data. The first is to select the Load option and go to the Unfiled Data by Provider report located on the Reports menu Reports submenu Planning tab Unfiled Data by Provider report. The second way to view unfiled data when the provider cannot remember exactly what was saved as unfiled data is to select the View button. This option directs the user to the Unfiled Data by Provider report, but it does NOT load the unfiled data. If the user wants the unfiled data loaded and filed, then they must close the report and select the Refresh Patient Chart option under the File menu. Selecting the View button displays a screen giving instructions to the end-user on how to load the data into the patient’s chart. Selecting the Load button when the patient’s chart reopens after the refresh allows the user to file the encounter. The following informational screen displays the steps to Load the unfiled data. Figure 137: Instructional Steps to Load Unfiled Data If Load or View were selected upon entry into the patient’s chart and the provider wants to delete the unfiled data after viewing it, use the Delete Checked button in the Unfiled Data by Provider report. If the Load button was selected, then the user also needs to select the Refresh Patient Chart submenu from the File menu. May 2018 DRM Plus Administrator Manual v6.9 113 Note: All data, including unfiled saved data or filed data for ‘test’ patients configured with the first three digits of the SSN as zeros will NOT appear in any DRM Plus report. Unfiled Data becomes inactive after eight calendar days. The end-user receives a screen message on the ninth day after saving data whenever they enter the patient’s chart. This message provides two button options to either View or Delete the inactive unfiled data. The following screen displays when loading the patient’s chart which has inactive unfiled data by the provider or from another provider. Figure 138: Inactive Unfiled Saved Data The View button takes the user directly to the Unfiled Data by Provider report, where they can view, print or delete the inactive unfiled data. There is no way to load inactive unfiled data into the patient’s chart except to re-enter all the data manually. The Delete button deletes the patient’s inactive unfiled data from the VistA scratch pad. May 2018 DRM Plus Administrator Manual v6.9 114 Service Reports Use the Service Reports submenu from the Reports menu to select and create a service report. Figure 139: Service Report Selection Screen 1. 2. 3. 4. 5. 6. Choose the desired type of service report check box(s). Set the Fiscal Year or date range, if applicable. Change the All Station and All Providers options. Select the date type that is to be represented on the report. Click the OK button. The Service Reports screen displays with the results. May 2018 DRM Plus Administrator Manual v6.9 115 Figure 140: Service Reports 7. If more than one report, or all report options are checked on the Service Reports Selection screen, the reports appear in tabs on the Service Reports screen. 8. Save the report to Excel or print. May 2018 DRM Plus Administrator Manual v6.9 116 Data Warehouse Reports The Data Warehouse Reports submenu will connect to specific reports as maintained by the Office of Dentistry. The Office of Dentistry may change this submenu at any time. The submenu is dynamically created based on settings of web addresses in the Administrative Toolbox settings in DRM Plus. Figure 141: Reports Menu The DRM Plus Administrator has the ability to maintain the web addresses for the Data Warehouse Reports. The website addresses should end in ‘.xml’. These XML addresses/files build the structure for the Data Warehouse Reports submenus. When selecting the Reports menu there may be a few seconds delay. Once the submenu has been loaded, there should no longer be a delay. If there is a failure to load the submenus, the website is down or you have lost connection; the next time you try the Reports menu, it will try to load the submenus again. This delay can be shortened by the retrieval timeout set by the DRM Plus Administrator (0-60 seconds). A setting of 0 seconds does NOT mean there will NOT be a delay. It may take DNS a few seconds to resolve the name of each website into an IP Address. So in the case of a complete failure and a setting of 0 seconds on the timeout – you may still experience a delay of 20 seconds or so when selecting the menu. The submenu would then display ‘currently unavailable – try again later’ as the submenu. It is suggested that you wait and try later in the day or even possible the next day. If the connection failure persists, please contact the local DRM Plus Administrator. Figure 142: Data Warehouse Reports Submenu Failure May 2018 DRM Plus Administrator Manual v6.9 117 Also a setting of 0 may NOT allow your site time enough to connect and get the submenu, so use with caution. A setting of 5 seconds is the default. This may need to be adjusted (lengthened or shortened) based on your sites Internet/network connectivity. The first XML file retrieval timeout (0-60) field from the Administrative Settings screen is associated with Data Warehouse Reports. Figure 143: Administrative Toolbox Submenu - General Tab May 2018 DRM Plus Administrator Manual v6.9 118 Adverse Events Report The Adverse Events report may be opened from the Reports menu by selecting the Adverse Events submenu which is displayed in the following dialog. The Adverse Events report submenu will only be active for any full DRM Plus Administrator to create a report. Figure 144: Reports Menu When selecting the Adverse Events submenu the following Report Queue screen will display. Figure 145: Report Queue The Report and Parameters drop-down field allows for the selection of either the Adverse Events report or the Device Tracking report to have a new scheduled report created. The rest of the following functionality found on the Report Queue screen will allow the provider to schedule a report, view a report, export a report to Excel, or delete a report. May 2018 DRM Plus Administrator Manual v6.9 119 Status may be selected to customize the Adverse Events report. The default status is only the Active check box selected however the provider may select any combination of Active, Resolved or Deleted which would be included in the final report. Date Range may be selected to customize the Adverse Events report. The default date range is set to include the previous year from the creation date of the Adverse Events report. Schedule Report button when selected will create a new Adverse Events queued report using the Status and Date Range selections by the provider. The provider may change the schedule such as the date and/or time so the report will get generated during a time when there is little or no effect on the functionality of the workstation. Refresh Queue button would be used when the Progress, last column in Queued Reports table, is displaying any value less than 100% complete. Continue to select the Refresh Queue button until the Progress is 100% complete. Then the recent queued report may be viewed by the provider. View Report button requires one of the Adverse Events report to be highlighted so the provider may view the Adverse Events report. Export to Excel button when selected with a queued report highlighted allows the provider to export all the data from the queued report to an Excel document. Delete Report button when selected with a queued report highlighted will delete that queued report. Close button when selected will close the Report Queue screen. To create/schedule and view the Adverse Events report: 1. 2. 3. 4. 5. 6. 7. Select any combination or all the Status check boxes Select the Date Range for the Adverse Events report Select the Schedule Report button Select the OK button on the informational Adverse Events pop-up screen May need to select the Refresh Queue button multiple times until the Progress is 100% Highlight the Adverse Events report in the Queued Reports table Select the View Report button May 2018 DRM Plus Administrator Manual v6.9 120 The following dialog displays an Adverse Events report with seven columns of the data displaying in the dialog. There are actually eleven columns of data in all Adverse Events reports so four are NOT displayed in the following dialog. Figure 146: Adverse Events Report Note: There are five columns containing dates in the Adverse Events report which are listed and explained in greater detail. 2nd column VISIT – VISIT date selected for the encounter 6th column ENTRY DATE – real time date when encounter was filed 7th column RESOLVED DATE – real time date when adverse event was edited and filed 8th column VISIT DATE – VISIT date selected for the encounter 9th column LAST EDIT DATE – real time date when adverse event was edited/removed/deleted and filed Note: The Adverse Events report is only available for selection eight days when one is scheduled/created. After the eighth day the report will be automatically deleted and a new report will have to be scheduled/created. Note: The Adverse Events report will contain test patient data if any has been filed in the VistA production account. Adverse event Excel reports should have all test patient data removed after it has been saved. May 2018 DRM Plus Administrator Manual v6.9 121 Device Tracking Report The Device Tracking report may be opened from the Reports menu by selecting the Device Tracking submenu which is displayed in the following dialog. The Device Tracking report submenu will only be active for a full DRM Plus Administrator to create a report. Figure 147: Reports Menu When selecting the Device Tracking submenu the following Report Queue screen will display. Figure 148: Report Queue The Report and Parameters drop-down field allows the selection of either the Device Tracking report or the Adverse Events report to have a new scheduled report created. May 2018 DRM Plus Administrator Manual v6.9 122 The rest of the following functionality found on the Report Queue screen will allow the provider to schedule a report, view a report, export report to Excel, or delete a report. Status may be selected to customize the Device Tracking report. The default status is the Active check box however the provider may select any combination of Active, Resolved or Deleted which would be included in the final report. Date Range may be selected to customize the Device Tracking report. The default date range is set to include the previous year from the creation date of the Device Tracking report. Schedule Report button when selected will create a new Device Tracking queued report using the Status and Date Range selections by the provider. The provider may change the schedule such as the date and/or time so the report will get generated during a time when there is little or no effect on the functionality of the workstation. Refresh Queue button would be used when the Progress, last column in Queued Reports table, is displaying any value less than 100% complete. Continue to select the Refresh Queue button until the Progress is 100% complete. Then the recent queued report may be viewed by the provider. View Report button requires one of the Device Tracking report to be highlighted so the provider may view the Device Tracking report. Export to Excel button when selected with a queued report highlighted allows the provider to export all the data from the queued report to an Excel document. Delete Report button when selected with a queued report highlighted will delete that queued report. Close button when selected will close the Report Queue screen. To create/schedule and view the Device Tracking report: 1. 2. 3. 4. 5. 6. 7. Select any combination or all the Status check boxes Select the Date Range for the Device Tracking report Select the Schedule Report button Select the OK button on the informational Device Tracking pop-up screen May need to select the Refresh Queue button multiple times until the Progress is 100% Highlight the Device Tracking report in the Queued Reports table Select the View Report button The following dialog displays a Device Tracking report with thirteen columns of the data displaying in the dialog. There are actually twenty five columns of data in all Device Tracking reports so twelve are NOT displayed in the following dialog. May 2018 DRM Plus Administrator Manual v6.9 123 Figure 149: Dental Devices Report The first two columns on the report, the DEVICE TRACKING IEN and the TRANSACTION, are numbers that don’t represent any value to the provider viewing the report. However they are extremely useful when an issue results with one of the device tracking entries and we need assistance from VA OI&T to resolve the problem. The Device Tracking report column of TRANSACTION contains the filed dental transaction IEN number from VistA identifying that transaction internally. The Device Tracking report column of DATE only will contain information from the filed non-transaction device entry and no data from the filed transaction device entry. The Device Tracking report column of TOOTH will display the tooth number for both the filed nontransaction device entry if entered and the filed transaction device entry if the transaction had one. Note: There are five columns possible containing dates in the first half of the Device Tracking report and are listed below explaining the detailed date reference. 5th column DATE – date entered for a non-transaction device tracking entry 9th column ACTIVE DATE – real time date when encounter was filed 10th column REMOVED DATE – real time date when device tracking was edited and filed 12th column LAST EDIT DATE – real time date when adverse event was edited/removed/deleted and filed 13th column VISIT DATE – VISIT date selected for the encounter when adding the device tracking Note: The Device Tracking report is only available for selection eight days when one is scheduled/created. After the eighth day the report will be automatically deleted and a new report will have to be scheduled/created. Note: The Device Tracking report will contain test patient data if any has been filed in the VistA production account. Adverse event Excel reports should have all test patient data removed after it has been saved. May 2018 DRM Plus Administrator Manual v6.9 124 Extract History File The Extract History File submenu function is used to extract raw data and save it to a text (.txt) file, then convert to Microsoft Access or Excel. Prior to extracting data, the DRM Plus Administrator should create a folder on the hard drive or network. This folder can be designated in the User Options submenu, by clicking the Set extract folder button. Please see the User Options section in this chapter for additional information. Figure 150: Extract History File Data Screen To extract data: 1. Use the drop-down menus to set the start and end dates. 2. The Output file selection requires the creation of a folder on the hard drive or network, as previously explained. The directory should default if the Set extract folder parameter is used. 3. Select File to Replace from the right window, or add a new file to the directory by typing it directly into the text box. Click in the text box, add a backslash <\>, then type the name of the file, and then type .txt. 4. The All Stations check box is checked by default. This can be changed by selecting a single optioned station. 5. Check the Optional Select Provider check box to retrieve information about a specific provider. The Select Provider screen displays. May 2018 DRM Plus Administrator Manual v6.9 125 Figure 151: Select Provider Screen 6. Enter the search term, press the key. Highlight the desired result and click the OK button. The provider name appears on the screen. 7. Click the OK button to complete the extract function and save the file to the designated folder. Note: Do NOT use this extract function for long reports. The workstation screen displays an hourglass, and no other applications can be run until the extract report finishes. When planning to run a long report, use the Queued Extract History File function. May 2018 DRM Plus Administrator Manual v6.9 126 Queued Extract History File The Queued Extract History File submenu allows larger sites to setup an extract to run in the background so that there is no effect on the functionality of the workstation. The Queued Extract History File submenu is available in the Reports menu, and runs via a TCP/IP server on the user’s workstation, rather than through the VistA RPC Broker on a local PC. This provides at least two major benefits: the workstation is NOT tied up while the extract is running, and the RPC Broker does NOT time out during long extracts. Note: Obtain a valid Port # and IPaddress from the local IT department to use this function. The Port # should be 15,000 or greater. Figure 152: Extract History File Data Screen This screen is similar to the Extract History File Data screen, with several key differences: 1. Use the drop-down menus to choose the Start Date and End Date for the date range the extract is performed in. Use the Run Extract On drop-down menus to determine the date/time to perform the extract. May 2018 DRM Plus Administrator Manual v6.9 127 2. The Output File Selection and the All Stations functions are identical to those found on the Extract History File Data screen. See the previous section for further information. 3. Check the Optional Select Provider check box to gather information from a specific provider. The Select Provider screen does NOT display; instead, a scroll menu displays on screen. Select the provider by highlighting a specific name. 4. Check the desired Transaction Status check box. 5. Click the radio button corresponding to the desired File Format. 6. Click the Parameters button. The Extract System Parameters screen displays. Figure 153: Extract System Parameters 7. Enter the IPaddress and Port # number. IT can provide this information. 8. Verify the Current Machine IP Address(es) is correct every time. 9. Once the parameter information is entered, click the OK button. This extracts the data to the chosen directory folder location. Considerations and Additional Information Output from the extract is sent to the file location specified on the Extract History File Data screen. No changes are made to the content, and no manipulations are part of the extract. The extract application (DRMEXTSRV.exe) must reside in the same location as the DRM application (typically \DOCTSTORE). If upon clicking the OK button on the Extract History File Data screen, the user receives a message that reads “The specified file was not found,” this means the DRMEXTSRV.exe file was NOT found. Clicking the OK button starts the DRMEXTSRV application listening on the Port # defined on the parameters screen. A DRM Extract icon appears in the system tray. It can be manually shut down by rightclicking the icon, and selecting Shutdown from the right-click menu. The DRMEXTSRV application can also be manually shut down by task manager from the Processes tab. If the DRM Extract process is actively “talking” to VistA, placing the cursor over the icon displays the message, “Receiving Data.” Extract successfully queued displays the following screen. May 2018 DRM Plus Administrator Manual v6.9 128 Figure 154: Extract Successfully Queued The Task # refers to the Taskman job number, and can be used by the local IT department to check if the Taskman task is completed, or if an error has occurred. If an extract is queued on the VistA side, and DRMEXTSRV is NOT running, the tasked job quits without outputting the .txt file. Note: Since the extract is queued, there is no notification to the user that the IPaddress or Port # might be wrong. It is critical that the IPaddress and Port # fields are confirmed correct. Only one DRMEXTSRV application may run on a workstation at a time (specifically: only one may be performed after work hours on the same machine). Trying to queue another extract results in the following error message. Figure 155: DRM Extract Already Running When the extract is completed, the DRMEXTSRV application closes automatically, and another extract can be queued. If multiple files are generated for the extract, they are numbered sequentially, i.e., Extract.txt is the user selected name, followed by: Extract1.txt, Extract2.txt, etc. Since the extract is queued, and the user does NOT know if it ran to completion, the last row in the .txt file is “END OF FILE”, denoting that all rows were sent to the workstation TCP/IP process. If there are multiple files, all files except the last contain the text END OF FILE (CONT...) to denote that additional extract data remains in other files. Note: Multiple files are only output if the Excel format is selected from the extract screen, and there are greater than 65K rows of text. Once the tasked job is completed, and the file is created, the process for retrieving and creating Excel worksheets is the same as discussed previously in the Extract History File Data section of this chapter. May 2018 DRM Plus Administrator Manual v6.9 129 Help Use the Help menu to access more information on DRM Plus. There are seven submenus: Contents; Version Release Notes; Last Broker Call; VA Intranet Website; Find your DRM Plus Administrators; Have a Question, Comment or Suggestion about DRM?; and About. Figure 156: Help Menu Contents Use the Contents to find information on using DRM Plus. Figure 157: DRM Plus Contents Screen May 2018 DRM Plus Administrator Manual v6.9 130 Version Release Notes Select the submenu to view what was introduced in the current version of DRM Plus. Figure 158: Release Notes Screen May 2018 DRM Plus Administrator Manual v6.9 131 Last Broker Call Select the submenu to see the last broker call. Figure 159: Broker Calls Screen Use the up and down arrows next to the Maximum Calls text box to adjust how many broker calls are retrieved. Use the previous and next arrows to scroll through the broker calls. Use the Show All button to scroll through the list of broker calls. VA Intranet Website Select the submenu to access the VA Intranet website. Note: Clicking this submenu connects the user to the VA Intranet website, where additional dental-related information can be obtained. This includes the latest DRM Plus manuals. Find your DRM Plus Administrators Select the submenu to display a list of all the DRM Plus administrators that have full admin functionality. The list of DRM Plus administrators may be from the local dental clinic or every dental clinic that shares the same VistA server. Have a Question, Comment or Suggestion about DRM? Select the submenu and it will display a VA email screen with the VHA Dental Software Support group pre-selected in the ‘To’ email field. The provider will receive a reply from the VHA Dental Software Support group in response from the provider’s question, comment or suggestion when requested. May 2018 DRM Plus Administrator Manual v6.9 132 About The About screen contains information on the DRM Plus application currently in use at the facility, including the version number of the executable. Figure 160: DRM Plus About Screen The System Report button and the Reporting Off button are located on the About screen. Both buttons are useful for Document Storage Systems (DSS) in helping to evaluate any issue that may have occurred in DRM Plus. It is strongly suggested NOT to select ether button except when working with a DSS employee who will be helping the provider in finding details about the issue occurring in the DRM Plus application. The System Report button will cause the DRM Plus application to freeze. When selecting this button any unfiled data entered this session and NOT saved as unfiled data will be lost. The provider will NOT be able to recover the unsaved unfiled data and would have to re-enter all the data after restarting the DRM Plus application. Selecting the System Report button will give the provider an option NOT to continue if they desire. The following informational screen will inform the provider to select the No button if they would prefer NOT to lose any unsaved unfiled data recently entered this session. May 2018 DRM Plus Administrator Manual v6.9 133 Figure 161: System Report Informational Screen Selecting the Yes button from the informational screen will freeze the DRM Plus application and give the provider an error system report. All unsaved unfiled data at this point will be lost. The provider may select the restart application button to re-launch DRM Plus and continue with their dental charting. The default Reporting Off button will NOT affect the provider’s work process during this session unless they experience an error using the application. The only visible change the provider may notice when the button is selected will be changing the button’s name to Reporting On. When the button displays Reporting On then the madExcept application, system report, will become inactive. The madExcept system report is explained in detail when reading the madExcept Application appendix from the DRM Plus manuals. Note: The Reporting On button’s name will change back to the default Reporting Off button’s name each time DRM Plus is closed and relaunched. May 2018 DRM Plus Administrator Manual v6.9 134 DRM Plus Banner The DRM Plus Banner contains vital information about the patient, providers, and also coding standards and alerts. Figure 162: DRM Plus Banner Patient Information Patient information displays on the far left side of the DRM Plus banner. Figure 163: Patient Inquiry Button The patient information area shows the patient’s first and last name, social security number, date of birth and current age. Click the Patient Inquiry button of the banner to open the Patient Inquiry screen. Figure 164: Patient Inquiry Screen The Patient Inquiry screen contains more detailed information about the patient, including: address, phone number, means test information, status, and admissions information. May 2018 DRM Plus Administrator Manual v6.9 135 Visit Information Visit information is displayed on the banner in the second box from the left. It contains information on the current encounter. A scheduled appointment automatically fills the field when the provider enters data into DRM Plus on the same day of the appointment. When no scheduled appointment automatically imports into banner or if one is NOT manually selected from the banner after opening the dental chart then the following will result. After the first completed procedure code has been selected during the current session results in the launch of the Provider and Location for Current Activities screen. This will force the dental user to select a scheduled appointment before the first diagnosis code can be selected for the completed transaction. Figure 165: Provider/Visit Button To change visit or provider information, click the Provider/Visit button of the banner. The Provider and Location for Current Activities screen displays. Figure 166: Provider and Location for Current Activities Screen Select the provider in the top part of the screen and the correct appointment information in the bottom part of the screen. The information in the banner changes to reflect the adjustments made on this screen. For more information on navigating this screen, please see the Dental Encounter Data section in the Using the DRM Plus Drop-Down Menus chapter of this manual. May 2018 DRM Plus Administrator Manual v6.9 136 Dental Provider Information This section of the banner displays information on the primary and secondary dental providers. To assign a primary and/or secondary dental provider for a patient requires an administrative parameter option, given by the DRM Plus Administrator. Primary/Secondary providers are for planned care, and show who is responsible for a given patient, and what is upcoming for the patient, regardless of who entered the information. Figure 167: Designate Dental Providers Button To select a primary and/or secondary dental provider for a patient: 1. Click the Designate Dental Providers button of the banner. 2. The Designated Dental Providers screen displays. Figure 168: Designated Dental Providers Screen 3. Select the provider from the list of active dental providers. 4. Click the right arrow associated with the Primary Dental Provider and/or Secondary Dental Provider windows. 5. The provider’s name displays in the designated provider area. To remove the provider, click the left arrow. 6. Click the OK button. 7. The provider information displays in the banner. The primary dental provider or secondary dental provider can be set as Fee Basis in DRM Plus. The Fee Basis provider does NOT exist in VistA. This is a “free-text” entry and therefore, most reports in DRM Plus do NOT recognize the Fee Basis provider. May 2018 DRM Plus Administrator Manual v6.9 137 Designating primary and/or secondary provider(s) is optional. Since the field is located in the DRM Plus banner, it can be viewed from all DRM Plus screens. Note: The Panel Add/Edit administrative option changes all patients assigned to the original primary provider to the selected new primary provider for the entire block of patients. Note: This option is utilized for these DES reports: Recare, Provider Planning, Planned Items List, Planned Non-VA Care and Active Patients by Provider. Vitals Button This section of the banner contains a Vitals button to launch the Enter Vitals screen, which will add specific vitals to the patient’s VistA database. Only the blood pressure, pulse and general pain maybe added using the Enter Vitals screen. Figure 169: Vitals Button After selecting the Vitals button from the banner the Enter Vitals screen will display for the provider to enter and save three specific vitals to the VistA database. After entering any of the three possible vitals select the OK button to save to the VistA database. Figure 170: Enter Vitals Screen Adverse Events Button The Adverse Events (AE) button in the banner when selected will launch a screen where an adverse event may be entered and filed with an encounter for the selected patient’s chart. Figure 171: Adverse Events Button on DRM Plus Banner The AE button, displayed as a yellow button in the banner screen above, only results as a yellow icon when at least one Active adverse event entry has been filed with the patient’s chart. Selecting the AE button will open the following Adverse Events screen. When only filed Resolved entries are listed in the History section of the Adverse Events screen then the AE button in the banner will remain the same background color as the banner. May 2018 DRM Plus Administrator Manual v6.9 138 To add an adverse event: 1. 2. 3. 4. 5. 6. 7. 8. 9. Select the drop-down arrow on the Select Category and Provider Details window Select one of the twelve categories from the list View the blue Categories with Examples window with the category listed at the top Add or provide detailed text into the upper text window about the adverse event Select the correct Status radio button (Resolved or Remain Active) Select the Add button to temporary save the new adverse event May add multiple adverse events this session if desired When all adverse events have been added select the Done button to save as unfiled data Filing an encounter is required when adding any adverse event during this session Figure 172: Adverse Events Screen Note: The Add button from the Select Category and Provide Details section will temporary save each adverse event that may be entered this session. The name on the button will change to Save Changes when a filed adverse event is selected from the History table and edited by the provider. After all the adverse events have been added/edited/deleted during this session select the Done button to save all adverse events as unfiled data. Note: There is one trigger, completed procedure (D9930), which will automatically open the Adverse Events screen when selected this session. The trigger occurs when the provider selects the Next button, which will automatically open the Adverse Events screen. The completed procedure D9930 is only suggested to include an adverse event associated with the procedure however NOT required for an adverse event to be entered and filed. Selecting the Cancel button will allow the provider to complete the encounter without adding an adverse event. May 2018 DRM Plus Administrator Manual v6.9 139 To edit a filed Active adverse event: 1. 2. 3. 4. 5. 6. 7. Highlight the filed Active adverse event entry from the History table May edit or add to the Provider Details in the upper text window Or may change the Status radio button (to Resolved) Select the Save Changes button to temporary save the edited adverse event Select the OK button on the informational Adverse event edited screen When all adverse events have been added select the Done button to save the unfiled data Filing an encounter is required when editing any adverse event during this session Figure 173: Adverse Events Screen Note: Only a filed Active adverse event may be edited. When trying to edit a filed Resolved adverse event the provider will get a screen informing them they can NOT edit any item that is not Active. The Display Resolved check box is defaulted as checked when opening the Adverse Events screen. The provider may uncheck the Display Resolved check box if the provider doesn’t want the History table to display any resolved adverse events. The provider may select the Display Deleted check box to see if there are any deleted adverse events filed for the patient’s chart. Any newly entered resolved and deleted adverse event will be required to be filed with an encounter before that adverse event will be permanently viewable with either of these check boxes. To delete a filed adverse event: 1. 2. 3. 4. 5. Highlight the adverse event in the History table Select the Delete button to temporary save the deleted adverse event Select the OK button on the informational Adverse event deleted screen When all adverse events have been entered select the Done button to save the unfiled data Filing an encounter is required when deleting an adverse event this session May 2018 DRM Plus Administrator Manual v6.9 140 The Delete button selection for any filed adverse event may only be completed by a full DRM Plus Administrator. The deleted adverse event requires an encounter to be filed to complete the process. When selecting the Delete button as a non-admin provider the following screen will display. Figure 174: Not DRM Plus Administrator Informational Screen Note: All deleted adverse events will display as a line through the entry in the History table when selected by any DRM Plus provider that would want to view them. When the Cancel button is selected before the Done button while the Adverse Events screen is open then the add/edit/delete entries will NOT be saved. The Cancel button will undo any action taken with any new entries by the provider when adding a new adverse event, modifying a filed adverse event, or deleting a filed adverse event. All recent adverse event data entered while the Adverse Events screen was open will be lost and will need to be re-entered again if the Cancel button is selected. Note: When the Done button has been selected and any saved adverse events were entered in error during this session follow one of the methods that follow to remove them. The only way to remove the adverse event this session would be by selecting the Delete button from the Adverse Events screen and then the Done button or refresh the patient’s chart and don’t save the unfiled data that has been entered up to this time. Each header on the History table is selectable for sequence reorder of the data listing in each column. When the header is selected, a horizontal bar triangle displays and informs the provider the directional order of data in that header column. In the next dialog the Visit column selected would display the oldest visit at the top with the more recent visits following in sequence. Figure 175: History Section on Adverse Events Screen May 2018 DRM Plus Administrator Manual v6.9 141 The Examples button will open and close the right half of the screen labeled Categories with Examples in the header. This blue view-only window allows the provider to view common examples associated with each category that is listed as an adverse event. The common examples in the blue window that may be viewed are NOT an exclusive list. The next dialog does NOT display the blue Categories and Examples view-only window because the Examples button was selected. Select the Examples button again and the blue view-only window will display. Figure 176: Adverse Events Screen without Categories and Examples Device Tracking Button The Device Tracking (DT) button in the banner when selected will launch a screen allowing device tracking identifiers to be entered and then filed with an encounter for this patient’s chart. Figure 177: Device Tracking Button on DRM Plus Banner May 2018 DRM Plus Administrator Manual v6.9 142 Selecting the Device Tracking (DT) button, only results as a yellow button in the banner when at least one device completed procedure has been filed without any device identifiers attached, will open the following Device Tracking screen. When all filed device completed procedures have device identifiers filed to them in the Device Tracking screen then the DT button in the banner will remain the same background color as the banner. Figure 178: Device Tracking Screen From the Device Tracking screen, a provider may add device identifier(s) with a completed procedure transaction, a diagnostic finding transaction, or a No Transaction by using the Save Entry button. The previous dialog displays no current session device procedures entered. There are 26 different completed procedures that may be displayed in this screen if entered this session or filed in the past on the patient’s chart. The device tracking Transactions table may display four different views. The other three views occur when selecting the following check boxes; Display All Findings, Display All Completed Care, or Display All “No Transactions”. The check box selections may be individual or accumulative. All four different views may have device identifier(s) filed/attached to a specific procedure transaction or non-transaction. The following options explain the details about the four views that may result when selecting a check box or combination of check boxes. No check boxes selected; which is the default selection when opening the Device Tracking screen, will display all the unfiled/filed 26 trigger completed procedures suggested to have device identifiers. May 2018 DRM Plus Administrator Manual v6.9 143 Selecting the Display All Findings check box displays all the unfiled/filed diagnostic finding transaction(s) for the patient’s chart. Selecting the Display All Completed Care check box displays all the unfiled/filed completed care transaction(s) for the patient’s chart. Selecting the Display All “No Transactions” check box, inactive until the first no transaction device has been added and filed, displays all the filed No Transactions for the patient’s chart. Any combination of one or three check boxes selected would result in the Transactions table displaying the accumulation of transactions/non-transactions from the check boxes that were selected. To add completed procedure device identifiers: 1. 2. 3. 4. 5. Enter one of the 26 trigger completed procedures from the Treatment & Exam screen this session Select the DT button from the banner or select the Next button when completing the encounter Highlight the completed procedure transaction in the Transactions table to add device identifiers Required to enter at least one device identifier with this completed procedure transaction Select the Save Entry button to save the new device identifiers to the completed procedure transaction 6. Select the OK button on the informational Device identifiers saved screen 7. Select the Done button to save all the device identifier(s) during this session 8. Filing an encounter is required when adding device identifier(s) this session Figure 179: Device Tracking Screen with Completed Transaction Entry May 2018 DRM Plus Administrator Manual v6.9 144 Any unfiled/filed Diagnostic Finding transaction or any other unfiled/filed completed procedure transaction, which is NOT one of the 26 trigger completed procedures, may have device identifier(s) added and filed following the steps listed previously. Use the two check boxes at the bottom of the Transactions table; Display All Findings and Display All Completed Care to display the transactions to be associated with new Device Identifiers. The easiest way for recording the UDI (unique device identification) is to scan it using the barcode labeled on the packaging. There are several types of barcodes. The DataMatrix (similar to the QRcode) has become more popular recently. There are three issuing agencies for UDI details; GSI, HIBCC, and ICCBBA. Sometimes the UDI barcode will be labeled with one of those identifiers. The UDI icon at the end of the UDI field in the Device Identifiers window allows importing of a few or many Device Identifiers. After the UDI has been entered, the provider may select the Enter key or select the UDI icon to import the field values found in the UDI. The imported field values come from the U.S. National Library of Medicine. The retrieval may require several import attempts depending on the network traffic. Note: The drop-down field lists of (Types:) and (Sub-Types:) in the Device Identifiers section is information obtained from the FDA. When the Cancel button is selected before the Done button while the Device Tracking screen is open then the add/edit/delete entries will NOT be saved. The Cancel button will undo any action taken with any new entries from the provider when adding new device identifiers, modifying filed device identifiers, or deleting filed device identifiers. Any recent device identifier data entered this session will be entirely lost and will need to be re-entered again. Under certain circumstances there may be a reason why device identifiers should NOT be filed with a dental transaction. The No Transaction section, right below the Transactions section, which includes the Add button on the Device Tracking screen will allow the following. To add non-transaction device identifiers: 1. 2. 3. 4. 5. 6. 7. 8. 9. Select the DT button in the banner Select the Add button from the No Transaction section Data may be entered into Date, Description or Tooth fields Description field is the only required data needed for entry Required to enter at least one device identifier with the non-transaction entry Select the Save Entry button to save the new device identifiers to the non-transaction entry Select the OK button on the informational Device identifiers saved screen Select the Done button to save all the device identifier(s) during this session Filing an encounter is required when adding device identifier(s) this session When adding a new No Transaction entry after selecting the Add button; the button will become a Cancel button. Selecting the Cancel button will NOT save any data entered into No Transaction fields or device identifier fields. Any No Transaction field data and device identifier data will need to be re-entered. The next Device Tracking screen will display the No Transaction filed in the Display All “No Transactions” view screen. Highlighting the non-transaction entry displays the device identifiers filed with the non-transaction entry. May 2018 DRM Plus Administrator Manual v6.9 145 The Transactions table displays a green (check-mark) icon in the first column, which identifies the nontransaction entry having saved unfiled Device Identifiers. Figure 180: Device Tracking Screen with No Transaction Entry Note: The only way to delete any filed No Transaction entry has to be done in the Device Tracking screen. The No Transaction may have been filed by mistake on a patient’s chart or filed to the wrong patient’s chart. Deleting the encounter on the wrong patient’s record will NOT delete the No Transaction entry if one was filed with that encounter. The following explains the meaning of the icons found in the Device Tracking screen. The first column icons from any of the multiple Transactions views may be displayed as either a green icon, red icon or a blue icon. The green icon represents unfiled/filed device identifier(s) filed with a transaction or non-transaction found in all four views. The green icon also may represent a filed transaction or non-transaction as a Removed device tracking entry. The red icon represents any of the 26 trigger completed procedures having NO device identifier(s) filed with the completed procedure transaction. The red icon will only be displayed in the default view or when the Display All Completed Care check mark has been selected. The blue icon represents all other unfiled/filed completed procedures or diagnostic findings. These completed procedures/findings are left up to the provider if they would prefer to file a device identifier(s) with the transaction. These completed procedure/finding transactions are NOT identified for any device tracking entry by the VHA Office of Dentistry. May 2018 DRM Plus Administrator Manual v6.9 146 Note: The red icon will display for any of the 26 unfiled/filed trigger completed procedures identified by the VHA Office of Dentistry. When one of the 26 trigger completed procedures is entered during the current session it will force the provider to the Device Tracking screen when the provider selects the Next button when trying to complete the encounter. Then it will be up to the provider to decide if they want to save any device identifiers to the unfiled completed transaction or NOT. The Cancel button on the Device Tracking screen may be selected to complete the encounter by NOT entering any device identifiers to the trigger completed procedure. The DT icon button in the banner will also display as a yellow icon informing the provider at least one trigger completed procedure having no device identifiers associated with it is in the Device Tracking screen. Note: The 26 unfiled/filed trigger completed procedures identified by the VHA Office of Dentistry are suggested to have device identifiers associated with them however they are NOT required to have device identifiers. Each header at the top of the Transactions table is selectable for sequence order of data listed in that column. When the header is selected, a horizontal bar triangle displays and informs the provider the directional order of data in that header column. In the next dialog the Icon column, first column, selected displays the red icon, green icon and then blue icon from top to bottom. Figure 181: Transaction Section on Device Tracking Screen Here is how to Remove filed device identifiers for a transaction or non-transaction. The provider will be required to highlight the filed completed procedure transaction, the filed diagnostic findings transaction, or the filed non-transaction to label the device identifiers as removed. To remove filed device identifiers for a transaction or non-transaction: 1. 2. 3. 4. 5. 6. 7. Find the filed transaction or non-transaction that should be marked as Removed Highlight the filed transaction or non-transaction listed on the Transactions table Select the Removed check box in lower left corner of the Device Tracking screen Select the Save Entry button to save the transaction or non-transaction marked as Removed Select the OK button on the informational Device identifiers edited screen Select the Done button to save all the Device Tracking entries during this session Filing an encounter is required when removal of a device tracking entry this session Here is how to delete device identifiers that were filed to a transaction or non-transaction. The provider will be required to highlight the filed completed procedure transaction, the filed diagnostic findings transaction, or the filed non-transaction that should be deleted. May 2018 DRM Plus Administrator Manual v6.9 147 To delete the filed device identifiers for a transaction or non-transaction: 1. Find the filed transaction or non-transaction where the device identifiers should be deleted 2. Highlight the filed transaction or non-transaction listed on the Transactions table 3. Select the Delete Entry button to save the deleted device identifiers for transaction or nontransaction 4. Select the OK button on the informational Device identifiers deleted screen 5. Select the Done button to save all the Device Tracking entries during this session 6. Filing an encounter is required when deleting device identifiers this session Only a full DRM Plus Administrator is able to delete device identifiers filed to a transaction or nontransaction. When selecting the Delete button as a non-admin provider the following informational screen will display. Figure 182: Not DRM Plus Administrator Informational Screen The Examples button will display and hid the right half of the screen labeled Device Instructions and Examples as the header. This blue view-only window allows the provider to view device instructions and examples of the UDI (unique device identification) information. The next Device Tracking screen doesn’t display the blue Device Instructions and Examples view-only window because the Examples button was selected. Select the Examples button again and the blue viewonly window will display. May 2018 DRM Plus Administrator Manual v6.9 148 Figure 183: Device Tracking Screen without Device Instructions and Examples Note: The FDA website on UDI Basics address found on the bottom of the Device Instructions and Examples view-only window will launch the U.S. FOOD & DRUG ADMINSTRATION website that will explain the UDI, unique device identifier, in greater detail. Note: If there is not a successful response, check to see that the correct barcode/UDI is being scanned or entered. If these are correct, then it is possible the information is not available from the National Library of Medicine and the information will need to be entered manually. Dental Class Information This section of the banner contains information on the patient’s dental class. Figure 184: Dental Class Button Click the Dental Class button of the banner to go to the DRM Plus Cover Page tab. However, only a DRM Plus Administrator or an end-user that has this administrative parameter option can change a patient’s dental class. Please see the Cover Page chapter of this manual for more information. May 2018 DRM Plus Administrator Manual v6.9 149 Clean Slate This section, when present, is located between the Dental Class button and the icons on the far right of the banner. Clean Slate is only a viewable window that displays the most recent date that a clean slate was performed on the patient’s chart. Clean slate may only be performed by a DRM Plus Administrator, or an end-user who has received the administrative parameter option. Figure 185: Clean Slate Banner Notification The clean slate functionality has been added to clear the graphical portion of the Treatment & Exam screens in DRM Plus, and delete all planned treatment for the selected patient. The recent clean slate can be restored for this patient at any time until a new encounter has been filed. Icons The icons located on the right side of the banner show patient flags, alerts and provide an easy way for the user to view general coding standards. Figure 186: DRM Plus Banner Icons General Coding Standards The first icon is the General Coding Standards icon. Clicking this icon takes the provider to the VA Office of Dentistry website where current General Coding Standards may be viewed. This hyperlink should be changed by the DRM Plus Administrator if requested to do so by the VA Dental Informatics and Analytics Director. Note: If NOT immediately directed to the website after clicking the icon please notify the Help Desk. Patient Flags There are four possible patient flags that can display in DRM Plus, including: Clinical Reminders, Consult, Exam Quality Indicator and Fluoride Quality Indicator. Clinical Reminders The Clinical Reminders icon displays on the right side of the DRM Plus banner when there are clinical reminders due for the selected patient. Providers must still process clinical reminders using CPRS. May 2018 DRM Plus Administrator Manual v6.9 150 Clicking the Clinical Reminders icon displays an information screen, stating that the selected patient has clinical reminders due. Figure 187: Clinical Reminders Due The Clinical Reminders icon should only display if the current end-user is responsible for, and may resolve the clinical reminder(s) listed on the CPRS cover sheet. If clinical reminder(s) displaying in the list cannot be resolved by the end-user, contact local IT for assistance. Consult The Consult icon displays when the patient has an incomplete consult in their chart. Click the icon. The Clinical Record tab displays with consultations selected. For more information, see the Clinical Record chapter of this manual. Exam Quality Indicator The Exam Quality Indicator icon displays when the patient is due for a follow-up exam. The icon only displays if the patient meets certain class restrictions. Clicking this icon produces a screen, which reveals when the patient last received a qualifying exam. Figure 188: Exam Quality Indicator Screen Click the OK button and the informational screen will close. For more information, see the Cover Page chapter of this manual. Note: The Exam Quality Indicator and Fluoride Quality Indicator only are active for VA dental care under Class I, IIA, IIC or IV classification. These dental classes are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. May 2018 DRM Plus Administrator Manual v6.9 151 Fluoride Quality Indicator The Fluoride Quality Indicator icon displays when the patient is due for a fluoride intervention. Clicking this icon displays an explanation of why the patient is at risk and needs intervention. Figure 189: Fluoride Quality Indicator Screen Click the OK button and the informational screen will close. After the patient’s chart has been loaded and the Fluoride Quality Indicator icon is selected the DRM Plus Cover Page tab display after clicking the OK button. For more information, see the Cover Page chapter of this manual. Note: The Exam Quality Indicator and Fluoride Quality Indicator only are active for VA dental care under Class I, IIA, IIC or IV classification. These dental classes are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. May 2018 DRM Plus Administrator Manual v6.9 152 Alerts The DRM Plus Alert icon shows if the patient has any associated alerts. It can also be used to add alerts to the patient’s chart in DRM Plus. To add an alert: 1. Click the Alert icon. 2. The Dental Alert screen displays. Figure 190: Dental Alerts Screen 3. 4. 5. 6. 7. Click the desired Common Dental Alerts check box on the left side of the screen. Click the right arrow button. The selected alert(s) display on the right side of the screen. Alternatively, type the alert directly into the Patient’s Dental Alerts screen window. Click the OK button. The Alert icon changes when patient alerts are present and displays as a stop sign. To view the alerts: 1. Click the Alert icon displaying a stop sign. 2. The Patient’s Dental Alerts screen displays. May 2018 DRM Plus Administrator Manual v6.9 153 Figure 191: Dental Alerts Screen without Common Dental Alerts 3. Click the Common Alerts button to include the Common Dental Alerts window. 4. The full Dental Alerts screen will display. From here, more dental alerts can be added, or the alert can be removed by placing the cursor into the Patent’s Dental Alerts window and deleting the text. 5. Click the OK button to finish. May 2018 DRM Plus Administrator Manual v6.9 154 Cover Page The DRM Plus Cover Page tab displays important patient information. The tab has 8 major sections: Dental Eligibility, Demographics, Case Management, Recent Dental Activity, Fluoride Indicator Prescription Date, Dental Alerts, Notes and Filed Planned Care. Figure 192: Cover Page Tab Screen May 2018 DRM Plus Administrator Manual v6.9 155 Dental Eligibility The patient’s dental class, service connected teeth/service trauma, adjunctive medical conditions, eligibility expiration date, and anticipated rehab date are displayed in this section. Dental Eligibility can only be changed by a DRM Plus Administrator, or an end-user who has received this administrative parameter option. Figure 193: Dental Eligibility Section Dental Class Use the drop-down menu to change the patient’s Dental Class. Selecting the top, empty field on this menu allows the administrator to remove any dental classification saved/filed with the patient’s chart. Service Connected Teeth/Service Trauma The Service Connected Teeth/Service Trauma will be optional for any or all dental classes however a Service Connected Teeth/Service Trauma will still be required for all Class IIA patients. The Class IIA no longer requires trauma to a particular tooth, just some documentation of trauma to the oral cavity so the Other check box has been added. Figure 194: Service Connected Teeth/Service Trauma May 2018 DRM Plus Administrator Manual v6.9 156 Adjunctive Medical Condition(s) The Adjunctive Medical Condition(s) field is still required for all Class III & Class VI patients but maybe optional for all other dental classes if desired by the provider. Deletion of the Adjunctive Medical Conditions will NOT be required when changing a patient’s dental class from Class III or Class VI to any other dental class. 1. Click the Add/Edit AMC button. 2. The Add/Edit Adjunctive Medical Conditions screen displays. Figure 195: Add/Edit Adjunctive Medical Conditions Screen 3. 4. 5. 6. 7. 8. 9. Add the diagnosis code. Type in the word or diagnosis code and press the key. Choose the desired result from the drop-down menu. Click the green add button to add the diagnosis code to the adjunctive medical conditions list. Active Problems, if present, can also be added to the adjunctive medical conditions list. Use the blue up arrow button to move conditions within the list. Use the red X button to delete items from the list. Click the OK button. The condition displays on the Cover Page tab. Note: The Diagnosis Code Search field on the Add/Edit Adjunctive Medical Conditions screen only allows for CPT diagnosis code search and entry and NOT for SNOMED codes. Use the Active Problem section in CPRS to search for SNOMED codes if desired. SNOMED codes may be added to the Active Problem section in CPRS and then selectable in the Add/Edit Adjunctive Medical Conditions screen. May 2018 DRM Plus Administrator Manual v6.9 157 Eligibility Expiration Date The Eligibility Expiration Date field will be optional for all dental classes. A bubble pop-up informs the provider if they really want to include an eligibility expiration date for any Class I, Class IIA, Class IIC and Class IV since they rarely expire. To change the eligibility expiration date: 1. Click the Eligibility Expiration Date Ellipsis (…) button. 2. The Select Date/Time screen displays. Figure 196: Select Date/Time Screen 3. Select the desired date from the screen. 4. Click the OK button. The date is updated. Anticipated Rehab Date The Anticipated Rehab Date field had no updates to the Anticipated Rehab Date functionality. The Anticipated Rehab Date is required for all Class V patients and will NOT be allowed for any other dental classification. Note: After entering any new dental eligibility, always click the Save button to update the VistA database. May 2018 DRM Plus Administrator Manual v6.9 158 Demographics Patient demographic information is located here and is imported from VistA. The fields cannot be updated or changed in DRM Plus. Figure 197: Demographics Section Case Management Use the Case Management (Disposition) section to adjust the patient’s status and file suggested recare dates. Click the Save button to update any new changes. Figure 198: Case Management Section Status Change the Status of the patient by clicking the appropriate radio button. Suggested Recare Date 1. Click the Ellipsis (...) button to display a calendar screen. 2. Select the desired date from the menu and click the OK button. 3. Click the Save button to file the data. May 2018 DRM Plus Administrator Manual v6.9 159 Recent Dental Activity This section displays visit dates, if applicable, when specific completed procedures were last performed on the patient. Procedure codes that activate and display the visit date in this section may be viewed by hovering the mouse cursor over the recent dental activity description. Figure 199: Recent Dental Activity Section Fluoride Indicator Prescription Date Add a fluoride indicator prescription date here. Figure 200: Fluoride Indicator Prescription Date Section 1. Click the Ellipsis (...) button. 2. Select a date from the calendar screen and click the OK button. 3. Click the Save button to file the date. To delete the prescription date: 1. Click the date to place the cursor in the field. 2. Delete the date. 3. Click the Save button to file. The field is active regardless of whether or NOT the patient has a fluoride quality indicator. Note: No future dates are allowed for the fluoride indicator prescription date. May 2018 DRM Plus Administrator Manual v6.9 160 Dental Alerts The patient’s Dental Alerts, if any, are listed here. Figure 201: Dental Alerts Section Please see the Alerts section in the DRM Plus Banner chapter of this manual for more information. Notes Add general notes in this text box. These notes are NOT imported into the TIU progress note. Figure 202: Notes Section 1. Place the cursor in the text box and begin typing. 2. Click the Save button to file the notes. 3. A screen will display showing that the information was saved. Click the OK button. May 2018 DRM Plus Administrator Manual v6.9 161 Filed Planned Care The filed planned treatment for the patient, if applicable, is displayed here. It cannot be edited on this page. Figure 203: Filed Planned Care Please see the Treatment Plan section in the Chart/Treatment -Treatment & Exam chapter of this manual for more information. May 2018 DRM Plus Administrator Manual v6.9 162 Clinical Record The Clinical Record tab allows access to various areas of the patient’s record. From here, view Problems, Medications, Vital Signs, Radiology, Allergies, Lab Results, Postings, Immunizations, D/C Summaries, Consultations, Health Summary and Notes. Figure 204: Clinical Record Tab 1. Click the radio button that corresponds to the type of clinical record to be viewed. Figure 205: Clinical Record Radio Buttons May 2018 DRM Plus Administrator Manual v6.9 163 2. A list of TIU note entries, corresponding to the selected Notes radio button, displays in the area below the list of clinical record radio button section. Figure 206: Clinical Record Selection Window 3. Select/highlight a TIU note entry. Details of the TIU note display on the right side of the screen. Figure 207: Clinical Record TIU Note Window May 2018 DRM Plus Administrator Manual v6.9 164 Problems Click the Problems radio button to view a list of active problems previously entered. To inactivate a problem: 1. Select the problem from the list that should be inactivated. 2. Right-click on the problem selected. 3. The Inactive Highlighted Problem List Entry button displays. Figure 208: Inactivate Highlighted Problem List Entry Button 4. Select the Inactive Highlighted Problem List Entry button to inactivate the problem. 5. Select Yes and a screen displays, confirming the inactivation. The problem is removed from the list in DRM Plus and in CPRS the problem is listed as inactive. Note: Use CPRS to reactivate the problem. Please see the File Data Option Screen section in the Completing the Encounter chapter of this manual for more information to add a new problem. Consultations Selecting the Consultations radio button displays a complete list of consults. They appear with the abbreviated notation of the consult status included in the listing. Consults can be filtered by status, service or date range. To filter consultations by status, service or date range: 1. Click the Consultations radio button. Consultations, if present, display in the entries area. 2. Right-click in the entries area. The filter menu displays. Figure 209: Consultations Filter Menu 3. Select the desired filter from the menu. 4. Consults filtered by status, service or date range have a drop-down menu to filter the consults into smaller sub-views. 5. The consultation sub-view list displays results in this consult on the right side of the Clinical Record tab screen. May 2018 DRM Plus Administrator Manual v6.9 165 Notes Selecting the Notes radio button reveals a listing of all completed notes (the default listing). Right-clicking the note window, where all notes are listed, brings up an option box. Figure 210: All TIU Completed Notes List Select the TIU Filters menu to filter the list of TIU progress notes by the listed criteria. Figure 211: TIU Filters Submenus May 2018 DRM Plus Administrator Manual v6.9 166 Open the desired note. Right-click the list of notes again to view the functions available for the selected note. Figure 212: Note Functions Menu The functions available coincide with the Action menu options, as seen on the Notes tab in CPRS, and works similarly. The note functions can be selected with a left-click. Adding a New TIU Progress Note To add a new TIU progress note for informational purposes only, without an ADA procedure code: 1. Select the New Note option from the Note Functions menu. 2. The Set Progress Note Title screen displays. Figure 213: Set Progress Note Title Screen May 2018 DRM Plus Administrator Manual v6.9 167 3. Select the TIU progress note title from the list on the Set Progress Note Title screen. Note information displays on the screen. Figure 214: New TIU Progress Note without Any Procedures 4. Use the tools to create a historic visit or select a scheduled visit by using the drop-down menu. 5. Enter notation directly into the note. 6. Enter the Provider’s electronic signature and click the Finish button to complete the note. Note: Historical notes may be entered using this option. May 2018 DRM Plus Administrator Manual v6.9 168 Adding a New TIU Progress Note Addendum Creating an addendum to a previously completed TIU progress note to provide additional information, or to clarify any issues, does NOT require entering an ADA/CPT procedure code. This type of addendum can be done from DRM Plus in the Clinical Record tab or in the CPRS GUI. An addendum that adds an ADA/CPT procedure to a signed note requires passing information to VistA PCE/DES and requires entering an ADA/CPT code through the Completed Care screen entry process. To record a note addendum without an ADA/CPT procedure code: 1. 2. 3. 4. 5. Select the note to be appended from the list of notes. The note displays in the viewer. Right-click the area where the notes are listed to view the Note Functions menu. Select Addendum to a Note from the menu. Only signed notes can have an addendum. Type the note directly into the note viewer. Right-click on the note viewer to import menu information or cancel the note. Figure 215: Import Menu Information Screen 6. Enter the provider’s Electronic Signature and click the Finish button to add the addendum. 7. A confirmation screen displays. Click the OK button. Note: If Addendum to a Note is selected in error, right-click the appended note and select the Cancel Note submenu. May 2018 DRM Plus Administrator Manual v6.9 169 Dental History The Dental History tab displays all dental completed care information for each tooth and non-tooth entry filed in DRM Plus. Figure 216: Dental History Tab May 2018 DRM Plus Administrator Manual v6.9 170 Viewing Dental Information by Tooth To view dental information by tooth: 1. Click a tooth in the tab diagram. Teeth numbered in red with an asterisk have information associated with them. When a tooth is selected, the tooth graphic is colored red in the diagram. Figure 217: Dental History Teeth Diagram 2. Information about the selected tooth displays on the right side of the screen. 3. To de-select a tooth, click it again. The tooth graphic turns white and the information about the tooth is removed from the right side of the screen. Viewing Other Dental History Information To see dental history that is NOT listed by tooth, select the Other check box. The information displays on the right side of the screen. Viewing All Dental History Information To see all dental history associated with this patient, select the All check box. The information displays on the right side of the screen. May 2018 DRM Plus Administrator Manual v6.9 171 Viewing Dental History Information by Episode of Care To view a patient’s dental history by episode of care: 1. Choose whether to view the Current Episode of Care or All Episodes of Care by selecting the appropriate radio button. Figure 218: Episode of Care Radio Buttons 2. Select the tooth or teeth to be viewed, or click the Other or All check boxes. 3. The information displays on the right side of the screen. Episode in Date Range To view a patient’s dental history information by date: 1. Click the Start and End drop-down arrows. Figure 219: Episode in Date Range 2. Use the calendar screen to choose the desired start and end dates. 3. Click the Episode in Date Range button. The results display on the right side of the screen. 4. Select the tooth or teeth, or the Other or All check boxes to view the desired information. Deleting an Encounter An erroneous dental history encounter may be deleted directly from DRM Plus. Only DRM Plus Administrators can delete filed dental history encounter data. To delete an encounter: 1. Right-click in the large window on the tab. A pop-up button displays. Figure 220: Delete History File Encounter/Visit Button May 2018 DRM Plus Administrator Manual v6.9 172 2. Select Delete History File Encounter/Visit button from the pop-up. 3. The Delete Encounter/Visit Dental History screen displays. Figure 221: Delete Encounter/Visit History Screen 4. Select the PCE Encounter Date/Time from the list. 5. Click the Delete button. A confirmation screen displays. 6. Click the OK button. The PCE encounter dental data is deleted if there are no multiple entries. Completed care transactions can also be deleted via the Chart/Treatment – Treatment & Exam screen. Please see the Deleting Completed Care Line Item(s) section, in the Chart/Treatment – Treatment & Exam chapter of this manual, for more information. Note: Deleting information from the Dental History tab removes the entire encounter from the chart. Once an encounter is deleted, it cannot be recovered. DRM Plus automatically updates PCE encounter entries and deletes data from the VistA PCE Encounter List. Multiple entries on a PCE Encounter List may require manual deletion(s) in VistA via PCE. Note: Local IT support follows local guidelines as to whether to append or hide the associated TIU (CPRS) Note. May 2018 DRM Plus Administrator Manual v6.9 173 Chart/Treatment – Treatment & Exam There are two main sections to the Chart/Treatment tab: Treatment & Exam and Periodontal Chart. Figure 222: Chart/Treatment Tab Displaying Treatment & Exam Screen The Treatment & Exam screen has several important component views. On the upper left side of the screen are the following functions: the Diagnostic Findings, Treatment Plan and Completed Care views, with their corresponding buttons. These tools are used to enter information on diagnostic findings, create treatment plans, view previously completed care, or enter dental procedures/diagnoses on today’s encounter. The Include “...” button allows the user to view information from a combination of the aforementioned views on one screen. Figure 223: Diagnostic Findings, Treatment Plan, Completed Care and Include Buttons May 2018 DRM Plus Administrator Manual v6.9 174 The Seq Plan (Sequencing), Chart Hx (History), Summary, TMJ, Habits (Parafunctional), H&N, PSR, OHA (Oral Health Assessment), Occl (Occlusion), and Social Hx (History) buttons are on the upper right side of the screen. Figure 224: Treatment & Exam Specialty Buttons The center of the screen has a graphic display of all the teeth. Use the visual representation in combination with the Diagnostic Findings, Treatment Plan and Completed Care buttons and icons to enter information about the patient. There is also a Key button on the right side of the display that shows which conditions the various colors, patterns and symbols represent. Figure 225: Completed Care Graphic Display The lower portion of the screen has buttons to change the view in the graphic display. Additionally, the transaction table, which shows detailed information entered in the Diagnostic Findings, Treatment Plan and the Completed Care view screens. There are tool buttons to the right of the transaction table, which allow the user to Edit, Delete or Complete the planned treatment; the Next button moves on to completing the encounter. Toggle between the teeth of the upper and lower arch by clicking the Upper and Lower buttons to the left of the transaction table on the bottom section of the screen. The Full button allows the user to view both arches. Figure 226: Completed Care Transaction Table May 2018 DRM Plus Administrator Manual v6.9 175 Diagnostic Findings 1. Click the Diagnostic Findings button on the left side of the screen. 2. Select the desired finding from the icons to the right of the Diagnostic Findings button. Figure 227: Diagnostic Findings Button with Icons 3. Click the tooth/area of the tooth in the graphic display. Use the Upper and Lower buttons on the left side of the text display to view the arch and the previous diagnostic findings on the upper and lower arches. Figure 228: Diagnostic Findings Graphic Chart and Transaction Table 4. The finding appear in both the text and graphic display. Click the Key button in the upper right corner of the graphic display to see how various findings are shown in the graphic. 5. Use the Clear icon to remove any finding entered during today’s encounter only. Click the Clear icon and then click the desired finding on the graphic to remove the finding from both the graphic and the transaction table. Note: The Stats column in the transaction table displays an ‘F’ when the transaction is a finding. May 2018 DRM Plus Administrator Manual v6.9 176 Editing Diagnostic Finding Descriptions Diagnostic Findings descriptions that have been entered, but for which no TIU progress note has yet been filed, can be edited. To edit a diagnostic finding description: 1. Select the finding by highlighting it in the transaction table. 2. Click the Edit button to the right of the transaction table. 3. The Edit Transaction screen displays. Figure 229: Edit Transaction Screen 4. Enter the new description in the text box. Note that only the description can be edited. The other information, such as Visit Date, Tooth/Quad or Category cannot be edited with this button. 5. Click the OK button. The edited information displays in the transaction table. Deleting a Diagnostic Finding Diagnostic Findings that have been entered, but for which no TIU progress note has yet been filed, can be deleted. To delete a diagnostic finding: 1. Select the finding by highlighting it in the transaction table. 2. Click the Delete button on the right side of the transaction table. 3. The finding is deleted. Note: If the user attempts to delete a finding that has already been filed with an old encounter, the item is removed from the graphic display, but remains in the transaction table with a line through it. The DRM Plus Administrator may delete the finding from the graphic and the transaction table, unless the transaction has previously been deleted by a DRM Plus non-Administrator. Note: Clicking a transaction table column heading sorts the table. Generally in ascending order depending on the current view. Clicking the column heading a second time returns the table to the original descending view. This functionality works the same for all three Treatment & Exam transaction table views. May 2018 DRM Plus Administrator Manual v6.9 177 Treatment Plan Entering a Treatment Plan There are multiple ways to enter a planned procedure code for a patient: by adding the code directly utilizing the Add button with text box, or by selecting the icon that corresponds to the planned treatment and choosing the tooth from the graphic display. Use the ADA Codes icon, CPT Codes icon, Quick Codes icon or Personal Speed Code icon as additional ways to enter planned treatment for the patient. Rules for entering a procedure code for a planned item in the Treatment Plan view include: 1. Always use a standard icon, first four columns and P&C, if one is available first. 2. When NO standard icon is available, use the ADA Codes, CPT Codes, Quick Codes or a Speed Code icon. 3. The Add button with text box may be used interchangeably with rule 2. 4. Always enter transactions in the same order that they are performed on the patient. Figure 230: Treatment Plan Button with Icons To enter a planned treatment using the Add button and text box: 1. Click the Treatment Plan button. Notice that the Add button and text box are active. 2. Type a word or procedure code into the Add text box and click the Add button. 3. The Code Details screen displays if the procedure code is tooth or quadrant related. Figure 231: Code Details Screen Enter the Tooth number and, if applicable, the Area or Surfaces modifiers and click the OK button. The graphic and the displays adjusts to reflect the addition. Note: When surface modifiers are required for a procedure code, they must be entered using uppercase letters (M, O, D, F, B, L, and I). When root modifiers are required for a procedure code, they must be entered using lowercase letters (r, b, l, d, and m). May 2018 DRM Plus Administrator Manual v6.9 178 To enter a planned treatment using the standard Treatment Plan icons: 1. 2. 3. 4. Click the Treatment Plan button. Click the icon to the right that corresponds to the desired planned treatment. Click the appropriate tooth, area and/or surface. As in diagnostic findings, toggle between the upper and lower arch by clicking the Upper or Lower button on the left side of the display. 5. The graphic display and the transaction table display the new addition. To enter a planned treatment using the ADA Codes icon or the CPT Codes icon: 1. Click the ADA Codes icon. Figure 232: ADA, CPT and Quick Codes Icons 2. The Procedure Code Selection screen displays for the selection. Figure 233: Procedure Code Selection Screen May 2018 DRM Plus Administrator Manual v6.9 179 3. Type the procedure code into the filter, or use the scroll bar to search for a code. 4. A description of the highlighted procedure code displays in the Full Description text box. 5. Click the Category button to return to the list of categories at the top of the scroll sheet. Click the Multi-Add button to add multiple procedure codes on other teeth. 6. When the desired code is highlighted, click the Add button. 7. If the procedure code needs to be attached to a specific tooth and surface modifier, the Code Details screen displays. Figure 234: Code Details Screen 8. Fill in the fields with the requested information and click the OK button. 9. The Diagnosis Code screen displays if the parameter is activated. 10. Select the planned treatment procedure on the left side of the screen (default is all selected) and the diagnosis code(s) on the right side. If the correct diagnosis code does NOT appear, use the Additional Diagnosis Code Search to find a different diagnosis code. 11. Click the OK button. The information displays in the transaction table on the graphic chart. 12. To undo any graphical entry on today’s encounter, use the Clear icon as described in the Diagnostic Findings section of this chapter. Entering a planned treatment using the Quick Codes icon is similar to adding a planned treatment with the ADA Code icon. To enter a planned treatment using the personal Speed Code icons, please see the Perio Buttons section later in this chapter. Editing a Treatment Plan Description 1. Select the desired planned entry in the transaction table. 2. Click the Edit button. The Edit Transaction screen displays. Figure 235: Edit Transaction Screen May 2018 DRM Plus Administrator Manual v6.9 180 3. Enter the new description in the text box. 4. Click the OK button. 5. The Description is changed in the transaction table. Note that the Code, Category and other information cannot be changed with the Edit button. Deleting a Treatment Plan 1. Select the desired planned entry in the transaction table. 2. Click the Delete button. 3. The planned treatment is removed from the graphic and the transaction table. Every DRM Plus user is allowed to delete any planned item, regardless of who entered it. The planned entry is removed from the graphic and transaction table in the Treatment Plan and Sequencing screens. Completing a Treatment Plan 1. Select the planned procedure to be completed from the transaction table. 2. Click the Complete button. 3. The Diagnosis Code screen displays. Figure 236: Diagnosis Code Screen 4. Select the planned treatment procedure on the left side of the screen (default is all selected) and the diagnosis code(s) are mapped on the right side of the screen. If the correct diagnosis code is NOT listed, use the Additional Diagnosis Code Search to find a different diagnosis code. 5. The diagnosis codes in the lower section comprise the diagnosis quicklist which have been filed with every encounter for this patient’s chart during the past 24 months. This should help the provider decrease the entry time for searching and locating past diagnoses that may still be relevant for the patient’s visit. May 2018 DRM Plus Administrator Manual v6.9 181 6. Notice the File in PCE check box. If the completed treatment is NOT to be filed in PCE, uncheck this box. 7. Click the OK button. 8. The planned procedure is removed from the transaction table and is now part of Completed Care transactions for the patient. Note: When no diagnosis code(s) are mapped to (or listed with) a procedure code on the Diagnosis Code screen the Additional Diagnosis Code Search must be used to find the appropriate diagnosis code(s) to be filed with the selected procedure. Note: The PCE check box option should only be used by advanced users. Changing this option effects the data being sent to VistA PCE. Do NOT change this check box unless the user does NOT want the data to be sent to VistA PCE. Note: Planned procedure codes can be designated with or without a related diagnosis. The parameter change for users to acquire this functionality is Tools menu User Options submenu Treatment System tab select the top check box. Completed Care Click the Completed Care button to see all treatments that have been previously completed in the VA for the patient, or entering any new completed treatment for today’s visit. Figure 237: Completed Care Button Active with Icons The rules for entering a procedure code for a completed treatment in the Completed Care view include: 1. 2. 3. 4. Always use a standard icon, first four columns and P&C, if one is available first. When NO standard icon is available use ADA, CPT, Quick Codes or a Speed Code icon. The Add button and corresponding text box may be used interchangeably with rule 2. Always enter transactions in the same order they are performed on a patient. Entering Completed Care There are several ways to enter completed treatment. Planned treatments, which are completed (see Completing a Treatment Plan), display in the Completed Care transaction table. Completed treatment can also be entered manually: May 2018 DRM Plus Administrator Manual v6.9 182 1. 2. 3. 4. 5. 6. Click the Completed Care button. Select the desired associated standard icon. Choose the appropriate tooth/area on the graphic display. Complete the Diagnosis Code screen. The entry displays in the graphical/transaction table. To undo any graphical entry on today’s encounter, use the Clear icon as described in the Diagnostic Findings section of this manual. Completed treatment can also be entered through the Add button and text box; the ADA, CPT and Quick Codes icons, as well as the Speed Code icons. Please see the Treatment Plan section of this manual for further information on these functions. Editing Completed Care Description Completed Care description can only be edited if it has NOT yet been made a part of the TIU progress note. To edit a completed care entry: 1. Choose a completed care entry from the transaction table. 2. Click the Edit button. 3. The Edit Transaction screen displays. Figure 238: Edit Transaction Screen 4. Type the new description into the text box. 5. Click the OK button. Note that only the description can be edited. Deleting a Completed Care 1. 2. 3. 4. Click the desired completed entry in the transaction table. Click the Delete button. The completed treatment is removed from the graphic and transaction tables. To finalize the deletion, the encounter with the patient must be completed and filed. See the Completing the Encounter chapter of this manual for further information. Only DRM Plus Administrators may delete line item entries, and this updates only DRM Plus charting, VistA DES and VistA PCE. VistA TIU progress notes viewed in CPRS are NOT updated. If the deleted completed transaction was associated with the Primary Diagnosis for the visit in which it was originally entered, a new Primary Diagnosis for the encounter must be entered. The PCE Select Primary data screen displays after the Electronic Signature is entered, so that a new Primary Diagnosis can be chosen. Click the desired diagnosis (Dx) code/description check box, then click the OK button. May 2018 DRM Plus Administrator Manual v6.9 183 Figure 239: PCE Select Primary Data Screen Note: The DRM Plus Administrator should follow local guidelines as to whether they append the associated TIU progress note, or have some other guideline option. Note: To delete all entries from a dental encounter, never use the line item deletion in Completed Care screen. Instead, delete the entire dental encounter in the Dental History tab. Please see the Deleting an Encounter section in the Dental History chapter of this manual for further information. Include “Completed”/Include “Findings and Completed”/Include “Findings” This button can be used in conjunction with the other buttons to include more than one type of information on the display. When the Diagnostic Findings button is active, and the associated information is displayed in the graphic and transaction tables, clicking this button adds the Completed Care information to the display. If the Treatment Plan button is active, and the associated information is displayed, clicking this button adds the Diagnostic Findings and the Completed Care information to the graphic and transaction tables. Finally, when the Completed Care button is active, and the associated information is displayed, clicking this button adds the Diagnostic Findings. May 2018 DRM Plus Administrator Manual v6.9 184 Perio Buttons Icon The icon table includes the Perio Buttons icon. Click this Perio Buttons icon to see the second set of speed codes associated with perio mode, if entered by the user. Please see the Speed Codes section in the Using the DRM Plus Drop-Down Menu chapter of this manual for further information. Figure 240: Perio Buttons and Speed Code Icons This option is only available while Treatment Plan or Completed Care are active, but NOT with Diagnostic Findings. Click the desired icon to add it to the planned treatment. If these buttons are clicked when Completed Care screen is active, the Diagnosis Code screen displays, which allows the selection of diagnosis codes that are mapped to that procedure code to be entered. To change the location of the speed code icon: 1. Click one of the blank icons where the speed code icon is to be moved. 2. The Configure Button screen displays. Figure 241: Configure Button Screen 3. Use the drop-down menu to assign the speed code. 4. Use the Perio Mode check box to link the speed code icon with the Perio Buttons icon. 5. Click the OK button. The old speed code icon location is cleared and the speed code icon is now in the new assigned icon location. May 2018 DRM Plus Administrator Manual v6.9 185 Seq Plan/Sequencing Button Use sequencing in combination with the Treatment Plan screen to organize when to perform specific planned treatment. There are nine buttons on the Tx Planning/Sequencing screen. The nine buttons are Add Phase, Add Sub-phase, Add Non-VA Care Phase, Copy Non-VA Care Phase to Clipboard, Copy All to Clipboard, Print, Save & Exit, Save and Cancel. The Tx Planning/Sequencing screen has the nine buttons positioned or grouped on the right side of the screen. Figure 242: Tx Planning/Sequencing Screen All planned transactions sequenced into a Phase 1, Phase 2, etc. and with all sub-phases associated with numbered phases has full functionality of Next Appt., Complete and Delete check boxes. The Add Non-VA Care Phase button allows only one Non-VA Care phase to be added. The Non-VA Care phase will be listed below the Unsequenced Treatment and above Phase 1. Users may add an unlimited number of sub-phases in a Non-VA Care phase. When trying to add a second Non-VA Care phase a warning message appears stating that only one Non-VA Care phase may be added. The Next Appt. and Complete check boxes for the Non-VA Care phase are inactive; if selected, an informational screen appears stating these check boxes may NOT be used in the Non-VA Care phase. The Delete check box remains active for the Non-VA Care phase and all of Non-VA Care sub-phases. Note: The DRM Plus user should delete a planned Non-VA Care phase, sub-phases and transactions after receiving verification from the Non-VA Care provider that the procedure(s) has/have been completed. May 2018 DRM Plus Administrator Manual v6.9 186 The two buttons of Copy Non-VA Care Phase to Clipboard and the Copy All to Clipboard when selected will allow the user to copy the planned transactions listed in the Tx Planning/Sequencing screen. The copied data includes filed and unfiled planned treatment from only the Tx Planning/Sequencing screen to paste on any word document, text document or any application window if allowed. The end-user may use the key now in the Additional Dental Treatment Plan Notes to import a date/time stamp identifier before or after the text entry if desired. Plan a Treatment Sequence 1. Click the Seq Plan (Sequencing) button. 2. The Tx Planning/Sequencing screen displays. 3. Information from the Treatment Plan transaction table is shown on the screen. Use the Add Phase, Add Sub-phase or Add Non-VA Care Phase buttons to add a new phase and/or subphase. Highlight the desired phase listed in the screen to add the sub-phase under this phase. 4. Change the sequence of the planned treatments by dragging and dropping them into the correct phase. 5. If the planned treatment is to be completed at the next appointment, click the corresponding check box. Non-VA Care phase is NOT allowed a next appointment. 6. Add Additional Dental Treatment Plan Notes in the text box. 7. Click the Save & Exit button if only planned items have been added or sequenced for this patient. This option requires that NO new data be entered as completed transactions, Perio, H&N or any other modal at the same time for the option to work. 8. Click the Save button to save the progress in sequencing and keep working on this encounter. Note: Always enter planned treatment in the same order they are performed on a patient. Note: The Save & Exit button from the sequencing screen files any changes and minimize DRM Plus. Any new planned entries added have the same Visit date as the latest TIU progress note filed on this patient. The most recent dental encounter must have an Active status for this feature to work. Complete a Planned Treatment in the Sequencing Screen 1. Click the Seq Plan (Sequencing) button. 2. The Tx Planning/Sequencing screen displays. 3. Choose the planned treatment that is to be completed by checking the corresponding check box in the Complete column. Non-VA Care phase is NOT allowed to be completed in the Tx Planning/ Sequencing screen. 4. Click the Save button. 5. The Diagnosis Code screen displays. Please see the Completing a Treatment Plan portion in the Treatment Plan section of this chapter for further information. May 2018 DRM Plus Administrator Manual v6.9 187 Deleting a Planned Treatment in the Sequencing Screen 1. Click the Seq Plan (Sequencing) button. 2. The Tx Planning/Sequencing screen displays. 3. Choose the planned treatment that is to be deleted by checking the corresponding check box in the Delete column. The DRM Plus user should delete a planned Non-VA Care phase, sub-phases and transactions after receiving verification from the Non-VA Care provider that the procedure(s) has/have been completed. 4. Click the Save button. 5. The planned treatment is deleted from the sequencing screen, the transaction table and the graphical chart on the Treatment Plan screen. Chart Hx (History) Button Click the Chart Hx button to see a completed care chart of the patient’s dental history. The transaction table includes the text details of the Visit Date, Stat, Category, Tooth/Quadrant, Surface/Root modifiers, Codes, CPT Description and Provider initials. Figure 243: Tx History Screen Use the Appointments drop-down menu to see the patient’s history by different appointment dates. View tooth notes on the patient’s file by clicking the Notes button tied to the note’s appointment date. May 2018 DRM Plus Administrator Manual v6.9 188 Note: To display any past tooth-specific note, click the Chart Hx button. Continue by clicking the dropdown arrow of the Appointment field, in the top left corner of the Tx History screen, and selecting the appropriate date the tooth-specific note was entered. Once the date is selected, the tooth numbers in the graph displays in yellow. Once the desired tooth is found, click the Notes button. Then use the drop-down arrow to select the tooth-specific note of interest and view its contents. Summary Button Click the Summary button to view a summary of a patient’s chart. Periodontal information displays in the summary as well. Figure 244: Tooth/Quadrant Summary Screen Use the tools on the screen to view the information by quadrant or by tooth. May 2018 DRM Plus Administrator Manual v6.9 189 Note: On the Treatment & Exam screen, with the following views: Diagnostic Findings, Treatment Plan or Completed Care, clicking the Summary button displays the history of the selected primary view. The upper half of the window shows the summary of the primary view that is active when the Summary button is selected. Only the activated primary view, with all of its entries, displays in the restorative top window. The lower half of the screen displays the periodontal summary, which includes the latest exam in periodontal history with filed Diagnostic Findings and Completed Care; however, NOT including surfaces or roots. H&N Button Use the functions in the H&N (Head and Neck) button to enter and view diagnostic information on the patient’s head and neck. Figure 245: Head and Neck Findings Screen To enter an H&N finding: 1. Select the graphic shape that best represents the finding by using the Shape drop-down menu. 2. Select the contrasting color for the finding by clicking the Color box. A visual list of possible colors displays. 3. Select the size of the graphic by using the Size drop-down menu. May 2018 DRM Plus Administrator Manual v6.9 190 4. The date box defaults to Today, which is required for new data entries. After the first filed TIU progress note entry of H&N, the date box defaults to All. The user may click the drop-down arrow and highlight a previous exam to view the entries on a previous date. 5. Click the graphic to show where the lesion is located on the patient. 6. The H&N Detail screen displays. Figure 246: H&N Detail Screen 7. Enter the description of the lesion in the Description column, or click the Common Findings button to see a list of commonly appearing lesions and add the description to the finding. 8. Click the Save button. The finding displays on the H&N Findings transaction table. May 2018 DRM Plus Administrator Manual v6.9 191 To add new details of an H&N finding: 1. Click the desired finding in the H&N Findings transaction table and click the Details button. 2. The H&N Detail screen displays with progress information to be entered. Figure 247: H&N Detail Screen with Progress Description 3. Enter information in the Description column of the Progress window. 4. Click the Save button to save the entered information and return to the H&N Findings screen. To delete a lesion: 1. Highlight the finding entry on the H&N Findings transaction table. 2. Click the Delete button. 3. A screen confirming that the entry is to be deleted displays. Click the OK button. Note that this screen only displays if the finding entry is made during this session. 4. The entry and the mark on the H&N Findings graphic is removed if entered this session. Note: Clicking the Delete button deletes the highlighted finding entry(s) during the same session the H&N Findings transaction was entered. Deleting any filed H&N Findings transaction by any DRM Plus end-user results in a line through the entry, and it remains in the transaction table. May 2018 DRM Plus Administrator Manual v6.9 192 PSR Button Click the PSR button to view the Periodontal Screening/Recording (PSR) screen. Use this screen to view previously entered PSR information if present, or to enter new PSR information. Figure 248: Periodontal Screening/Recording (PSR) Screen Use the Exam Date drop-down menu to view past periodontal screening information. To enter new information: 1. Click the New button. All the Sextant text boxes will default to a 0 dental value. 2. Enter the desired national dental value in each Sextant text box. Entering an “*” requires a number added with the symbol to be saved (i.e., “3*”). 3. Click the Definitions button to view PSR definitions of national dental values. 4. Click the OK button to complete. Note: The PSR modal allows two providers to enter a PSR exam on the same day; however, it only displays the last PSR exam that was filed on that day. The first entered/filed PSR exam is only viewable in the TIU progress note of the provider that filed the encounter. The second provider’s filed note has a different header, which includes the word ‘modified’ in the PSR exam of the TIU progress note. May 2018 DRM Plus Administrator Manual v6.9 193 OHA (Oral Health Assessment) Button The specialty Plaque button was combined with Xerostomia, Caries Risk and Oral Hygiene to create the OHA button. This also applies to the Plaque button on the Periodontal Chart screen. To enter new data in the Oral Health Assessment (OHA) screen, click the New button. Today’s date is imported into the Date field on the screen. Figure 249: Oral Health Assessment (OHA) Screen The NFT check box, Patient has no remaining functional teeth, roots or implants; may be selected in the event the patient meets these criteria and no findings can be entered in the Diagnostic Findings chart. Checking this box automatically completes the Diagnostic Findings element and the Periodontal Assessment element when filing any exam/consult code during a dental encounter. It also automatically selects the 0-Edentulous radio button in the Caries Risk section. The radio buttons default to 4 – Not Recorded in all four fields. This selection does NOT import any clinical finding into the TIU progress note, nor does it display in the transaction table of the OHA screen. The provider has the option of selecting the appropriate radio button (0-3) for each of Plaque Index, Xerostomia, Caries Risk and Oral Hygiene, or simply leaving the default setting. The entry of date, provider’s initials and each field value entered is captured in the transaction table at the bottom of the screen. The provider has to enter at least one value (between 0-3) in one of the four fields to save and file an oral health assessment. May 2018 DRM Plus Administrator Manual v6.9 194 The Definitions button has the American Dental Association definitions for field values when entering Plaque Index, Xerostomia Risk and Caries Risk. The rest of the Xerostomia and Caries Risk definitions may be viewed using the scroll bar on the right side of the screen. Figure 250: OHA Definitions Displaying Plaque Index/Xerostomia The OHA (Oral Health Assessment) Definitions Panel is displayed in the previous screen. The Definitions Panel may be automatically expanded due to the parameter selection that is defaulted when first loaded. The user may change this parameter by navigating to Tools menu User Options submenu Exam Settings tab uncheck the Requirements. At the bottom of the OHA definitions panel the VA Dental Definitions hyperlink takes the provider to the VA dental website to view current OHA definitions. This hyperlink should be changed by the DRM Plus Administrator when instructed to do so by the VA Dental Informatics and Analytics Director. Note: If NOT immediately directed to the website when selecting the hyperlink, please notify the Help Desk. Note: The Plaque Index definitions have been reprogrammed and only allow whole number entries. Most Plaque Index values filed before the loading of the exam template patch retain the decimal value, if entered with one, and is located in the PI column of the OHA transaction table. May 2018 DRM Plus Administrator Manual v6.9 195 TMJ Button The TMJ modal functions similar to the OHA modal when entering a new exam. Click the New button and today’s date imports into the Date field. At least one entry in either the History or Clinical Findings sections from this TMJ screen requires data to be selected in order to save. Selecting the second History radio button, Patient reports symptoms associated with TMJ’s; allows multiple check box selections and at least one is required for this option to save. The text windows below the Other check box in History or Clinical Findings only opens if the check box has been selected and each requires a text entry. The Other text boxes allow an unlimited text field. Figure 251: TMJ Screen The Clinical Findings section has three numerical fields to enter a millimeter value and four drop-down menu options in selecting popping/clicking, crepitus, pain to manipulation, and deviation upon opening. The Other check box allows an unlimited text field for additional text information if selected. May 2018 DRM Plus Administrator Manual v6.9 196 The minimum requirement to enter a new TMJ finding is the selection of only one historical or clinical finding from this screen. Occl (Occlusion) Button The Occl (Occlusion) button functions are different from the other modals when entering a new occlusion finding. Click the New button and today’s date imports into the Date field. When there is previous filed data present then all that filed data imports into the new exam. The user needs to add/delete any new occlusion findings and click the OK button to save. Figure 252: Occlusion Screen The Clinical Findings drop-down menu option Mandibular relationship* is the only required (*) field on this screen. The six other drop-down menu options and the two numerical box selections are optional entries. May 2018 DRM Plus Administrator Manual v6.9 197 The Definitions Panel displays the Angle’s Classification definitions. These angle’s classifications are for the selections displayed in the left bottom four drop-down menus. The Definitions Panel maybe reduced to display only the Occlusion screen by selecting the Definitions button. Figure 253: Occlusion Angle’s Classification Definitions The Definitions Panel may be expanded due to the parameter selection that is defaulted when first loaded. The user may change this parameter by going to the Tools menu User Options submenu Exam Settings tab uncheck the Requirements. At the bottom of the occlusion Definitions Panel, the VA Dental Definitions hyperlink takes the provider to the VA dental website to view current occlusion definitions. This hyperlink should be changed by the DRM Plus Administrator when instructed to do so by the VA Dental Informatics and Analytics Director. Note: If NOT immediately directed to the website when selecting the hyperlink, please notify the Help Desk. May 2018 DRM Plus Administrator Manual v6.9 198 Habits (Parafunctional) Button The Habits (Parafunctional) modal functions similar to the OHA modal when entering a new exam. Click the New button and today’s date imports into the Date field. The History and Clinical Findings fields each have two radio buttons for selection. When the second radio button is selected in each field, multiple options become active for selection. The Other check box allows an unlimited text field for additional text information. The minimum requirement to enter a new parafunctional habit finding is to select only one historical or clinical finding from the Parafunctional Habits screen. Figure 254: Parafunctional Habits Screen May 2018 DRM Plus Administrator Manual v6.9 199 Social Hx (Social History) Button The Social History modal functions similar to the OHA modal when entering a new exam. Click the New button and today’s date imports into the Date field. The minimum requirement is the selection of one of the two History radio buttons. When selecting the second radio button then at least one check box option is required to save the new historical data. Any combination of check boxes maybe selected for Present/Past. The tobacco and alcohol drop-down options are per day, per week, per month, and per year except for cigarettes. Cigarettes have only the dropdown options of pack year history, per day, and per week. The text box with the Drug Abuse selection is optional when one of the check boxes is selected. The bottom text box is optional and allows an unlimited text field of formation if selected to enter data about eating disorders, dietary concerns, piercings, etc. Figure 255: Social Hx (History) Screen Note: All entries made into the Social History, OHA, Occlusion, Parafunctional Habits and TMJ modals NOT filed are cleared by selecting the Cancel button. May 2018 DRM Plus Administrator Manual v6.9 200 Multiple Filings to Same Modal on Same Day The following occurs when any modal has multiple filed findings and/or history during the same day on the same patient's chart; subsequent filings may be changed/edited or remain the same as the previous filing. The last modal filing during one calendar day is the only record present from the date drop-down menu of that modal screen. The TIU progress notes filed that day will have the record of the modal data entered that session/encounter. The first provider (HYG) may file findings in the OHA modal and that data displays in the screen for every other user of DRM Plus to review. Figure 256: Provider HYG Filed OHA Data First Today May 2018 DRM Plus Administrator Manual v6.9 201 If the second provider (ADMIN) changes/edits the filed OHA findings from the first provider (HYG) on the same calendar day; modifies the findings in the OHA modal. The modified OHA findings filed by the second provider will be the data viewed by the local clinical providers in the patient’s OHA screen. Figure 257: Provider ADMIN Edited and Second Filed OHA Data Today Note: The first provider’s OHA findings are only present in their filed TIU progress note. Note: The OHA and H&N modals are the only screens that displays the date and the provider’s initials filed with the findings and/or history data. May 2018 DRM Plus Administrator Manual v6.9 202 Chart/Treatment – Periodontal Chart Enter periodontal information on the patient from the Periodontal Chart screen, within the Chart/ Treatment tab. Figure 258: Periodontal Chart Screen The upper left side of the screen shows the History, Compare, Summary, H&N, PSR, Stats, OHA and Notes buttons. The top center of the screen displays various periodontal condition-specific icons. Use these to mark periodontal findings on the patient’s chart. Use the options on the upper-right side of the screen to adjust the view of the tooth/arch graphic. The center of the screen features the tooth/arch graphic. Clicking various areas in combination with the condition-specific icons located in the top center of the screen enters information into the patient’s chart. The bottom of the screen shows text (only a quadrant is viewable depending where the cursor shield is located) of the periodontal information entered using the graphic and the condition-specific icons in the top center of the screen. Note: The Periodontal Chart screen allows two providers to enter perio data on the same day. However, it only displays the last perio data that was filed on that day. The first entered perio data is only viewable in the TIU progress note of the provider that filed the first encounter. May 2018 DRM Plus Administrator Manual v6.9 203 History and Compare Buttons Clicking the History or Compare buttons display similar perio screens. Use the Compare function to compare two periodontal charts that have been filed previously to the patient’s chart. Figure 259: Periodontal History/Compare Screen – Compare Viewable The information is color-coded. The data from the earlier date is displayed in red, while the data from the later date is displayed in blue. Use the drop-down menus to change the dates. May 2018 DRM Plus Administrator Manual v6.9 204 Click the History button to view a graphic of the patient’s history. Figure 260: Periodontal History/Compare Screen - History Viewable Use the drop-down menu to change the date. Use the Notes button to view previously entered notes concerning the patient’s periodontal history. Summary Button See the Summary Button section in the Chart/Treatment – Treatment & Exam chapter of this manual. H&N Button See the H&N Button section in the Chart/Treatment – Treatment & Exam chapter of this manual. PSR Button See the PSR Button section in the Chart/Treatment – Treatment & Exam chapter of this manual. May 2018 DRM Plus Administrator Manual v6.9 205 Stats Button Use the Stats function to view the patient’s total number of periodontal warning levels. Figure 261: Periodontal Statistics Screen OHA (Oral Health Assessment) Button See the OHA Button section in the Chart/Treatment – Treatment & Exam chapter of this manual. May 2018 DRM Plus Administrator Manual v6.9 206 Notes Button Use the Notes button to enter general patient notes or tooth specific notes into the chart. Figure 262: Notes Screen Choose between creating a more general note on the patient by using the tools on the left side of the screen, or a note about a specific tooth on the right side of the screen. To create a new note, click the New Entry button. To view all general patient notes in the patient’s chart, click the Show All button. To make an entry about a specific tooth, use the drop-down menu on the right side of the screen to select a tooth before making a new entry. To view any tooth-specific note that has been entered during the past year into the patient’s chart, click the History button. View the note by clicking the selected history’s Notes button, according to the appropriate visit date. Note that this is the same screen that displays if the Notes icon is clicked on the Treatment & Exam screen. May 2018 DRM Plus Administrator Manual v6.9 207 Entering Periodontal Information The condition-specific icons in the top center of the screen works in combination with the tooth/arch graphic. Figure 263: Periodontal Condition-Specific Icons and Periodontal Graphical Chart To enter periodontal information: 1. Click the desired condition-specific icon (Pocket, FGM, Bleeding, Mobility, etc.). 2. On the graphic, the cursor shield is the graphical pocket location for perio data entry. 3. Click the desired number below the list of condition icons (if applicable). Bleeding, Delayed Bleeding and Suppuration do NOT require any clicks on a number. 4. Use the buttons on the top right of the screen to view different areas of the tooth/arch, or to change the view. 5. The condition and location displays on the graphic and on the transaction table below the graphic. The transaction table only displays a quadrant of the upper/lower arch. Note: Only one periodontal chart exam should be completed per day, per patient. When a second exam is completed during the same day, the periodontal chart history only saves the second exam. TIU progress notes in VistA still have all the data entered. May 2018 DRM Plus Administrator Manual v6.9 208 Other Tools The last line of buttons in the top center of the screen features several tools. Key button Undo button nine actions performed. Keyboard Mode button Advance button arrow. Back button displays keyboard shortcuts. removes the last action performed on the screen. This action is limited to the last switches the program to keyboard mode. moves the cursor shield on the graphic forward due to the direction of the moves the cursor shield on the graphic back due to the direction of the arrow. Direction button shows the direction the cursor shield moves on the graphic. The direction of advancement depends on the orientation of this button. Auto Advance button when the button is active, the cursor shield automatically moves in the way designated for the perio exam entry of the condition-specific icons. It does NOT allow Bleeding, Delayed Bleeding or Suppuration, to automatically move. The auto exam sequence is a parameter adjustment that may be redesigned by each provider. For more information, please see the Treatment & Exam/Show Configuration/Periodontal section of the Using the DRM Plus Drop-Down Menus chapter of this manual. May 2018 DRM Plus Administrator Manual v6.9 209 Exam Providers have the ability to file required data using a national standard exam style format for each exam/ consult code (D0120, D0140, D0150, D0160, D0170, D0180 and D9310) in conjunction with the Exam tab in DRM Plus. Mandatory elements for each exam/consult code and requirements for each element are based on the user’s exam/consult code selection. Initially, each element is marked with required or optional icon. The Exam tab interfaces automatically with existing DRM Plus modals (i.e. Head & Neck) for easy data entry. The Exam tab, when activated, generates a TIU progress note associated with a specific visit containing the entire exam or consult’s required information, along with other DRM Plus note objects (i.e. dental alerts, etc.). To proceed to the Exam tab, the user is prompted to select one of the six exam or consult procedure codes from the Chart/Treatment tab’s Completed Care screen. Figure 264: Exam Tab Message Entering the exam/consult procedure activates the Exam tab and displays the procedure in the Exam Type drop-down menu. One way to change the exam/consult procedure after selecting it and determining it was incorrect is to use the drop-down menu located on the Exam tab. Another way to change the exam/consult procedure is by deleting the procedure from the Completed Care screen and entering a new one. Selecting the exam/consult code from the Completed Care screen triggers all of the elements on the Exam tab with a required icon or optional icon. When these elements are satisfied, a completed icon displays. Some elements automatically pull data from the modals when entered from the Chart/ Treatment tab. Note: Users may enter additional optional information in each element, if desired, for the selected exam/ consult code. In the following example, the D0150, comprehensive exam, was selected from the Treatment & Exam/ Completed Care screen. Upon selecting the Exam tab, D0150 Comprehensive displays in the Exam Type drop-down menu. Twelve of the sixteen elements require data entry by the provider when selecting the D0150, comprehensive exam. May 2018 DRM Plus Administrator Manual v6.9 210 Figure 265: Exam Tab The seven exam/consult codes each have a different set of required and optional elements activated when selecting a specific code. The dialogue found in each element section that follows are those that would display if the user selected D0150, comprehensive exam, during a session. The Back button located on the Exam tab screen returns the end-user to the Chart/Treatment tab. The Next button located on the Exam tab allows the end-user to proceed to the Filing Options screen, which is the next screen when completing the encounter. This Next button also opens any required element if that element has NOT been completed. The Back/Next buttons located on each element screen only move backward or forward to other element screens. The buttons allow the provider to move to the next required element for this exam type depending on the parameter the user selected. Usage of the Back button is NOT dependent on the element’s completion. Note: The icon on the right of the element button displays when there was previously filed data on the same day and that data is associated with the element it is displayed on. May 2018 DRM Plus Administrator Manual v6.9 211 Exam Elements Presentation/Chief Complaint Element The Presentation/Chief Complaint element is required for all seven exam/consult procedure codes and defaults open when the Exam tab is selected. The presentation of the exam/consult code is automatically imported and displayed at the top of the element. This element requires one of the two radio buttons to be selected. The selection of the second radio button, Patient presents with dental complaint(s) opens two text boxes which require a text entry only in the first text box intended for the dental complaint of the patient. The second text box (optional text entry) allows data entry for the history of the patient’s present illness. Figure 266: Presentation/Chief Complaint Element Screen The following information is the same with all sixteen elements except the Presentation/Chief Complaint does NOT have a Back button, and Disposition does NOT have a Next button. Additional Annotations is a free text window, which allows the provider to enter additional information about the patient’s chief complaint. It offers right-click functionality for importing .txt files, if desired. Annotations is view-only, and captures everything entered into this element. Select the OK button to save all required information entered and close the element, or click the Next button to move to the next required element, depending on the selected parameter. May 2018 DRM Plus Administrator Manual v6.9 212 Vitals Elements The Vitals element is required for all seven exam/consult procedures. This element requires one of the two radio buttons to be selected. The second radio button, Vital signs obtained, defaults to vitals that have been entered, using the Enter Vitals screen, during 24 hours of the visit date. The Visit/Date for this encounter also must be entered in the banner for this feature to work. Entering the Visit/Date should be the first action taken when opening any patient’s chart for a new encounter. Figure 267: Vitals Element Screen If no vitals have been entered using the Enter Vitals screen, the information can be entered manually; however, no date is attached to these entries. Dental Pain is the only required vital sign. To enter vitals, first select the scheduled appointment or visit and then select the Vitals button located on the DRM Plus banner. The user can also click the Enter Vitals button in the lower left portion of the Vitals element screen. Specific vitals information can be entered into the Additional Annotations free text window. Right-click this window to import text files, if desired. All information entered into the Vitals element appear in the read-only Annotations window. Once the element is complete, click the Next button to move to the next element, or the OK button to close the element. The Back button moves to the previous required element, depending on the selected parameter, and is NOT dependent on the element’s completion. Note: The only vital sign, Dental Pain, may be saved as unfiled data for this element. May 2018 DRM Plus Administrator Manual v6.9 213 PMH (Past Medical History) and Medications Element The PMH element is required for all seven exam/consult procedures. This element requires one of the three radio buttons to be selected. The selection of the first radio button opens an optional text box to enter additional information if the patient is new to the clinic. The selection of the third radio button opens a required text box to enter any significant changes noted since the last dental visit. The eight positive/negative check box conditions, one free text positive condition or the five Imports check boxes are optional entries of patient information for this element. The user may select one import such as the patient’s medications or use the Select ALL Imports button to import all four previously filed medical histories about the patient which are being stored in a VistA database. Figure 268: PMH and Medications Element Screen Additional Annotations is a free text window, which allows the provider to enter additional information about the patient’s past medical history. It offers right-click functionality of import text files, if desired. Annotations is view-only, and captures everything entered into this element. Once the element is complete, click the Next button to move to the next element, or the OK button to close the element. The Back button moves to the previous required element, depending on the selected parameter, and is NOT dependent on the element’s completion. May 2018 DRM Plus Administrator Manual v6.9 214 Social History Element The Social History element is required for the D0150 and D0180 exams. This element requires new social history findings entered with the Social History screen when completing one of the two required exams. The Social History screen may be opened with the specialty button located on the Chart/Treatment tab, or by the Social History button located in the lower left corner of this screen. The minimum requirement to enter a new social history entry is to select at least one historical finding from the Social History screen. Figure 269: Social History Element Screen Additional information regarding the patient can be entered into the Additional Annotations window. Right-click in this window to import text files, if desired. All information added to this element displays in the read-only Annotations window. Once this element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 215 H&N (Head and Neck) Findings Element The H&N Findings element is required for the D0120, D0150 and D0180 exams. This element requires a new H&N finding or historical entry using the H&N Findings screen. This element imports data entered from the H&N Findings screen. The Screening Negative button on this element’s screen allows a new screening negative entry directly into the element and import it into the H&N Findings screen for the patient’s permanent record. Figure 270: H&N Findings Element Screen The H&N Findings screen can be accessed by either clicking the specialty button from the Chart/ Treatment tab, or clicking the H&N Findings button in the left bottom corner of this element. Once the H&N findings are added to this element, additional information regarding the patient can be entered in the Additional Annotations free text window. Right-click this window to import text files, if desired. All information entered into this element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 216 Radiographic Findings Element The Radiographic Findings element is required for the D0150 and D0180 exams. The radiographic element requires at least one selected check box from the top six options. The provider may select any combination of the top six check boxes for the patient’s TIU progress note. The fourth check box down the left column requires some data entry in the text box or at least one per-defined statement to satisfy the requirements. The Exams Settings tab located using the Tools menu User Options submenu Exam Settings tab Configure Radiographs Requirement parameter that allows each user to require a radiographic finding for all exam/consult codes with mandatory entries in the Exam tab. Figure 271: Radiographic Findings Element Screen Up to twelve pre-defined statements on radiographic findings can be selected from this screen. The check boxes found in the pre-defined statements window have three national radiographic findings statements preloaded; however, all twelve statements can be created locally. The DRM Administrator has priority over all other users and may add or delete all twelve, if desired. Additional information regarding the patient can be added in the Additional Annotations free text window. The user can right-click to import a text file, if desired. All information entered into this element displays in the Annotations read-only window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 217 Diagnostic Findings Element The Diagnostic Findings element is required for all seven exam/consult procedures. All exam/consult codes are required as appropriate for new and updated findings. The second check box only displays after data is entered from at least one Chart/Treatment findings screen that satisfies this option. Informational screens advise the user of any missing requirements for a specific exam code. The NFT, no functional teeth, check box when selected in the OHA screen, bypasses all requirements in this element for all exam/consult procedures. The OHA screen may be opened from the Chart/Treatment tab or by selecting the OHA button in the lower left area of this screen. D0120: Requires a Plaque Index entry from the OHA screen. Also requires the selection of a Mobility radio button, as it pertains to the patient. D0150: Requires at least one entry from the Diagnostic Findings screen or the first check box of no apparent pathology selected. Requires a Plaque Index entry from the OHA screen. Also requires the selection of a Mobility radio button, as it pertains to the patient. D0180: Requires an Oral Hygiene entry from the OHA screen. Figure 272: Diagnostic Findings Element Screen The user can enter any additional information regarding the patient into the Additional Annotations free text window. Right-click this window to import a text file, if desired. All information entered into this element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 218 Periodontal Assessment Element The Periodontal Assessment element is required for the D0120, D0150 and D0180 exams. The D0120 and D0150 exams required at least one selection from the Periodontal General Assessment section. The Detailed Assessment button allows the user to enter additional perio data; however, this is optional for the D0120 and D0150 exam codes. The Include Last Perio Chart check box defaults as unchecked if the provider wants to import the last filed periodontal chart into this element. The Include Last Perio Chart check box, when selected, satisfies the requirements for this Periodontal Assessment element for the D0140, D0160, D0170, and D9310 procedures. When any new perio data has been added to the perio chart during this session, that data imports into this element and satisfies the same four exam/consult procedures as stated previously. The NFT, no functional teeth, check box when selected in the OHA screen, bypasses all requirements for the D0120, D0150 or D0180 exams in the periodontal element. The user may access the Periodontal Chart screen, OHA screen or PSR screen using the buttons found on this Periodontal Assessment element screen. Figure 273: Periodontal Assessment Element Screen The D0180 exam requires one selection from the Periodontal General Assessment section as well. The Periodontal Detailed Assessment section is optional and has optional text boxes with each selection if more descriptive detail is needed. May 2018 DRM Plus Administrator Manual v6.9 219 The D0180 exam also requires the first four rows in the Additional Periodontal Detail section to have at least one selection. The Additional Periodontal Comments text box is optional in this section. When the Other check box is selected from the Past Periodontal Tx History options, data entry is required in the Additional Periodontal Comments text box. Figure 274: Periodontal Detailed Assessment Button Selected Note: The D0180 exam code does NOT allow the user to select the Brief Assessment button from this screen. Additional information regarding the patient may be entered into the Additional Annotations free text window. The user may right-click in this window to import a text file, if desired. All information entered into this element appears in the read-only Annotations window. Once this element is complete, click the Next button to move on to the next element. The provider may open the OHA screen or the PSR screen using the buttons in the lower left area of this screen or the Chart/Treatment tab to enter an OHA finding or a PSR exam. The Periodontal Chart button on the middle right side of this screen allows access to that chart to enter any new findings for this session. May 2018 DRM Plus Administrator Manual v6.9 220 The following dialog displays the VA Office of Dentistry perio definitions when selecting the Definitions button. Figure 275: VA Dentistry Periodontal Definitions May 2018 DRM Plus Administrator Manual v6.9 221 Parafunctional Habits Element This element is optional for all seven exam/consult types. It imports all data entered in this session from the Parafunctional Habits screen, or simply is left blank. The Parafunctional Habits screen can be opened by clicking the Habits (Parafunctional) button from the Chart/Treatment tab, or by clicking the Parafunctional Habits button in the bottom left portion of this element. The minimum requirement to enter a new parafunctional habit finding is to select at least one history or one clinical finding from the Parafunctional Habits screen. Figure 276: Parafunctional Habits Element Screen Additional information regarding the patient may be entered into the Additional Annotations free text window. The user can right-click in this window to import a text file, if desired. All information entered into this element displays in the read-only Annotations window. Once this element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 222 TMJ Findings Element This element is required for the D0120, D0150 and D0180 exams. It requires new TMJ findings entered from the TMJ screen, which can be opened either by clicking the TMJ button from the Chart/ Treatment tab, or the TMJ Findings button located in the bottom left portion of this element. The minimum requirement to enter a new TMJ exam finding is to select at least one historical or clinical finding from the TMJ screen. Additional information regarding the patient can be entered into the Additional Annotations free text window. The user can right-click in this window to import a text file, if desired. Figure 277: TMJ Findings Element Screen All information entered in this element appears in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 223 Occlusal Findings Element The Occlusal Findings element is required for every D0150 and D0180 exams. Occlusal findings must be entered into, and imported from the Occlusion screen when completing one of these exams. The Occlusion screen can either be opened by clicking the Occl (Occlusion) button from the Chart/Treatment tab, or by clicking the Occlusal Findings button in the bottom left corner of this screen. From the Clinical Findings section, the Mandibular relationship* is the only required field. All data from the last filed occlusion exam imports into the screen with a new exam, which requires the provider to remove and/or add correct data for the new exam. Figure 278: Occlusal Findings Element Screen Enter additional information regarding the patient in the Additional Annotations free-text window, which offers right-click functionality to import text files, if desired. All information entered into this element displays in the read-only Annotations window. When the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 224 Salivary Flow Element The Salivary Flow element is optional for all seven exam/consult procedures. This element requires one of the two radio buttons to be selected when entering data. The second radio button; Clinically abnormal salivary quantity and/or quality noted, requires a statement to be entered in the text box. The Xerostomia value and description imports for viewing on this Salivary Flow element screen if entered from the OHA screen during this session. Figure 279: Salivary Flow Element Screen The user can enter additional information regarding the patient into the Additional Annotations free text window. This window offers right-click functionality to import text files, if desired. All information entered into the element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 225 Removable Prostheses Element The Removable Prostheses element is optional for all seven exam/consult types. This element requires one of the top three radio buttons to be selected when entering data. If the user selects the third radio button, Patient presents with removable prosthes(es), the user must then select one of either the Maxillary or Mandibular radio buttons: Partial or Complete. Only one is required and, once selected, it pens two more radio buttons: Satisfactory or Unsatisfactory. If the user selects Unsatisfactory, four check boxes (Occlusion, Retention, Stability and Esthetics) and a text box become active. The user needs to check any box pertaining to the patient, and note any additional prostheses in the text box. The Other Prostheses check box opens a required text box for any other prostheses that should be added to the TIU progress note for the patient. Figure 280: Removable Prostheses Element Screen The user may enter any additional information regarding the patient into the Additional Annotations text window. This window offers right-click functionality to import text files, if desired. All information entered into the element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 226 Assessment/Plan Element The Assessment/Plan element, comprised of an assessment and planned section, is required for all seven exam/consult procedures. The top assessment section is optional for the completion of this element. The Treatment Plan section requires one of the four check boxes or only one pre-defined statement to be selected to complete the element. The first check box, Include charted treatment plan, loads automatically and imports the patient’s newly entered and/or past planned treatment. Up to twelve pre-defined statements for the Assessment Summary and twelve Treatment Plan statements can be selected from this screen. The check boxes found in the pre-defined statement windows have three national assessment and three national planned statements pre-loaded; however, all twelve statements from either can be created locally. The DRM Administrator has priority over all other users and may add or delete all twelve, if desired. Figure 281: Assessment/Plan Element Screen The user may enter additional information regarding the patient into the Additional Annotations free text window. This window offers right-click functionality to import text files, if desired. All information entered into this element appears in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. Usage of the Back button is NOT dependent on the element’s completion. May 2018 DRM Plus Administrator Manual v6.9 227 Note: The Assessment/Plan element imports incomplete when it is saved as unfiled data and reloaded. The provider is required to review/edit this element again at this time. Patient Education Element The Patient Education element is optional for all seven exam/consult procedures. This element requires one of the two radio buttons to be selected when entering data. The selection of the second radio button opens a text box that requires specific information regarding the patient or one pre-defined statement may be selected. Up to twelve pre-defined statements on patient education can be selected from this screen. The check boxes found in the pre-defined statements window have two national patient education statements pre-loaded; however, all twelve statements can be created locally. The DRM Administrator has priority over all other users and may add or delete all twelve, if desired. Figure 282: Patient Education Element Screen The user may enter additional information regarding the patient into the Additional Annotations free text window. This window offers right-click functionality to import text files, if desired. All information entered into this element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. May 2018 DRM Plus Administrator Manual v6.9 228 Disposition Element The Disposition element is required for all seven exam/consult procedures. This element requires one of the two radio buttons to be selected when entering data. The selection of the second radio button, Next visit, requires at least one of the following; one selection of the eight date ranges, a text description about the next visit typed in the text box, or one selection from the pre-defined statements. The Next Appointment check boxes, if selected in the Tx Planning/Sequencing screen, import automatically into the Annotations view window of this element. Up to twelve pre-defined statements on disposition can be selected from this screen. The check boxes found in the pre-defined statements window have four national disposition statements pre-loaded; however, all twelve statements can be created locally. The DRM Administrator has priority over all other users and may add or delete all twelve, if desired. Figure 283: Disposition Element Screen The user may enter additional information regarding the patient into the Additional Annotations free text window. This window offers right-click functionality to import text files, if desired. All information entered into this element displays in the read-only Annotations window. Once the element is complete, click the Next button to move on to the next element. Usage of the Back button is NOT dependent on the element’s completion. May 2018 DRM Plus Administrator Manual v6.9 229 Import Previously Filed Data Screen When any provider has filed patient dental data previously that day in any of the following screens: Social History, OHA, TMJ, Parafunctional Habits, Occlusion, Diagnostic Findings, Head and Neck Findings, PSR or Periodontal Chart; then that data may be imported by a second provider entering an exam encounter that same day. The second provider, after selecting an exam code and then selecting the Exam tab, has the following Import Previously Filed Data screen display. This screen allows the provider an option to import the data into his exam template to satisfy some possible requirement from the exam code that they may have selected. Selecting the check boxes of any or all previously filed data that day imports that data into their present exam template session. There is a Check ALL the above check box at the bottom of the screen which allows all that day’s filed data to be imported into this new TIU progress note. After selecting the desired check boxes, the provider click the Import button to incorporate this data into the current exam template. If none of the data should be imported into the current exam template, then select the Cancel button. Figure 284: Import Previously Filed Data Screen The icon on the right of the element button displays when there was previously filed data the same day and that data is associated with the element. The Diagnostic Findings element informs the provider, by displaying the icon, there is one or any combination of diagnostic findings and periodontal charting filed earlier the same day by another provider. May 2018 DRM Plus Administrator Manual v6.9 230 Below the element icons located on the left side of the Exam tab, there is a Review Data Filed Today button. This button only displays when data was filed to the VistA database earlier that day by all providers working with this patient. This button allows the provider to open the Import Previously Filed Data screen to make edits or corrections by the present provider on what was filed previously that day. Note: The yellow asterisk icon will always display when vitals have been entered for this patient during a 24 hours range from the Visit date and taken anywhere in the hospital for this patient. May 2018 DRM Plus Administrator Manual v6.9 231 Completing the Encounter Click the Next button, located in the bottom right corner of both the Treatment & Exam and Periodontal Chart screens, to begin completing the encounter for the patient’s chart. If there was no provider/visit/date in the banner, imported or selected, when the patient’s chart was opened and NOT one completed transaction selected; then clicking the Next button brings up the Provider and Location for Current Activity screen to select/enter a visit. After selecting one procedure code the File Data Option screen displays, which is explained later in this chapter. In addition, if the system finds possible duplicate procedure codes in the planned and completed transactions, the Potential Duplicate Transaction screen displays. To complete the patient encounter with completed transactions: 1. Click the Next button on the bottom right corner of either the Treatment & Exam or Periodontal Chart screens. 2. The Filing Options screen displays. Figure 285: Filing Options Screen 3. Select the correct Filing Option. The information displayed in the Visit Date/Time and the Disposition defaults can be changed. The Encounter Dental Class defaults if saved on the cover page. Select the Suggested Recare Date if applicable to the patient. 4. Select the Primary PCE Diagnosis for the encounter, unless there is only one no matter how many transactions there are which defaults checked. 5. Provider may select the diagnosis to be sent to the patient’s problem list. May 2018 DRM Plus Administrator Manual v6.9 232 6. Enter the locally required information for service connection. 7. Enter the optional information of Additional Providers or Additional Signers on this screen. Please see the Additional Providers/Additional Signers section, found later in this chapter, for more information. 8. Select the appropriate facility (station) by clicking the appropriate radio button. 9. Click the Next button. 10. The Dental Class Discrepancy screen may display, if the encounter dental class and cover page dental class do NOT match. This does NOT stop the user from completing the encounter. 11. The Set Progress Note Title screen displays. Note that this screen does NOT display if the File Data with a Note Addendum or File Data Without a Note options were selected from the filing options. Figure 286: Set Progress Note Title Screen 12. Search for the title using the Progress Note Title search box, or use the scroll bar to select the desired title from the list. Default TIU progress note titles at the top of the list are set in the CPRS Tools menu Options submenu Notes tab Document Titles button. 13. Click the OK button. 14. The progress note screen displays. May 2018 DRM Plus Administrator Manual v6.9 233 Figure 287: Progress Note Screen 15. Ensure the information on the screen is correct. Enter the electronic signature and click the Finish button. An electronic signature is NOT required to file the note as unsigned. Please see the Electronic Signature section, found later in this chapter, for more information. 16. The Change Provider screen displays. Figure 288: Change Provider Screen 17. Click the Yes button to change the provider. The Search for Provider screen displays. If No is selected, a screen displays. Please see step 19. May 2018 DRM Plus Administrator Manual v6.9 234 Figure 289: Search for Provider Screen 18. Enter the search information and press the key. Select the provider from the list and click the OK button. 19. An informational screen displays stating that the encounter record has been created. Figure 290: Dental Encounter Record Created 20. Click the OK button. The DRM Plus screen minimizes, and the CPRS main screen remains open, unless it has timed out. May 2018 DRM Plus Administrator Manual v6.9 235 Potential Duplicate Transactions Screen If the system detects that a possible duplicate transaction exists, the Potential Duplicate Transactions screen displays, when the Next button on the Treatment & Exam or Periodontal Chart screens is clicked. Figure 291: Potential Duplicate Transactions! Screen A list of planned transactions for a tooth, along with the procedure code and the description, are listed in the top portion of the screen. Completed transactions taken during this encounter are listed in the bottom portion of the screen, with elements that match other planned transactions for the same tooth. The radio buttons on the lower left portion of the screen designate which information is kept or discarded. The Keep Planned radio button keeps the planned transaction and deletes the conflicting completed transaction entered during the encounter. The Keep Completed radio button keeps the completed transaction entered during this encounter and deletes the planned transaction. The Let Me Decide radio button clears all check boxes and allows for picking and choosing among the planned and completed transactions. Keep All allows all conflicting procedure codes that are planned and completed to be processed. After clicking the desired radio button and selecting, if necessary, which transactions are kept and/or discarded, click the Process and Go Back, Cancel or Process and Continue buttons to continue completing the encounter. Process and Go Back processes the procedure codes and returns to the Treatment & Exam or Periodontal Chart screen. Cancel displays the Periodontal Chart or Treatment & Exam screen without processing any information. Process and Continue processes the procedure codes and continues updating the TIU progress note. The Filing Options screen displays. Continue completing the encounter from this point, as outlined previously in this chapter. May 2018 DRM Plus Administrator Manual v6.9 236 Note: The system does NOT present a user with the Potential Duplicate Transactions screen when the potential duplicate is a tooth-related radiographic procedure. File Data Option Screen If no procedure code has been entered as completed treatment on the Completed Care screen and the user clicks the Next button, the Provider and Locations for Current Activities screen displays if no visit is present in the banner. When the visit is present or after one has been selected then the File Data Option screen displays. Figure 292: File Data Option Screen Click the appropriate radio button to designate whether the data is to be filed to PCE/DES with a procedure code, or to file to DES-Only data. File to PCE/DES with Code To file data to PCE/DES with a procedure code: 1. The Provider and Location for Current Activities screen displays. Select the correct visit. 2. Click the File to PCE/DES with code radio button on the File Data Option screen. 3. The program defaults to D4999 if entering this screen from the Periodontal Chart, and D9999 if entering from Treatment & Exam. 4. If the default procedure code is incorrect, click the code drop-down menu and select the desired procedure code. 5. Click the OK button. 6. The Diagnosis Code screen displays. 7. Select the procedure code on the left side of the screen (default is all selected) and the diagnosis code(s) on the right side. If the correct diagnosis code does NOT appear, use the Additional Diagnosis Code Search to find a different diagnosis code. May 2018 DRM Plus Administrator Manual v6.9 237 File to DES-Only Data To file to DES-Only data: 1. The Provider and Location for Current Activities screen displays. Select the correct visit. 2. Click the File to DES-Only Data radio button. 3. If a procedure code is desired (NOT required), check the Add code check box and use the dropdown menu to select a procedure code. 4. The Diagnosis Code screen displays. 5. Select the procedure code on the left side of the screen (default is all selected) and the diagnosis code(s) on the right side. If the correct diagnosis code does NOT appear, use the Additional Diagnosis Code Search to find a different diagnosis code. Filing Options Screen The Filing Options screen is divided into ten main sections: Filing Options, Visit Date/Time, Encounter Dental Class, Disposition, Suggested Recare Date, Primary PCE Diagnosis & Send DX to CPRS Problem List, Service Connection, Additional Providers, Additional Signers and Station. Filing Options Use the Filing Options radio buttons to choose how the encounter is to be filed. Figure 293: Filing Options The options are: File to Data with a Note, File Data With a Note Addendum and File Data Without a Note. The File Data Without a Note creates no TIU progress note. Visit Date/Time Adjust the Visit Date/Time using this function. The program defaults to whatever was entered on the Provider and Location for Current Activities screen. Figure 294: Visit Date/Time To change the visit date and time: 1. Click the Ellipsis (...) button. 2. The Provider and Location for Current Activities screen displays. May 2018 DRM Plus Administrator Manual v6.9 238 3. Choose the correct provider and appointment from the Provider and Location for Current Activities screen and click the OK button. Please see the Dental Encounter Data section in the Using DRM Plus Drop-Down Menus chapter of this manual, for further information. Encounter Dental Class Use the drop-down menu to change the Encounter Dental Class for this encounter. Figure 295: Encounter Dental Class Disposition Use the radio buttons to change the patient’s Disposition or case management status. Figure 296: Disposition Suggested Recare Date Use the Ellipsis (...) button to add/change the suggested recare date. Figure 297: Suggested Recare Date Click the Ellipsis (...) button to open the Select Date screen. Figure 298: Select Date Screen May 2018 DRM Plus Administrator Manual v6.9 239 Select the date from the calendar or select the number of additional months from the date selected first on the calendar and then click the OK button. Primary PCE Diagnosis & Send Dx to CPRS Problem List This window features a list of the diagnosis codes with descriptions, selections to send diagnosis to CPRS problem list, procedure codes with descriptions, and additional information. Select the primary PCE diagnosis by clicking the check box under the Select column in the Primary PCE Diagnosis window. If there is only one diagnosis, or several of the exact same diagnosis, the selection is checked by default. All encounters require only one primary diagnosis filed to VistA PCE. Select diagnoses to Send Dx to CPRS Problem List by clicking the check box in that column. Figure 299: Primary PCE Diagnosis Window The Primary PCE Diagnosis window allows one completed transaction at a time to be deleted when using the Delete Highlighted Transaction button. First highlight the completed transaction that should be deleted and then select the Delete Highlighted Transaction button located in the upper right corner of the window. Figure 300: Transaction Deletion Screen The resulting pop-up will display asking are sure you want to proceed. Selecting the Yes button will delete that completed transaction. Service Connection Use the check boxes to denote service connection, if applicable. Figure 301: Service Connection May 2018 DRM Plus Administrator Manual v6.9 240 Additional Providers/Additional Signers Add or remove providers from this patient encounter by using the tools in this area. Figure 302: Additional Providers/Additional Signers To add a provider or signer: 1. Click the Add button. 2. The Search for Provider or the Search for Signer screen displays. Figure 303: Search for Provider Screen 3. Enter the name into the text box and press . 4. Select the correct name from the results and click the OK button. 5. The provider displays on the Additional Provider/Signer window. Repeat as necessary. To remove a Provider/Signer: 1. 2. 3. 4. Highlight the provider or signer name. Click the Remove button. A confirmation screen displays. Click the Yes button. The name is removed from the Additional Provider/Signer window. May 2018 DRM Plus Administrator Manual v6.9 241 Station Select the appropriate Station (facility) by clicking the appropriate radio button, if applicable. Figure 304: Station Progress Note Screen The Progress Note screen has several major areas and functions. This is the final screen in completing an encounter with the patient, and has different incarnations depending on how the transaction is to be filed: File Data With a Note, File Data With a Note Addendum or File Data Without a Note. The following screen displays when the transaction is filed using the File Data With a Note option. Figure 305: Progress Note Screen Use the Ellipsis (...) button to change the TIU progress note title here if needed. Use the up and down arrows to change the Note Date/Time if desired. From this screen, the user can also: view and/or import DRM Plus objects, view and import CPRS templates, launch the CNT Navigator (DSS clinical note templates), view the patient’s TIU progress note, import VistA medical information, and add an electronic signature. In addition to the imports that can be made into a TIU progress note, free-texting for narrative may also be entered prior to filing the note by the user. May 2018 DRM Plus Administrator Manual v6.9 242 Viewing/Importing DRM Object/Progress Note To view/import DRM objects: 1. Click the View DRM Plus Objects button (defaulted) below the tree on the left side of the screen. 2. Double-click the DRM object and it displays in the viewer on the right side of the screen. The DRM object imports where the cursor is positioned. 3. Information can be added or deleted by typing directly into the progress note on the right side of the screen. Viewing/Importing CPRS Templates To view/import CPRS templates: 1. Click the View CPRS Template button below the tree on the left side of the screen. 2. The shared/personal templates tree, if expanded, displays on the left side of the screen. Most functionality of CPRS templates in DRM Plus is the same as in CPRS. 3. Click the View DRM Plus Objects button to return to the DRM object tree. Importing VistA Medical Information To import VistA medical information into the patient’s TIU progress note: 1. Right-click in the progress note area. 2. The Import Menu displays. Figure 306: Import Menu Screen 3. Choose the information that is to be imported from the top half of the menu. 4. The information displays in the progress note where the cursor was positioned. May 2018 DRM Plus Administrator Manual v6.9 243 Other Options in the Import Menu Hide Note Objects: Hides or closes the objects tree on the left side of the screen and enlarges the progress note viewer. View Note Objects: Undoes the hide note objects. Copy: Copies selected text in the progress note. Cut: Cuts selected information in the progress note. Paste: Pastes information into the progress note. Select All: Selects all text in the progress note. Print Note: Prints the progress note. Import Text File to Note: Navigates to a text file to import into a note. See the User Options section in the Using DRM Plus Drop-Down Menus chapter of this manual for more information on automatically setting the location for this text file. Accessing Dental CNTs Click the CNT Navigator button to access dental CNTs. These are DSS product clinical note templates. The dental CNTs may NOT be mapped for DRM Plus at the user’s site; it would require IT assistance. Please see the CNT Navigator section, further in this chapter. Electronic Signature Enter the Electronic Signature Code and click the Finish button to complete the TIU progress note. Clicking the Finish button without entering an electronic signature leaves the patient TIU progress note status as unsigned. May 2018 DRM Plus Administrator Manual v6.9 244 Progress Note Addendum When the File Data With Note Addendum option has been chosen, the Progress Note screen displays slightly different. The functions are the same as in the previously shown progress note screen with the additions of selecting the Note Categories radio button options and with the parent note displaying in the upper right window. Figure 307: Progress Note Addendum Screen The notes associated with the selected Note Categories appear in the narrow window below the note categories area. Use the drop-down menu below the note categories to filter the results. Click a parent note to view details in the upper right window of the screen. Finish the process of filing the encounter with a note addendum, which displays in the lower right window of the screen. May 2018 DRM Plus Administrator Manual v6.9 245 CNT Navigator Clicking the CNT Navigator button displays up a directory of clinical note templates in use, as a tool, to assist the user in writing a note, or additional information to a note. The CNT Navigator button is located on the bottom left side of the Progress Note screen. These are Document Storage Systems (DSS) product clinical note templates, and may NOT function unless they are mapped correctly, which requires IT assistance. Figure 308: CNT Navigator Button Using the mouse, point and click to select pre-determined text in the development of a note. Type the text within the CNT if the pre-determined text or statement does NOT contain the necessary verbiage. Figure 309: Clinical Note Template Navigator Screen To access a CNT: 1. Click any of the tabs. 2. A listing of CNTs specific to the selected tab displays. Either double-click the desired template, or click once to select it and then click the Run button. May 2018 DRM Plus Administrator Manual v6.9 246 Navigating Within CNTs To navigate within a CNT: 1. Point and click within the windows, tabs, drop-down arrows, check boxes, and radio buttons. Each navigational method provides the user with a different method of entering or selecting information. Figure 310: Navigating Within CNT 2. Preview the note by clicking the Preview button. 3. Click the Return button to continue writing the note. May 2018 DRM Plus Administrator Manual v6.9 247 Figure 311: Preview Note When the note is complete, click the Finish button. Then click the Accept Note button. May 2018 DRM Plus Administrator Manual v6.9 248 Consult Notes The option to complete a consult displays after the Filing Options screen, during the process of completing a patient encounter, when the Set Progress Note Title screen displays. Figure 312: Set Progress Note Title Screen To complete the consult: 1. Choose the consult title from the Set Progress Note Title screen. 2. The patient’s pending consults display on the screen. May 2018 DRM Plus Administrator Manual v6.9 249 Figure 313: Set Progress Note Title with Pending Consult 3. Select the consult from the list. 4. The consult is added to the progress note on the Progress Note screen. Once the electronic signature is entered on the Progress Note screen, the consult is complete. May 2018 DRM Plus Administrator Manual v6.9 250 Resident Filing as Cosigners or Distributed Providers A 2006 VA Directive stated that residents are users with a VistA Person Class of V030300, V11550 or V115600. All residents are required to have a distributed provider (attending) to complete the encounter with the patient. Since most sites require residents to enter a cosigner for the note, the cosigner defaults as the distributed provider in PCE. If there is no cosigner required for the resident, or the user filing data to a resident, they must enter the distributed provider before filing. To add a distributed provider: 1. Click the Finish button. 2. The Change Provider screen displays. Figure 314: Change Provider Screen 3. Click the desired response. (Residents click the No button). 4. The Search for Cosigner Provider screen or the Search for Distributed (PCE Primary) Provider screen displays. Figure 315: Search for Distributed Provider Screen May 2018 DRM Plus Administrator Manual v6.9 251 5. Enter the search terms in the text box and press the key. 6. Choose the provider from the search results and click the OK button. 7. An information screen displays confirming that the information was filed. Note: VA dental gives credit/RVU time to the resident actually performing the procedures, all of which is filed to DES; to meet the VA requirement that the attending (distributed) gains credit for the encounter, this has to be filed in PCE. When the encounter is filed to PCE, the resident becomes the secondary provider, and the distributed provider becomes the primary provider for the PCE encounter. All procedures and diagnoses are assigned to the distributed provider in VistA PCE. Figure 316: PCE Encounter Information in VistA May 2018 DRM Plus Administrator Manual v6.9 252 Appendix A – Glossary of VA Terms ADPAC Automated Data Processing Applications Coordinator AICS Automated Information Collection System; formerly Integrated Billing, the program that manages the definition, scanning and tracking of Encounter Forms. APPOINTMENT A scheduled meeting with a provider at a clinic; an appointment can include several encounters involving other providers, tests, procedures, etc. CBOC Community Based Outpatient Clinic CC Coordinating Committee CFO Chief Financial Officer CHECKOUT PROCESS Part of the Medical Administration (PIMS) appointment processing. The checkout process documents administrative and clinical data related to the appointment. CIO Chief Information Officer CIR Corporate Information Repository CIRN Clinical Information Resource Network CLINICIAN A doctor or other provider in the medical center authorized to provide patient care. CNT Clinical Note Template (Used to format TIU progress notes) CPR Cardiopulmonary Resuscitation CPRS Computerized Patient Record System CPT Common Procedure Terminology CQI Continuous Quality Improvement DAS Dental Activity System (also called AMIS) DES Dental Encounter System (also called DES) DHCP Decentralized Hospital Computer Program (See: VistA) DNR Do Not Resuscitate DOD Department of Defense DRG Diagnostic Related Group DSS Decision Support System DSS Document Storage Systems, Inc. May 2018 DRM Plus Administrator Manual v6.9 253 DVA Department of Veterans Affairs EDI Electronic Data Interchange ELC Executive Leadership Council EMR Electronic Medical Record ENCOUNTER A contact between a patient and a provider who has responsibility for assessing and treating the patient at a given contact, exercising independent judgment. A patient can have multiple encounters per visit. ENCOUNTER FORM A paper form used to display and collect data pertaining to an outpatient encounter, developed by the AICS package. EPISODE OF CARE Many encounters for the same problem constitute an episode of care. An outpatient episode of care may be a single encounter, or can encompass multiple encounters over a long period of time. FEMA Federal Emergency Management Agency FIM Federal Independence Measure FRP Federal Response Plan GAF Global Assessment of Functioning GPRA Government Performance and Results Act GUI Graphic User Interface HEALTH SUMMARY A Health Summary is a clinically-oriented, structured report that extracts multiple kinds of data from VistA and displays it in a standard format. HR IGA Human Resources Office of Intergovernmental Affairs INPATIENT VISIT Inpatient encounters include the admission of a patient to a VAMC and any clinically significant change related to treatment of that patient. IOM Institute of Medicine ISDA Intensity Severity Admission Discharge (criteria) IT Information Technology JCAHO Joint Commission on the Accreditation of Healthcare Organizations LAN Local Area Network MVV Mission Vision Values MAC Management Assistance Council MCCR Medical Care Cost Recovery MDS Minimum Data Set May 2018 DRM Plus Administrator Manual v6.9 254 NHCU Nursing Home Care Unit OERR Order Entry Results Reported OSHA Occupational Safety & Health Administration OUTPATIENT ENCOUNTER Outpatient encounters include scheduled appointments and walk-in unscheduled visits OUTPATIENT VISIT The visit of an outpatient to one or more units or facilities located in or directed by the provider maintaining the outpatient health care services (clinic, physician’s office, hospital medical center) within one calendar day. PACS Picture Archiving and Communications System PAI Patient Assessment Instruction PCE Patient Care Encounter PI Prevention Index PM Performance Management PROCEDURE A test or action done for or to a patient that can be coded with the CPT coding process. PROVIDER The entity which furnishes health care to a consumer. PSA Patient Service Area PTSD Post Traumatic Stress Disorder RM Risk Management RPM Resource Planning Methodology SD Standard Deviation SMI Seriously Mentally Ill SSC Shared Service Center TIU Text Integrated Utility TQI Total Quality Management UM Utilization Management UNC Universal Naming Convention. Used in place of Drive letters. VA Department of Veteran Affairs VAVS Veterans Administration Voluntary Service VHA Veterans Healthcare Administration VISN Veterans Integrated Service Network VISIT The visit of a patient to one or more units of a facility within one calendar day. May 2018 DRM Plus Administrator Manual v6.9 255 VistA Veterans Information System Technology Architecture, the new name for DHCP. VSO Veterans Service Organization May 2018 DRM Plus Administrator Manual v6.9 256 Appendix B – Common Application Functions Microsoft Windows tools are used in DRM Plus. Left-clicking, right-clicking, double-clicking, drop-down arrows, radio buttons, check boxes, text boxes, highlighting and scroll bars are used throughout DRM Plus. Certain buttons and clicking options are common to most screens and are discussed below. OK: Clicking the OK button is used to finalize a selection or end a process. The open screen is closed, and the user is moved to another screen. Cancel: Clicking the Cancel button cancels the action taken on a screen and returns the user to the previous screen. Next: Clicking the Next button moves the user to the next screen. Back: Clicking the Back button moves the user to the previous screen. Add: Clicking the Add button adds a selected item to a function. Edit: Clicking the Edit button allows the user to edit a selection. Delete: Clicking the Delete button allows the user to delete a selection. Reset: Clicking the Reset button resets changed settings to their original settings during this session. Finish: Same as the OK button. Browse Buttons: Clicking the Browse button moves the user to a previously-programmed selection screen. Radio Buttons: Clicking a radio button displays a dot in the button, designating a specific option. Only one radio button is allowed for a section in a group. Check boxes: Clicking a check box works the same as a radio button, however multiple selections may be added from one group. Text Boxes: Clicking in a text box allows the user to type text into the box. Drop-Down Arrows: Clicking these arrows displays a menu of selections. Selection Arrows: Clicking these arrows allows a selected item to be moved from one dialogue box to another. Search Boxes: Typing selection criteria in a search box causes the criteria to be matched to a master file. Matches are displayed, allowing the user to highlight the desired selection for further action. DRM Plus requires the user to press the key after entering the criteria. May 2018 DRM Plus Administrator Manual v6.9 257 Sorting: Clicking a Transaction table column heading sorts the table, usually in ascending order, depending on the current view. Clicking the column heading a second time returns the table to its original view. Highlighting: Clicking an item results in its being highlighted, and selected for the next action to be completed. Shift Key: Generally, holding the key down allows for selection of multiple consecutive items in Windows applications. Control Key: Generally, holding the key down allows for selection of multiple items in Windows applications. Keyboard Use: When a letter or a button name is underlined (Add or Speed Code) the keyboard can be used to activate the button. The action required is to press and hold the key, then press the underlined letter. May 2018 DRM Plus Administrator Manual v6.9 258 Appendix C – Hints and Notes Save Unfiled Data If the user has entered any data and attempts to close DRM Plus, or switch to a different patient, DRM Plus displays a screen prompting the user to save the current patient’s entries. Clicking the Yes button initiates the save unfiled data function. When the user has saved unfiled data and no longer needs this data for the patient, there are two options to eliminate this saved, unfiled data. The first is to select the Delete button when opening the patient’s chart; a dialogue screen asks the user if they want to load the saved data. The section option is to delete the saved unfiled data from the Unfiled Data by Provider report. Dental Class Displayed on Banner The patient’s Dental Class displays in the banner area, only if the information was entered on the cover page in the Dental Eligibility/Dental Class field by a DRM Plus Administrator. As soon as the Dental Class is selected, it displays in both fields: the dental class field on the Cover Page tab screen, and the Dental Class box in the DRM Plus banner. Diagnostic Findings Diagnostic Findings are NOT updated automatically from Completed Care entries for any encounter. Any Completed Care entries that are filed need to be entered as Diagnostic Findings during a patient’s future dental examination. Always mark teeth missing in Diagnostic Findings before entering Partials, Dentures, Implants or Bridge findings. DRM Plus works best when missing teeth or edentulous arch(es) are entered before any other findings. Dentition is always entered first on a new patient before any dental data is entered in DRM Plus, if the patient is a juvenile. Diagnostic Findings may be deleted after the encounter has been filed by a user. If this happens after the encounter has been filed, the deleted findings are removed from the graphic; however, the text entry remains in the transaction table with a line through it. DRM Plus Administrators can completely remove any Diagnostic Finding entry from the transaction table, unless the entry was already deleted by a user. Treatment Plan For implant procedures entered in the Treatment Plan screen, and if a related finding of Missing has NOT been entered, DRM Plus does NOT allow this corrective planned treatment procedure to be entered. It is recommended to use the Include Findings and Completed button to temporarily combine screens of the planned treatment with the findings and NOT use the automatic Include parameter in DRM Plus. The automatic Include parameter is the original default in DRM Plus when the user is viewing the Treatment Plan screen. End-users may edit this parameter by accessing the Treatment & Exam menu Show Configuration submenu Tx & Exam tab Display Defaults drop-down menu remove check marks in check boxes. May 2018 DRM Plus Administrator Manual v6.9 259 Multi-Add Screen Small buttons [<] and [>] have been added to the Procedure Code selection screen to enable the user to move the screen to the other half of the graphic chart. This may be necessary to see what is beneath, especially when entering multi-add codes. Missing teeth display as white text on a blue background. This can help the user visualize the mouth while entering multi-add codes. The missing teeth are still selectable if needed for the procedures partial, denture, implant or bridge. Ranged Codes Certain codes, designated as ranged codes, used for multiple teeth procedures, mostly in the prosthetics area, have been restricted and can only be used with hard coded DRM Plus icons. These icons are Partial, Bridge, Conn Bar and some Denture procedure codes. These icons are only found with the Treatment Plan and Completed Care screens. When other options are utilized for selecting these CPT procedure codes, when using the ADA Codes icon or Add box, the ranged codes are disabled and cannot be selected. Speed Codes Speed Codes do NOT have multi-add or suggestion links functionality. The multi-add and suggestion links functionalities work with the Quick Codes icon, ADA Codes icon, CPT Codes icon, using the Add box to select a procedure code. Some of the DRM Plus standard icons allow multi-add functionality. Speed codes are only used with the Treatment Plan and Completed Care view screens for selecting a procedure code. Speed Codes that include codes violating coding compliance rules need to be edited or deleted. Tx Planning/Sequencing Screen There is a maximum of nine phases which may be added to the sequenced planned treatment for one patient. There are an unlimited number of sub-phases possible in each phase. There is only one Non-VA Care phase that may be added however with an unlimited number of sub-phases. Ranged codes, mostly prosthetics, move as a block when one code is highlighted, by left-clicking the item, holding and dragging to the proper phase. End-users are able to re-size and move the Tx Planning/Sequencing screen in all directions. DRM Plus allows users to drag and drop multiple procedures at one time by pressing the and keys. Users may add or modify the Treatment Plan and Tx Planning/Sequencing screen and file the changes without having to click the Next button and create a TIU progress note as long as no new completed transactions, perio, PSR or Head & Neck data are entered. In addition, the most recent dental encounter must have an Active status for this feature to work. Clicking the Save & Exit button from the Tx Planning/Sequencing screen files any changes made, and minimizes DRM Plus. Any new planned entries added have the same visit date as the latest active TIU progress note filed for the patient. May 2018 DRM Plus Administrator Manual v6.9 260 If the completed care screen is set as the display default in DRM Plus, transactions completed from the sequencing screen may require a refresh for those transactions to display in the Completed Care screen. Selecting the Diagnostic Findings button or the Treatment Plan button and then reselecting the Completed Care button refreshes the application. Completed Care Completed procedures that have been filed can only be deleted by a DRM Plus Administrator. If an enduser, who does NOT have this administrative parameter option, highlights an entry in the Completed Care transaction table and clicks the Delete button, a screen stating that the transaction cannot be deleted displays. When a DRM Plus Administrator deletes an entry from DRM Plus, appropriate procedures must be followed to correct any associated entry filed in VistA TIU or possible VistA PCE. In those rare cases where pre-existing charted care does NOT allow the user to click and select a procedure code via the graphic chart, the user may enter the desired code via the ADA Codes icon. If one or more of the procedures entered with multi-add functionality require an assignment of a different diagnosis code, deselect the procedure code by clicking the check box of the procedure description located on the upper left side of the Diagnosis Code screen. The deselected procedure code no longer appears highlighted, and is removed from the table at the bottom of the screen, indicating that it does NOT associate with the selected diagnosis code. Click the OK button at the bottom of the screen, and the remaining unchecked procedure code(s) recycle and appear highlighted in the Diagnosis Code screen for the user to assign a diagnosis code. This process of recycling continues until all procedure codes added with the multiadd functionality have a diagnosis code assigned by the user. Periodontal Chart The History button maintains graphical entries from previous perio examinations; therefore, any prior perio exam graph may be viewed with the History button, selected from the Periodontal Chart screen. The Periodontal History/Compare screen may be vertically extended to view any data that is NOT visible. To use the Furcation icon, the cursor shield must be positioned at the root location where an entry in the graphics would be appropriate. The X button located at the end of the pre-defined measurement scale results in a null entry in the transaction table for Pocket, FGM, MGJ, Mobility and Furcation entries. This null entry only works when the specific icon is active for Pocket, FGM, MGJ, Mobility and/or Furcation. The null entry remains as a “-” mark in the transaction table, and there is no entry in the TIU progress note. If the error is recognized immediately, the Undo button may be clicked. Otherwise, place the cursor shield on the pocket where the incorrect value was entered. If the value is for Pocket, FGM, MGJ, Mobility or Furcation; the incorrect value can be replaced by entering the correct value. A zero entry results in no graphical view; however, it results in a zero entry in the transaction table and TIU progress note, since it is a measurement. If no recording should be present for a given icon, a null entry can be created by clicking the X button. If the incorrect entry is for Bleeding, Delayed Bleeding or Suppuration; click the identical icon again to remove the graphic display and transaction table entry. May 2018 DRM Plus Administrator Manual v6.9 261 When perio data is imported into the TIU progress note, it has each tooth displayed with each surface and condition shown in the vertical column, under the tooth number. The key at the bottom of the perio data explains certain symbols. There may be a statement at the bottom of the perio data, which informs other providers that this TIU progress note contains perio data from the current exam, as well as data that has NOT changed from at least one previous exam. If the Clear icon was used at the beginning of the perio exam, then only data from this current exam is imported into the note. Warning levels can be changed by the end-user and then displayed. The pocket depth warning level should be the same for the perio chart graphics, and for the pocket depth warning level listed on the Statistics tab. The pocket depth warning level on the Statistics tab must be the same as the pocket depth warning level in the Periodontal tab. Both of these tabs are found by utilizing the Treatment & Exam menu Show Configurations submenu. Completing the Encounter Selecting any Service Connection check box sends a flag to PCE for the encounter. DRM Plus is now aligned with CPRS for patients who are Combat Veteran service connected. If appropriate, the Combat Veteran option defaults to a check (Yes) in DRM Plus. To remove the check (change to No), click the check box to the left of the Combat Veteran field. The check is removed. VistA has co-signature functionality, and is checked by CPRS and DRM Plus. Both GUIs also have additional signer functionality. Additional signers are NOT required, but may be added to a TIU progress note by a provider. Do NOT confuse additional signers with co-signers. Co-signers are built into VistA by facility management based on business rules. If the software detects that a co-signers is required, a screen displays, requesting a co-signature. A provider may need a co-signer for one or all TIU progress notes. Since most sites require residents to enter a co-signer, the co-signer defaults as the distributed provider in PCE. If there is no co-signer (i.e., no note exists when using File Data Without a Note, or the resident is NOT required to have a co-signer) then the resident, or user filing resident data, must enter the distributed provider prior to filing. When the encounter is filed to VistA PCE, the resident becomes the secondary provider and the distributed (attending) provider becomes the primary provider for the encounter. All procedures and diagnoses are assigned to the distributed provider in VistA PCE. VA Dental wants to give credit/RVU time, etc. to residents who actually perform the procedures, and all of this is filed to VistA DES. However, to meet the VA requirement that gives credit for the encounter to the attending (distributed), requires this to be filed in VistA PCE. DRM Plus users may import a TIU Note Boilerplate into a patient’s TIU progress note. If the Note Boilerplate parameter is set with a check mark, an informational screen displays when selecting a TIU progress note or consult title, if that title has a note boilerplate associated with it. The informational screen allows a user to select Yes or No to the question of importing the note boilerplate. If this parameter is NOT set with a check mark then the note boilerplate imports into the patient’s TIU progress note without an opportunity to decline this action. This parameter is located under the Tools menu User Options submenu General tab Other Parameters button. May 2018 DRM Plus Administrator Manual v6.9 262 CPRS templates automatically import into a patient’s TIU progress note if the TIU note/consult title selected is associated with a CPRS template and there is no option for the user to decline this template import. When the template displays or opens, complete or fill-in the appropriate information on the template and close or finish it. The information entered on the template imports into the patient’s TIU progress note. Please note: DRM Plus does NOT support Reminder Dialog or COM objects CPRS templates. There are generally two types of TIU progress notes created using DRM Plus: 1) using the Exam tab or 2) NOT using the Exam tab. A TIU progress note created using the Exam tab sequences DRM Plus objects in the order designed and approved by the VA Dental Exam Committee. The sequencing of DRM Plus objects in the Note Objects Sequence parameter screen is overwritten by the Exam tab sequence design when the Exam tab is used. TIU progress notes created without using the Exam tab sequence DRM Plus objects in the order set by the user in the Note Objects Sequence parameter screen. This parameter is located by selecting the following: Tools menu User Options submenu Progress Note tab Set Note Sequence button. The Note Boilerplate in the list of Note Objects Sequence parameter screen includes both TIU Note Boilerplates and supported CPRS templates. All DRM Plus data objects displayed in the left narrow window of the Progress Note screen may be imported into the TIU progress note automatically. This depends on whether the parameters are activated by the end-user. However, most of the data objects are NOT allowed to be de-selected by the end-user for the automatic importing process. These parameters are located by selecting Tools menu User Options submenu Progress Note tab Progress Note Data button. DRM Plus Code Boilerplates are listed individually with the DRM Plus objects on the Progress Note screen. DRM Plus users who have created code boilerplates can now import them into a TIU progress note by clicking the desired Code Boilerplate object, listed with DRM Plus objects. Using the cursor, set the object where it is sequenced in the TIU progress note, then double-click to import the object. Text files may be created and saved in a preferred directory. Right-click in a Progress Note window and click Import Text File option to navigate to and open the saved file. The file is then placed in the TIU progress note as designated by the cursor placement. Follow these steps to set up a file for importing: 1. Create a folder in an appropriate directory (usually a server drive). 2. From the Tools menu User Options submenu Set File Folder button, navigate to the folder created in Step 1. Set the folder by double-clicking it. 3. Create a text file from the Tools menu Windows Notepad submenu and save it as a .txt file in the designated folder from Step 1. If the user clicks the Finish button before the provider’s electronic signature is entered, the dental data is filed in VistA (PCE, DES and TIU) as an unsigned progress note, and may be viewed with CPRS. If the electronic signature is entered before clicking the Finish button, the dental data is filed as a signed progress note in VistA (PCE, DES and TIU). When the user clicks the Finish button, a prompt may display if there are no planned items, and if the patient status is Active. Correctly identifying the patient’s status is important for reporting. The user should click the proper radio button (Active, Inactive or Maintenance) and then click the OK button. May 2018 DRM Plus Administrator Manual v6.9 263 Reports – Non-Clinical Time by Provider The Non-Clinical Time by Provider report displays an approximate numerical unit of days (1 day = 8 hours). Accumulation of less than 4 hours results in rounding down to the nearest whole number day, and accumulation of 4 or greater hours round up to the nearest whole number day. Code Boilerplates Multiple boilerplates may be added for a single code, or multiple codes may be associated with the same boilerplate. The user may establish as many boilerplates and related codes as necessary. If a DRM Plus Administrator creates a code boilerplate in their Administrative Toolbox submenu, then every user may use the code boilerplate by entering the name of that code boilerplate to their parameter. Enter the name precisely as it was entered by the DRM Plus Administrator and click the OK button in the end-user’s User Settings screen. This action imports the administrative code boilerplate to the end-user’s code boilerplates. Last Broker Call The Last Broker Call submenu is used by the IT or ADPAC personnel to document problems. It is NOT usually accessed by providers. Recent Dental Activity This section on the Cover Page tab displays the most recent visit date for selected types of procedure codes. Hover the cursor over the heading to display all of the ADA procedure codes; the following list comprise the procedure codes for each heading. Last Qualifying Exam = D0120, D0150 or D0180 Last Comprehensive Exam = D0150 or D0160 Last Brief Exam = D0120, D0140 or D0170 Last Periodontal Exam = D0180 Last Panorex Image = D0330 Last Full Mouth Image = D0210 Last Bitewing Image = D0270, D0272, D0273, D0274 or D0277 Last CBCT Image = D0364, D0365, D0366, D0367, D0368, D0380, D0381, D0382, D0383, D0384 Last Prophylaxis = D1110, D4341, D4342, D4346, D4355 or D4910 Last Visit = the last dental visit date the encounter was filed on. Last Provider = the provider that filed the last encounter. May 2018 DRM Plus Administrator Manual v6.9 264 Appendix D – Icon Definitions Diagnostic Findings The following table explains the actions required to enter a Diagnostic Finding: CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN ADDITIONAL COMMENTS Restore As many as required As many as required No Material or surfaces Graphic in green Missing As many as required No As many as required Selected Roots Graphic for roots is outlined Observe As many as required No As many as required Selected Roots Tooth outlined in red Partial As many as required No No Cancel or Complete Graphic allows root condition graphics to show. Graphic in purple. Denture Any tooth No No None Graphic allows root condition graphics to show. Graphic in purple. Implant As many as required No No None Graphic in violet Sealant No As many as required No None Graphic in green Endo No No Yes Materials and roots Graphic color denotes material Apico No No Yes Select roots Graphic in red Retro No No Yes Selected roots Requires Apico to and materials be present. Graphic denotes material ICON Bridge See special instructions Conn Bar See Special Instructions Hemi May 2018 No No As many as required Selected roots Graphic in dark gray DRM Plus Administrator Manual v6.9 265 ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN ADDITIONAL COMMENTS Coping Yes No No None Graphic in green P&C No No As many as required Selected roots Graphic in green and materials and denotes material Impact As many as required As many as required As many as required Selected surfaces and roots Def Rest Yes As many as required Yes Selected Graphic in yellow, surfaces, roots denotes material and materials Caries Yes As many as required As many as required Selected surfaces and roots Graphic in red, root caries initiates description box Drifting Yes No No Direction Graphic is yellow arrow to the left of tooth Tipped Yes No No Direction Graphic is light blue arrow to left of tooth Rotated Yes No No Direction Graphic is green arrow to left of tooth Ret Root No No As many as required None Graphic removes crown UndrCont No As many as required No Selected surfaces Graphic is red and yellow OverCont No As many as required No Selected surfaces Graphic is red and yellow Overhang No As many as required No Selected surface Graphic is red and yellow Lesion No No As many root surfaces as required Selected roots Can also click implant. Graphic is a red circle. Faceted No As many as required No Selected surfaces May 2018 DRM Plus Administrator Manual v6.9 Graphic in light blue, roots in bluegreen Graphic is red and yellow 266 ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN ADDITIONAL COMMENTS Cracked No As many as required As many as required Selected surfaces and roots Graphic is red and yellow Chipped No As many as required No Selected surfaces Graphic is red and yellow Supr/Sub Yes No No Direction Graphic is red arrow Open Ct Yes No No None Graphic is red arrow to right of tooth Abfract No Facial or lingual No None Graphic is blue arrows Dentition No No No Dentition box Converts graphic to juvenile. Must be done before other entries Perm/Prin Yes No No Dentition Box Designate selected tooth as primary or permanent Edentulous Any tooth No No None Graphic removes all teeth and roots in arch Note: Certain Diagnostic Findings or Completed Care procedures, once entered, display graphically on all screen views. These items are, if entered from the Diagnostic Findings screen: missing, implant, impacted, retained root, hemi section, dentition, and observe. If entered from the Completed Care screen: extract, hemi section, implant and observe. May 2018 DRM Plus Administrator Manual v6.9 267 Treatment Plan ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN ADDITIONAL COMMENTS Restore (2) Yes As many as required No Code Selection Graphic in Blue box Extract Yes No Yes Code Selection Graphic in shadow Box Observe As many as required No No None Tooth outlined in red Partial (1) As many as required No No Cancel or Complete Graphic allows root condition graphics to show Denture Any tooth No No Code Selection Graphic allows root box condition graphics to show. Implant Yes No No Code Selection Graphic in violet, Box Diagnostic Finding must be Missing Sealant No As many as required Yes Code Selection Graphic in blue, no Box root graphic Endo No No Yes Code Selection Graphic in blue Box Apico No No Yes Code Selection Graphic in red Box Retro No No Yes Code Selection Requires Apico to be Box present. Graphic in blue. Bridge (1) Code Selection See special Box instructions. Conn Bar (1) Code Selection See special instructions Box May 2018 DRM Plus Administrator Manual v6.9 268 ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN ADDITIONAL COMMENTS Hemi No No As many as required Code Selection Graphic in gray Box Coping Yes No No Code Selection Graphic in blue Box P&C No No As many as required Code Selection Graphic in blue Box Perio But- tons No No No None No Graphic. See Speed Code instructions. Certain codes associated with these icons are defined as ranged codes. Ranged codes can only be entered by clicking the proper icon button. The ADA Codes icon, CPT Codes icon, Quick Codes icon or Speed Code icons are NOT allowed for entering ranged codes. To designate a root restoration, click the Restore icon. Click the tooth surface that corresponds to the root surface. Using a tooth note, or the description edit feature in the transaction table, explain the root restoration. Note: Certain Diagnostic Findings or Completed Care procedures, once entered, appear graphically on all screen views. If these items are entered from the Diagnostic Findings screen, they are: missing, implant, impacted, retained root, hemi section, dentition, and observe. If entered from the Completed Care screen, they are: extract, hemi section, implant, and observe. May 2018 DRM Plus Administrator Manual v6.9 269 Completed Care ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN Restore (2) Yes As many as required No Code Selection Graphic in Green Box Extract Yes No Yes Code Selection Tooth disappears. Root Box graphic in dark gray. Observe As many as required No No None Partial (1) As many as required No No Cancel or Graphic allows root Complete. Then condition graphics to Code Selection show. Graphic in box. purple. Denture Any tooth No No Code Selection Graphic allows root Box condition to show. Graphic in blue-purple. Implant Yes No No Code Selection Graphic in violet, Box Diagnostic Finding must be Missing Sealant No As many as required Yes Code Selection Graphic in green. No Box root graphic. Endo No No Yes Code Selection Graphic in pink. Box Apico No No Yes Code Selection Graphic in red. Box Retro No No Yes Code Selection Requires Apico to be Box present. Graphic in green. Bridge (1) May 2018 ADDITIONAL COMMENTS Tooth outlined in red Code Selection See Special Instructions Box DRM Plus Administrator Manual v6.9 270 ICON CLICK TOOTH CLICK SURFACE CLICK ROOT POP-UP SCREEN Conn Bar (1) ADDITIONAL COMMENTS Code Selection See Special Instructions Box Hemi No No As many as required Code Selection Graphic in gray Box Coping Yes No No Code Selection Graphic in green Box P&C No No As many as required Code Selection Graphic in green Box Perio But- tons No No No None No Graphic. See Speed Code instructions. Certain codes associated with these icons are defined as ranged codes. Ranged codes can only be entered by clicking the proper icon button. The ADA Codes icon, CPT Codes icon, Quick Codes icon or Speed Code icons are NOT allowed for entering ranged codes. To designate a root restoration, click the Restore icon. Click the tooth surface that corresponds to the root surface. Using a tooth note, or the description edit feature in the transaction table, explain the root restoration. Note: Certain Diagnostic Findings or Completed Care procedures, once entered, appear graphically on all screen views. If these items are entered from the Diagnostic Findings screen, they are: missing, implant, impacted, retained root, hemi section, dentition, and observe. If entered from the Completed Care screen, they are: extract, hemi section, implant, and observe. May 2018 DRM Plus Administrator Manual v6.9 271 Special Descriptions – Bridge Icon Place the cursor on the first tooth included in the bridge and drag the cursor to the last tooth in the range of teeth included in the bridge so that the ‘bar’ drawn for the bridge is one continuous line encompassing all of the areas (teeth, whether missing or not) included in the bridge. The Code Selection screen displays, with the lowest number tooth selected, as shown below. Figure 317: Procedure Code Selection Screen Select the appropriate code and click the Add button. The Procedure Code selection screen moves to the first pontic tooth. Select the appropriate code and click the Add button again. Continue this process until all required teeth and codes have been selected. Click the Finished button once the selection process is complete. Note: The << and >> buttons may be clicked to move backward or forward to different teeth for code selection. The Reset button, when activated by using the << and >> buttons, clears all previously entered codes for the selected tooth. May 2018 DRM Plus Administrator Manual v6.9 272 Special Descriptions – Conn Bar Icon This functionality works for all three view screens of Diagnostic Findings, Treatment Plan and Completed Care. Place the cursor on the first tooth location and drag it to the final tooth location. When entering a connector bar from the Treatment Plan screen or the Completed Care screens, the Procedure Code selection screen displays, with no tooth selected. DRM Plus defaults to the correct connector procedure code, depending on what conditions the connector bar was entered on. Click the OK button to complete the connector bar entry. Special Descriptions – Notes Icon Please see the Notes section in the Chart/Treatment – Periodontal Chart chapter of this manual. This icon works the same for all three Treatment & Exam screen views. Items to consider on tooth notes: Teeth designated as primary show in the tooth drop-down menu with the appropriate letter without a number. A tooth designation for Supernumerary teeth is displayed after tooth #32 in the dropdown menu. When a tooth-specific note has been entered, the tooth number in the graphical chart on the Diagnostic Findings, Treatment Plan, Completed Care and Periodontal Chart screens displays in yellow. Previously entered notes (tooth/patient note) appear disabled. The note appears disabled if it was saved as unfiled data and DRM Plus is closed and reopened. It also becomes disabled when an assistant saves unfiled data to a provider. When the provider re-opens DRM Plus to complete the encounter, they may edit-delete the note (tooth/patient note) by clicking the New Entry button. This activates the disabled entry so the provider is able to modify or delete the note before the encounter is finished. After entering any new dental data into Patient Notes or Tooth Notes windows select the Notes icon to save and close the Notes screen. Closing the Notes screen before opening any other screen in DRM Plus is the only action that saves the data entered into the Notes screen. May 2018 DRM Plus Administrator Manual v6.9 273 Appendix E – Create Reports in MS Excel and Access Developing Excel Reports To open Excel: 1. 2. 3. 4. 5. Click the Excel shortcut (if available) If unavailable; Click the Start button. Click the Programs button. Click Microsoft Office. Click Microsoft Excel. A blank Excel workbook opens. To open a saved file: 1. 2. 3. 4. 5. Select the File menu from the top menu bar. Click the Open option. Navigate to the directory/network where the extract file is saved. Navigate to the saved .txt file and click Open or double-click the file name. A screen similar to the one below is displayed. Figure 318: Developing Excel Spreadsheet Reports 6. Click the Delimited radio button. May 2018 DRM Plus Administrator Manual v6.9 274 7. Click the Next button. Another screen displays. Figure 319: Delimiters Options 8. 9. 10. 11. The Tab check box is checked by default. Click the Other check box. Type a ^ ( + ) within the window beside Other. Then click the Next button. Click the Next button. A similar screen displays. May 2018 DRM Plus Administrator Manual v6.9 275 Figure 320: Text Import Wizard Final Screen 12. Click the Finish button. The extracted data displays in Excel. May 2018 DRM Plus Administrator Manual v6.9 276 Figure 321: Report Preview 13. The text file can now be saved in an Excel format (.xls file). Select File from the top menu bar, then choose the Save As option. Rename the file and save with the .xls suffix. 14. The Excel worksheet can now be modified to create any number of custom reports to meet specific needs. The Excel tools are powerful, and numerous report types can be created depending on the user’s level of Excel proficiency. Examples of possible reports include: All Procedures by Provider All Procedures by Patient All Procedures by Clinic Reports by ADA Code Specific ADA Codes by Provider Reports by Diagnosis Creating Custom Reports Using Excel Reports can be customized using a variety of Excel functions including: deleting, expanding, formatting, sorting and subtotaling fields. Data may also be copied to other Excel worksheets to create numerous separate reports. May 2018 DRM Plus Administrator Manual v6.9 277 Deleting Columns or Rows Figure 322: Creating Custom Reports in Excel - Deleting Columns or Row To delete a column or row: 1. Click the column or row header. This highlights the column or row for deletion. 2. Click the Home button. 3. Click the Delete button. This function can be initiated by right-clicking with the cursor in the highlighted area. Expanding Columns or Rows Put the cursor on the line between the column heading letters. The cursor turns into a cross with two arrows. Holding the left mouse button down and dragging right or left expands or contracts the column or row. Double-clicking automatically expands or contracts the column or row to fit the contents. Field Formatting Options Click the Home menu. The following is displayed. May 2018 DRM Plus Administrator Manual v6.9 278 Figure 323: Field Formatting Options Click Format button and then the Format Cells submenu. The following screen displays. Figure 324: Format Cells May 2018 DRM Plus Administrator Manual v6.9 279 Select the desired option, then enter the desired changes. Set Horizontal/Vertical settings to make the report easier to read. Setting the text control to wrap text automatically wraps the text within the space allotted for the cell. The height of the cells in a row or column changes. Click the Alignment tab to display the following screen. Figure 325: Text Alignment Options Click the Wrap text check box. Click the OK button to complete the process. May 2018 DRM Plus Administrator Manual v6.9 280 Creating a Header for a Report 1. Click the View menu. 2. Click Page Layout button. Figure 326: Header and Footer Option Selecting the Page Layout button results in the following screen display. May 2018 DRM Plus Administrator Manual v6.9 281 Figure 327: Page Layout Screen Click in the field labeled ‘Click to add header’ to enter a header or scroll to the field labeled ‘Click to add footer’ to enter a footer. May 2018 DRM Plus Administrator Manual v6.9 282 Figure 328: Header & Footer Tools Screen Sorting Data To sort data: 1. Highlight the fields to include in the sort. 2. Click the Data menu. 3. Click the Sort button. May 2018 DRM Plus Administrator Manual v6.9 283 Figure 329: Sorting Data The Sort screen displays. Figure 330: Data Sort Options Choose the sorting options by clicking the drop-down menus and selecting the desired options. Subtotaling Data To subtotal data: 1. Highlight the fields to be included in the sub-total. Then click Data menu from the menu bar. May 2018 DRM Plus Administrator Manual v6.9 284 Figure 331: Subtotaling Data 2. Click Subtotal button and the following screen displays. Figure 332: Subtotal Options May 2018 DRM Plus Administrator Manual v6.9 285 Pull Down Options At Each Change In: Select an item to perform subtotals when a change occurs. The example uses Record #. Use Function: This example counts the number of times a provider performs a CPT Procedure in a given time frame. Add Subtotal To: Location subtotals displays. Below is a sample report: Figure 333: Sample of History File May 2018 DRM Plus Administrator Manual v6.9 286 Importing the DRM Plus Extract Text File into an Access Report After creating a .txt file through the extract function, and saving this information in a preset folder, this information can be placed in Microsoft Access for reporting purposes. To import a DRM Plus extract file into Microsoft Access: 1. Open Microsoft Access. Click the File drop-down menu and choose the Open option. Figure 334: Import Extract File into Microsoft Access 2. The Open window displays. Using the drop-down menu, search and highlight the area where the preset extract folder is located. The preset extract folder contains the information previously extracted from DRM Plus. May 2018 DRM Plus Administrator Manual v6.9 287 Figure 335: Open File 3. Once the folder is located in the Open screen, click and highlight it. 4. Click the Files of type: drop-down menu and choose All Files (*.*) as the extension. 5. Click and highlight the .txt file extraction. To access the file, choose one of the following options: double-click the .txt file; or, with the .txt file highlighted, click the Open button. 6. The following wizard screen displays, and the radio button preceding Delimited... must be selected. Select the Next button to continue the process. May 2018 DRM Plus Administrator Manual v6.9 288 Figure 336: Link Text Wizard 7. Click the Next button to continue the process. May 2018 DRM Plus Administrator Manual v6.9 289 8. Within the Link Text Wizard screen, select the Other radio button and in the text area beside it, type a ^ ( + ). Figure 337: Link Text Wizard 9. To continue, click the Finish button. 10. When the Finished linking table... screen displays, click the OK button. 11. The file displays in the Access Database screen. May 2018 DRM Plus Administrator Manual v6.9 290 Figure 338: File in Access Database Screen 12. Click the Reports option, which displays on the remaining screen. 13. Highlight and double-click the Create report by using wizard feature. Figure 339: Create Report By Using Wizard May 2018 DRM Plus Administrator Manual v6.9 291 14. The Report Wizard window displays. Indicate the desired fields in the report by choosing by highlighting the field and moving it to the selected fields area using the double arrow (>>) buttons located in the center of the screen. Once all desired fields are selected, click the Next or Finish button to continue (or finish). Figure 340: Choose Desired Fields for Report May 2018 DRM Plus Administrator Manual v6.9 292 15. Customized Microsoft Access reports display with the selected field information. Figure 341: Customized Microsoft Access Report The number of pages for any report depends on the number of fields selected. Total viewing of the Access report may require the use of the Page arrow buttons, which display on the bottom left of the screen. May 2018 DRM Plus Administrator Manual v6.9 293 Importing the DRM Plus Extract Excel File into Access Database To import the DRM Plus extract file (Excel spreadsheet) into a new Microsoft Access database: 1. Open Microsoft Access. 2. Create a new database. Figure 342: Import Excel File in Microsoft Access 3. Select Create a blank database. 4. Save the new database. May 2018 DRM Plus Administrator Manual v6.9 294 Upon saving the database, the following screen displays. Figure 343: Microsoft Access Tables Window To import an extract Excel file: 1. 2. 3. 4. Click the File drop-down menu. Click the Get External Data option. Click the Import option. Select the desired Excel file to import. May 2018 DRM Plus Administrator Manual v6.9 295 5. Click the Import button, and the Import Spreadsheet wizard displays. In the event that this wizard is NOT installed, contact local IT for additional support. Figure 344: Import Spreadsheet Wizard May 2018 DRM Plus Administrator Manual v6.9 296 6. Select the defaults, then click the Next button to continue. Figure 345: Select Defaults for Storing Data May 2018 DRM Plus Administrator Manual v6.9 297 7. Continue to select defaults until the following screen displays. Figure 346: Import to Table 8. The extract spreadsheet is now in a Microsoft Access database. Note: Microsoft Access training may be available. Contact local IT for further information. May 2018 DRM Plus Administrator Manual v6.9 298 Appendix F – Using the Keyboard to Enter Periodontal Data Overview The Periodontal screen is designed for data entry using the mouse. Data entry using the keyboard is also an option. Clicking the Keyboard Mode key, , initiates keyboard navigation and data entry on this screen. Figure 347: Keyboard Mode Button on Periodontal Chart Screen When this button is clicked, all of the icons are disabled and the keyboard is activated. The keyboard functions are described in this section. Navigating the Periodontal Screen Use the following key strokes to change the screen views. Arch Views The screen moves from the existing view to any of the other views by using the following keys: U = Upper L = Lower N = Lingual F = Facial F11 = Full (This screen must be closed by using the mouse.) Cursor Movement There are four options for moving the cursor to select a tooth/surface. Enter: Moves the cursor one surface in the direction of the higher numbered tooth. Backspace: Moves the cursor one surface in the direction of the lower numbered tooth. “>” with or without the key: Moves the cursor one surface in the direction of the higher numbered tooth. “<” with or without the key: Moves the cursor one surface in the direction of the lower numbered tooth. Press the key to toggle the Auto Advance function on or off. May 2018 DRM Plus Administrator Manual v6.9 299 Entering Data Entering data from the keyboard requires the cursor to be placed on the desired tooth/surface. The user must then select the desired condition and enter the data values in the appropriate manner. Note: All numeric values must be entered with two digits (1= 01, 2 = 02 and 10 = 10). Entering FGM and Mobility require the values to have a prefix (see below). K = Pocket: Press the key and with the cursor in the correct position, enter a two digit value. Then move the cursor to the next surface. G = FGM: Press the key and with the cursor in the correct position, enter a plus sign (+) and a two digit value, or just a two digit value. Then move the cursor to the next surface. J = MGJ: Press the key and with the cursor in the correct position, enter a two digit value. Then move the cursor to the next surface. B = Bleeding: Press the key with the cursor in the correct position. D = Delayed Bleeding: With the cursor in the correct position, press the key. S = Suppuration: With the cursor in the correct position, press the key. O = Mobility: Press thekey with the cursor in the correct position and enter a two digit value. For a value of 1 1/2, 2 1/2, etc., enter the two digit value preceded by a plus sign “+”. I = Furcation: Press the key with the cursor in the correct position and enter a two digit value. Move the cursor to the next surface. R = Reset: Pressing the key resets all values to zero (use this functionality with extreme caution). Ctrl Z = Undo. Special Buttons Viewing the Special Buttons screen requires pressing the following keys: H = History C = Compare M = Summary E = Head & Neck P = PSR Q = Stats Note: Displaying these screens using the keyboard turns off the keyboard function for these screens. The mouse is required to navigate these screens. Other Functions Z = Cal and X = Lock For convenience, a tear-out of the Periodontal Keyboard shortcut chart is available on the last page of this manual. May 2018 DRM Plus Administrator Manual v6.9 300 Appendix G – Ranged Codes Using the graphic icon on the Treatment Plan and Completed Care screens is NOT only straightforward, it minimizes the potential for errors. Certain codes, designated as ranged codes, used for multiple teeth procedures, mostly in the prosthetics area, have been restricted to icon use only for procedure entry. These codes are listed below. May 2018 DRM Plus Administrator Manual v6.9 301 Appendix H – Active-Inactive Maintenance Control With the introduction of DRM Plus, the direct entry of [Completed] or [Terminated] cases was removed from the program. Instead, the concept of Patient Disposition was introduced. The provider can choose between an [Active] and [Inactive] status, and if no planned items remain, the case records as [Completed]. If the provider changed the patient from [Active] to [Inactive] status, and planned items remained, the case records as [Terminated]. The Current Episode of Care is defined as that interval from when the patient was last updated from [Inactive] to [Active], then back to [Inactive]. A need has been recognized to account for patients who may NOT be active under care (i.e., have currently planned dental procedures) but may be in a maintenance status, pending future diagnostic or preventive dental care. Effective with Patch 47, DRM Plus now allow providers to choose the status of [Active], [Inactive] or [Maintenance] for their patient. Figure 348: Case Management Status By design, whenever a new dental patient is created in the Dental Patient file that patient’s status is set to [Active]. As before, if the provider changes the patient from an [Active] to [Inactive] status, and there are no planned items remaining, the case is recorded as [Completed]. If the provider changes the patient from an [Active] to [Inactive] status, and there were planned items remaining, the case is recorded as [Terminated]. Now additionally, if the provider changes the patient’s status from [Active] to [Maintenance], and there are no planned items remaining, the case is recorded as [Completed] and the episode of care ends. If the provider changes the patient’s status from [Active] to [Maintenance], and there are planned items remaining, the case remains ongoing with no changes to the episode of care. No matter what the patient’s previous status, a patient’s status is set to [Active] if an entry is made for additional planned care. The provider also now has the option of entering a Recommended Recare Date for the patient, which provides a date flag for reporting and re-evaluation purposes. (As CPRS re-engineering continues, this flag eventually is used for setting a clinical reminder in CPRS). Effective with Patch 47, the install routine traverses the Dental Patient file and cross reference the most recent dental care for each patient. If there are no transactions on file for the patient in the last 24 months, the patient’s status is set to [Inactive]. Then, on a monthly basis, a maintenance routine is set [Inactive] those patients that have an [Active] status that have no transactions on file in the last 24 months and no Recommended Recare Date set, or those patients with an [Active] or [Maintenance] status where 24 months have elapsed past their Recommended Recare Date. May 2018 DRM Plus Administrator Manual v6.9 302 Here are some likely scenarios and the recommended use of this control: A newly enrolled Veteran is eligible for dental care and the patient is new to the dental clinic. Their case is automatically set to [Active] without user intervention upon the first time opening the patient in DRM Plus. A Class II patient has had their post-discharge dental care episode finished. Upon completion of care, their status is changed to [Inactive]. A Class I/IIC/IV patient has had all of their restorative and periodontal care complete. They should be seen in four months for a periodontal checkup. Upon completion of the restorative and periodontal care, their status is changed to [Maintenance] with the Recommended Recare Date set four months from today. There is no statutory requirement for the VA to meet that recommendation, but if the patient calls in for an appointment and an appointment cannot be scheduled within the later of 30 days of that recommended date or the patient’s call, they should be placed on the EWL. A Class III/VI patient has had their adjunctive care completed. Upon completion of the adjunctive care, their status is changed to [Inactive]. The provider can choose whether or not to recommend and enter a re-care date; there is no statutory requirement for the VA to meet that recommendation. A Class V patient has had their necessary dental care completed. Upon completion of care, their status is changed to [Inactive]. The provider can choose whether or not to recommend and enter a re-care date; there is no statutory requirement for the VA to meet that recommendation. A newly enrolled Veteran is eligible for dental care. Limited capacity requires they be placed on the EWL. Their dental eligibility information should be entered in DRM Plus and thus by opening the patient in DRM Plus as a new patient their status is set to [Active]. Patients on the EWL should always be recorded as [Active] until their care is complete. If it is likely the patient may have a significant wait for care, it is suggested the Recommended Recare Date be set to the approximate date the patient’s dental care is initiated to avoid automatic inactivation of the patient after 24 months. A Class I/IIC/IV patient has failed to keep appointments and not followed through with their care. The provider makes a progress note of the patient’s failure to adhere to medical recommendations and change the patient’s status to [Inactive]. The provider can choose whether or not to recommend and enter a re-care date; there is no statutory requirement for the VA to meet that recommendation. The patient’s status is changed to [Active] upon a new application for care. Necessary emergent care has been provided a patient with no other dental eligibility. Once all clinically proper follow-up care is complete, the patient’s status is changed to [Inactive]. May 2018 DRM Plus Administrator Manual v6.9 303 Appendix I – Option to Set Dental Patients to Inactive Status A new option that IT may run (or may give as a secondary VistA option to DRM Plus users) allows the user to check the system for patient activity, and set patients without current encounters to Inactive status. Use the OPTION NAME: DENTV INACTIVE PATIENTS and then select an inactivate date (defaulted to 2 years). Figure 349: VistA Option to Set an Inactivation Date May 2018 DRM Plus Administrator Manual v6.9 304 Appendix J – How to Map Dental CNTs Note: These procedures require IT assistance. The dental staff should provide these instructions to IT. In order to confirm that the CNTs are mapped correctly: 1. Open the \DOCSTORE\Array\dntarray.txt file located on the server to confirm that within the dntarray.txt file, the patch for each CNT is correct. Figure 350: Map Dental CNTs from dntarrary.txt file May 2018 DRM Plus Administrator Manual v6.9 305 2. Open one of the CNT .ini files within the \DOCSTORE\FORMS directory (i.e., \\vhaservername\DOCSTORE\FORMS\160_DENT\04160001\DRMEval.ini) Figure 351: DRMEval.ini File 3. Confirm that the VHAservername path matches what was in the \Array\dntarray.txt file and is correct. 4. If the VHAservername within any of the \FORMS\160_DENT\########\ini files does NOT match the directory shown above (in the ARRAY folder) then each .ini file within the FORMS directory need to be opened and edited to reflect the correct path. May 2018 DRM Plus Administrator Manual v6.9 306 Appendix K – Recommendations for Coding of Prosthetic Appliance Coding for prosthetic appliances is to be done at the time when the prostheses are delivered to the patient and/or home care instructions are provided and documented. Taking workload credit for the undeliverable prosthetic appliances should occur: 1. After death. 2. After 6 months and 3 attempted telephonic contacts. Attempts to reach patient should occur at a timely interval (i.e., at least one week apart). 3. No response to a final letter to patient’s last known address. 4. CPRS documentation to insure no citation for patient abandonment. To take workload credit with no associated patient visit (i.e., phone contact): 1. Follow local policies for documentation of telephonic contact. Codes for phone contacts in DRM Plus are listed under the CPT codes (99441, 99442 and 99443). To file workload credit: 1. Enter code(s) in the Completed Care screen. 2. Select the correct previously filed Visit Date/Time associated with this addendum. 3. Click the Next button and select the File Data With a Note Addendum radio button. May 2018 DRM Plus Administrator Manual v6.9 307 Figure 352: Filing Options Setting and Visit Selection 4. Complete the encounter as a note addendum. May 2018 DRM Plus Administrator Manual v6.9 308 Appendix L – Business Use of DRM Plus As important as it is to know how to use DRM Plus, it is equally important to be aware of how to enter codes, fees and similar DRM Plus business considerations. Entering DRM Plus business information may be viewed in three different components: Local policy and practice National policy and practice National business practice Adhering to the following guidelines for each is essential and critical to the success of treating our Veterans. Entering valid data can provide important information on the allocation of VA resources on a local and national level, clarify current and future funding issues, and determine how to provide even better care to patients. Review this information carefully. If the user has any questions about this software or the accompanying business policies, contact the local DRM Plus Subject Matter Expert on site. If this person cannot answer the question, s/he knows who to contact to find the correct solution. Local Policy and Practice This includes the workflow process addressing the provider’s data entries for the following: Diagnostic Findings Observations Approval for proposed Patient Treatment Plans are to be established by the local dental manager. National Policy and Practice Coding Standards All completed procedures on site must be entered into the DES through DRM Plus. This includes the following: Procedures by staff Fee-basis on site Sharing on site Contract on site Residents Without compensation Students Hygienists For example, if a surgeon goes to the OR and enters the procedure into PCE through the surgery package, or through an encounter, that procedure must be entered into DES through DRM. Coding standards should be followed in an attempt to calibrate providers, in the event that the same encounters are observed at two separate clinics. This ensures that the encounters are coded the same. May 2018 DRM Plus Administrator Manual v6.9 309 Appendix M – Data Security As a VA computer user, one of the best and most important ways to contribute to good computer security is to know all data, its level of sensitivity, that it is virus-free, what would happen if it were unavailable, how long it could be done-without, and the effect of another user changing it without approval. Classifying data involves determining how sensitive and valuable it is, and what protection it needs. Information is classified according to sensitivity, which is based on its need for: Confidentiality: The information must be kept private as its owner instructs. Integrity: The information must not be inappropriately changed or destroyed. Availability: The information must be ready for use, as needed. The amount of information and the context in which it is found can affect its value. Some information is confidential only at certain times (i.e., contracting or economic forecast information, which is sensitive until its publication or release date, after which it is made public). Current information is generally more valuable than older information. When protecting data, all employees and contractors have a responsibility to: Be familiar with VA security policies, procedures, rules and regulations (i.e., know what to do, how to do it and why). The user should ask a supervisor or ISO any questions about these security responsibilities. The user is responsible for: Reporting known or suspected incidents immediately to the ISO. Using VA computers only for lawful and authorized purposes. Choosing good passwords and changing them every 90 days. Do not write down or share log-in information with anyone, including Help Desk. Complying with safeguards, policies and procedures to prevent unauthorized access to VA computer systems. Recognizing the accountability assigned to the user’s UserID and password. Each user must have a unique ID to access the VA systems. Recognize that UserIDs are used to identify an individual’s actions on VA systems and the Internet. Individual user activity is recorded, including sites and files accessed on the Internet (recorded as the files go through the firewall). Ensuring that data is backed up, tested and stored safely. Not generating or sending offensive or inappropriate email messages, graphical images or sound files. Limit distribution of email to only those who need to receive it. Realize that the user is identified as a user of the VA computer systems when logged on to the Internet. Using authorized virus scanning software on the workstation or PC and home computer. Know the source before using discs or downloading files. Scan files for viruses before execution. Complying with terms of software licenses and only using VA-licensed and authorized software. Do not install single-license software on shared hard drives or servers. Complying with terms of software licenses and using only VA-licensed and authorized software. Do not install single-license software on shared hard drives or servers. May 2018 DRM Plus Administrator Manual v6.9 310 Knowing data and properly classifying and protecting it, as well as inputs and outputs, according to their sensitivity and value. Label sensitive media, use a screen saver with a password, logoff when leaving the work area, and secure that sensitive information is removed from hard disks sent out for maintenance. Do not send sensitive information over the Internet unless it has been encrypted. Learning as much as possible about information security to assist the user’s ISO. Numbers alone make users the most important security asset. Compared to one ISO for a system, users offer a chance for numerous eyes and ears to remain alert to potential threats to information systems. May 2018 DRM Plus Administrator Manual v6.9 311 Appendix N – madExcept Application The madExcept application is a tool that has been added to DRM Plus to assist with error reporting from the field and implementing a fix in the application. In order to be prepared to use this tool if an error occurs while using DRM Plus, please review the following directions: Select all the OK buttons from any traditional error screen that may display in DRM Plus. There may be more than one traditional error screen or there may be none, but no matter how many, select the OK button on all. If any informational screen displays asking if the provider would like to view the last broker call, select the No button from that screen and continue through this process. As soon as the DENTALMRMTX.EXE error screen appears, select the ‘send system report’ button (first button from the left) as displayed: Figure 353: DENTALMRMTX.EXE screen After selecting the ‘send system report’ button, the Contact Information screen will appear. The screen asks for contact information so enter provider’s name and VA email address. Select the Continue button on the Contact Information screen to move on to the next step. Figure 354: Contact Information screen The Error Details screen will immediately appear. Add information in the in the Error Details screen providing as much information as possible. If known, list every click that occurred prior to the error message. The more details listed; the easier it will be to reproduce the error and fix it. May 2018 DRM Plus Administrator Manual v6.9 312 Figure 355: Error Details Screen Select the Continue button from the Error Details screen which will launch an email. The following screen will open the provider’s email screen. The example used is MS Outlook. The email address of both Vicky Byers and J.D. Carr will populate the ‘To’ field and the system report will be attached. Figure 356: Outlook Window May 2018 DRM Plus Administrator Manual v6.9 313 Enter the name and location (include city and state) of the VA dental clinic where the error occurred. For example, if the error occurred at the Daytona Beach Dental Clinic, enter Daytona Beach, Florida and please do NOT enter Gainesville, Florida, even though Daytona Beach is a Gainesville satellite clinic. Also include, if known, the person class or provider type/specialty and the phone number that may be used to contact the person reporting the error. Enter all this data in the email address window. The provider may add any other individuals as recipients (To and CC) in the email address fields as appropriate. Additional information may be included by entering that information in the email address window. Click on the Send button from the email screen. Select the ‘restart application’ button (bottom button on the right) from the DENTALMRMTX.EXE screen. This will close the madExcept tool and restart DRM Plus. Note: After an error occurs while using DRM Plus, please reboot the computer before continuing. May 2018 DRM Plus Administrator Manual v6.9 314 Periodontal Keyboard Shortcuts Tear-Out Figure 357: Periodontal Keyboard Entry Screen May 2018 DRM Plus Administrator Manual v6.9 315
Source Exif Data:
File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.5 Linearized : No Page Count : 315 Producer : doPDF Ver 8.4 Build 935 Create Date : 2018:05:03 16:02:21-04:00EXIF Metadata provided by EXIF.tools