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        User Guide - Care Management Plus
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1.   ori  of 1       Figure 25    Page 22 of 26    CM Total Encounters by Enc  Type    Clicking on the    CM Total Encounters by Enc  Type    button will bring up the following query screen   Fig  26   This query displays the number of Care Manager Patient Encounters falling within the entered  date range  sorted by Type of Encounter     in      ele Edit view Insert Format Becorde Tools Window He     1 Johnson Harm Visa   1 Jobson Telephon  Contact   2 Thomsen Class   2 Thomsen CM Othce Visit   2 Thomsen Nan Encounter Retaled  2 Thomsen   Telephone Contact             Figure 26    CM Total Encounters by Insurance    Clicking on the  CM Total Encounters by Insurance  button will bring up the following query screen   Fig  27   This query displays the number of Care Manager Patient Encounters falling within the entered  date range  sorted by Insurance Provider and Patient Status       Eile Edit View Insert Format Records Tools Window Help  i   CM Total Pat Encounters by Insurance   Select Query     _  Care Mgr ID   CM Last Name   CM First Name  Insurance      Status   Total Pat Encounters    n 1 Johnson IHC Health Plans Active   1 Johnson Mailhandlers Active   2 Thomsen IHC Access Active   2 Thomsen Other 1X Only   2 Thomsen Private Pay Active    Record  1   4   1  gt   oi   gt    of 5  NN n  17    Figure 27          CM Total New Patients Referred    Clicking on the  CM Total New Patients Referred  button will bring up the following query screen  Fig   28   This query displays the 
2.  first name  last name  encounter date  encounter type  or encounter outcome     E VES er  ESA y List   pe      autos   com      v TE  inim     Care Manager  Sort by  Eos Name       Figure 15    Click    Run Encounter Summary    to run the report  Fig  16        fle Gd vew Jools wrew tele     attent Encounter Scummor    Care Manager Patient Encounter Summary  For Time l er  od   132 2004 m 1 1000    Arm Thomsen  Fea one Phonefiumt  r  Encounte Date     Encounter Type  ates DIT NAVIA Mp ome ves  Gotz CSS 203004 Teror Caimi  Bate BONA INGA Telephone Contact  i MOD ex Terr Cord   Sey  800 222 2220  wanu CM Ofte vist  S  78  222 7779 VIA    80022222222 12 9424  Roost  00 999 3998     101 2004  Aat Seen TA  Robet Roses NOD  Kobe eo eee BO  Robet PON 1040s       Figure 16    Page 18 of 26    Mental Health Reports    PHQ  List   e Clicking on the  PHQO List  button will bring up the following PHQ9 List Parameters screen  Fig   17   The PHQ9 List report generated is a list of PHQO scores for Patients assigned to the selected  Care Manager Diabetes Educator  This report can be sorted by date  first name  last name  or suicide  risk  The report is especially helpful for viewing progress over time        Figure 17    Click    Run Patient PHQ9 List  to run the report  Fig  18      Care Manager Patient PHQ9 List       i    HHEEIEEPEEET ETT TI  iitiiitittitiiitii    Peewee     Deum HGF Hew  Sect  Fan Dem QR hac Ste  wa eee LO    eee n  mere OF  eer  OF  fore oe  Mn nay  Ma Ae  ere OF  Mamm
3.  mee  Ma  Care  Mabe mt  eee OF  ome OF  ore  Cmm  eee t  uenen Cm  Mea nts  eo OF  Deme ter    HEEL FG       r  r        T  Li  t  T  v     r  L    Li     r  Li  r  t  LJ          MV M A     NU V 9 e      V 9 v 4    lJ  oDesaeooaoasssoou    i          Figure 18    Page 19 of 26    Queries  View Queries  Clicking on the    View Queries    button will bring up the following Queries screen  Fig  19    e Generate queries by entering a date range  Start and End Date  and choosing the button  corresponding to the query you wish to run     e These listed Queries are    canned    queries  Any queries not listed here are not available to the users  unless this screen is customized by a programmer              Page 20 of 26    CM Total Encounters   Clicking on the    CMT Total Encounters    button will bring up the following query screen  Fig  20   This  query displays the number of Care Manager Patient Encounters falling within the entered date range     E CMT    Eile Edit View Insert Format Records Tools Window Help    i   CM Total Pat Encounters   Select Query        Care Mgr ID   CM Last Name   CM First Name   Total Pat messem    gt      1 Johnson John  la  2 Thomsen Ann    Record  14  4    1  gt  Lot  gt   of 2       Figure 20    CM Completed Calls    Clicking on the    CM Completed Calls    button will bring up the following query screen  Fig  21   This  query displays the number of Care Manager Telephone Calls and Average Call Length for Care  Manager Patient Encounters falling
4.  within the entered date range     E CMT    Eile Edit View Insert Format Records Tools Window Help    2  CM Completed Calls   Select Query       Care Mgr ID   CM Last Name   CM First Name   Total Completed cus Average Call Length  mins  Per peret  n 1 Johnson John    os  2 Thomsen Ann i    Record  14  4    1 Lot   gt   of 2          Figure 21    CM Total Encounters by Diagnosis    Clicking on the    CM Total Encounters by Diagnosis    button will bring up the following query screen   Fig  22   This query displays the number of Care Manager Patient Encounters falling within the entered  date range  sorted by Diagnosis  Please note  In the CMT database  encounters are not linked with  specific diagnoses  Therefore  it cannot be deduced that there were 6 encounters geared specifically for  Diabetes management in this time period  see Fig  22   Rather it suggests that there were 6 encounters  within this time period with Patients who have Diabetes in the Problem List     CMT   Ele Ede view insert Format garnrds Took Window tsip    CM Total Pat Encounters by Diagnosis   SE    1 Johnson Joh Anxiety    Johnson CHF    1 Johnson Depres son  2 Thorsen Depressaon  2 Thomtan Diabetes   2 Thomsen Other          Figure 22    Page 21 of 26    CM Clinic Visits    Clicking on the    CM Clinic Visits    button will bring up the following query screen  Fig  23   This query  displays the number of Care Manager Patient Encounters of type Clinic Visit falling within the entered  date range  and th
5. 05    Care Manager  Ann Thomsen          Date Meo Stat SianiC  nc Mhi Debetesfd CmeMgnt GetticEn SetDeenn Teaching Dnighep teen Bula PO  WAI u a      u E    n 9 n g a  Tea v D  u a m   u s Li u L   1n2005  n a n a o     n   n   o  1130005 n n  0 a 140 o a a n    9  1250905 g v   o 99 e o o n 9 o  1  b 0    6 e    4 0 5 0   es u 9 v u LJ v    6   130 5 Ed o 240 12m e o 0 o o   Grane  otak  T 1      p                E    Figure 33    Page 26 of 26    Tips for Entry   Data Integrity    e Using drop downs   Always drop down to select   NEVER type in an entry  If it needs to be added   do so in Value List from the Main Menu or request a change from your database  administrator programmer     e Dates  If typing in a date  you must use the MM DD YYY Y format   03    instead of    2003    will  generate an error   or click on the         button for a pop up calendar     e Consult the Data Dictionary and or Data Manager for your program when in doubt as to what to  enter into a field     Technical Programmer Use Only    Following are instructions for revealing and hiding the tables of the CMT software so that programmers may customize it     1  Right click on the title bar of the CMT Care Management Menu    2  Choose Form Design    3  Right click again on the title bar of the CMT Care Management Menu    4  Choose Properties    5  Scroll down to the Form s  On Load  property and click on the words  Event Procedure   Click the button with the 3 dots   6  Change all the  False  booleans 
6. Care Management Tracking  CMT  Software  User Manual  Pediatric       Eile Edit View Insert Format Records Tools Window Help   amp  CMT Care Management Menu    Care Management Tracking    Record Entry and Modification General Reports Queries    Patient List   View Queries    Encounter Tickler    Care Manager Table Entry      Admin Time    Diagnosis Table Entry   cl lll Administrative Time Information      Facility Table Entry   Mental Health Reports Administrative Time List    Insurance Provider Table Entry   pS     Medication Table Entry     Physician Table Entry            Page 2 of 26    Care Manager Tracking  CMT  Software    Table of Contents    Installins the Databases e stance cadets eat eb testes ts stn e e dl o efr 3  Si A A tet tree o PO re SOLE PO ee inner ee eee ETT ae 3  The CMT Care Management MenLUF 5o a Grace tup tite ed 3  Record Entry and Modification Section ii toii pe Gees pati dade ie on cade eee 4  Entering Values on Main Menu for Care Managers  Diagnoses  Facilities  Insurance Providers   Medic atl ons  and  PHYSICIANS   d ee obi VI oido ies idas 4  Patient Information AE AAA AE EE e e eee SDE BER AER 5  General  REPO tmb 15  VS O RO 15  Encounter l iekler ooa re aio I REB aS 16  Encounter Summit o o eost e Educ M E UE 17  Mental Health REPASA a Lu oiu Re E o a BAe Ra Ms 18  ides UE MOT                                          E 18  UE o ee e AI Der cerco de c aot De e o kir ek E ces 19  VIEW QUEME NOCTEM EH 19  Admirm Die os e eosdebet i tv MUR 24  Adm
7. Date   o Diagnosis    Click the    Save Diag     Button to save the record and close the window to return to the main  Patient Information screen     5 Patient Diagnosis x     Patient Diagnosis    Diag  Date  T  Diagnosis          Specialist            um  Status   active        Notes             New Diag    Save Diag    Delete Diag       Record  14  4   1            of 1  Filte    Figure 4    Page 8 of 26    Encounter     Clicking this button will bring up the following Patient Encounter screen  Fig  5   Enter the  Encounter information  Please note that Scheduled Time must be entered in the format    HH MM  AM    or    HH MM PM        For a future Encounter to appear on the Encounter Tickler Report accessed from the database Main  Menu  you MUST enter the top half  above the line  of the Encounter pop up entry screen  This  portion drives the report     Required fields are in blue  Omitting these fields will generate a pop up error message when you  save the form    o Scheduled Date    Click the    Save Encounter    Button to save the record and close the window to return to the main  Patient Information screen  You will notice that the windowpane for Encounters on the Patient  Information screen will display that Encounter as    Pending        Once the Encounter has been completed  go back to the Encounter screen for the Patient to fill in the  bottom portion  below the line  of the Encounter record  Filling in an Actual Date will cause the  windowpane on the Patient Infor
8. Diabetes  Educator  This report can be sorted by first name  last name  diagnosis  insurance  PCP  Primary Care  Physician   or status     El CMT    Eile Edit View Insert Format Records Tools Window Help      CMT Care Management Menu    Care Management Tracking  Record Entry and Modification General Reports    once   mame     Blood Glucose Meter Table Entry    amp  Patient List  a   Patient List Parameters          Care Manager  Porn   Diagnosis Table Entry   Sort By   Last Name m  Facility Table Entry   Run Patient List    Insurance Provider Table Entry    Medication Table Entry   ADA Report    Physician Table Entry   Patient Goal Progress Report    Patient Education Progress Report            Figure 11    Click    Run Patient List    to run the report  Fig  12      Bom     Bie git View Tool Wiany Help    Care Manager Patient List  Care Manager  John Johnson    1  tan ter Lati Mena Pennee    Sidi Prorm Nunta Panay Cm ypc paps    i Jerre Amen Adiw     18907773777  Davies ro  o     c Aon   Aen Mitch  Dart Men  Mic  Dew Men Mith  hand G Durham Terry    Jon aden Minh          Trt Patierty E    Pap aL Td sj    mJ            Figure 12    Page 16 of 26    Encounter Tickler   e Clicking on the    Encounter Tickler    button will bring up the following Tickler List Parameters  screen  Fig  13   The Encounter Tickler report generated is a Tickler To do list for contact by date  range for Patients assigned to the selected Care Manager Diabetes Educator     Ed CMT    Eile Edit View Inse
9. E  OS 15  n  o D  S El    S o S   9 2    lt   iat   SIS  o  a D   lt  n  alale  5  pe 5  B 9             Check Adherence  ollowing recommendations Patient following recommendations    Patient taking medications    Patient seeing therapist    Patient practicing self management    Patient Identified Goal   Severity of Patient validated  standard measure   of impairment over time   Include Patient at next MH Care Conference    Was Patient referred to MH off site    General MH Comments for Patient      No    aking medication  Checkbox       YesiNo          No    eeing therapist  Checkbox      YesNo     1 1   No    elf Management Checkbox_____  Yes No__________  No    dentified Goal Textbox         JFreTe   No       No       No      N    O  o  c  D  C  D   lt   o  a      lt               Care Conf  site  Texbox          FreeTet       No     PHQ 9  Depression    Symptom Count Drop down 0 1 2 3     Z  O    oa  2   e         DIO  el  o  3  3 z  ac  alg  Q9           U         Es     Depression Symptoms Score based on the  personal health questionnaire nine symptom  checklist  PHQ 9  calculated by totaling the  values for each depression symptom question        Page 4 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Severity Score Textbox Numeric No Severity Score based on the personal health  questionnaire nine symptom checklist  PHQ 9   calculated by totaling the values for each severity  question    Functional Difficulty Not at all  Somewhat  Very  Level of di
10. Y  7 N   Vent type   T  Fomula    p  Feeding pump supplies   T  N G Tube    GT GJ type size  T  Carseat   Wheelchair   T BP Monitor   Other    Home Care Comments       Developmental Rehab  Company Name    Phone     mo   el   m  I         Speech     Vision      Developmental Rehab Comments     School    Phone     Community Resources  Applied Accepted Denied    DSPD  Caseworker   Phone      ssl   Waiver Program    Technology Dependent Children    TBI    DDMR r   WorkForce Service    Food Stamps    Child Care n    WIC r  r  r    m    Housing Assistance    Medicaid  Caseworker   Phone    Medicaid  Community Resources Comments     Mental Health    Phone    Other   Last revision date     gt       New Ped Save Ped Print Ped Delete Ped  Assessment Assessment Assessment Assessment    71111111  LCM ICH    a  Record  i4   4    2    gt t  rl of 2  Filtered  X  ee  4       Figure 8    Function     o Assessment Date    Page 12 of 26    Clicking this button will bring up the following Function screen  Fig  9   Enter the Function  information     Required fields are in blue  Omitting these fields will generate a pop up error message when you  save the form      Click the    Save Function Assess    Button to save the record and close the window to return to the  main Patient Information screen      amp  Function    Function    x           Assessment Date   9 5 2006              Activities of Daily Living Score  ADL     Instrumental Activities Score  IADL        Able to do without help   1  Ge
11. ___________  __No_  Activities of Daily Living Score  Values 1 to 6    Instrumental Activities of Daily Living  Checkbox Yes No No IADL Question  ls Patient able to  Shop  without  Question 1 help     Question 2 telephone  without help    Question 3 help    Question 4 the home  without help    Question 5 Checkbooks  Finances  without help   Question 6  Housekeeping  without help     IADL Question  Is Patient able to  Take    Question 7 Medications  without help   Values 1 to 7  i    MMSE Mini Mental Status Examination Score    Pain Score  Scale 0 10  Comments relating to Function       Page 10 of 10    
12. ail   Non Encounter Related    Diab Initial  Diab Followup    Diab Class 1  Diab Class 2    Diab Class 3  Diab Class 4    Diab Class 5  Diab Class 6    Diab Additional Class  Diab   Inpatient  Diab Insulin Start         Class    Patient Education     Non Encounter Related    Filling out forms  admin  other charting  etc      Drop down   Active  Resolved   No  Status of the Diagnosis    No       Yes      Page 2 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Enc  Reason Drop down DEA Screen  PHQ 9 F U  Reason for the Care Manager Patient Encounter  MHI F U  DM F U   Depression F U   DM Depression F U  Med   Assist   Medication Mgmt  Agreement  Status Check   Resource Management  New  Patient    Assistance Financial Assistance  AAA eee EA  Narcotic use    Resource Management Assisting Patient with Referrals  Procurement   Research  etc   ex  finding MDs or Nursing  Home  obtaining equipment     Actual Date Date field Date MM DD YYYY Date Patient Encounter Actually took place    Outcome Drop down Completed  No Show  Outcome of Care Manager Patient phone  Cancelled  Reschedule  call visit  Wrong Number  No Answer   Left Message  Letter Sent   Disconnected  Deceased    No Answer    Includes Busy Signal  Call Attempts to Pts 1 2 3 4 5  Number of tries to reach Patient by Phone    Total Call Time for Day Textbox Numeric No Total Length of time on phone  in minutes  for the  day for the Encounter    Resource Time Textbox Numeric No Total Time spent on any prepa
13. d  Anxiety Comments Textbox     J FreeTet              No   Comments relating to Patient anxiety  Sleep Assessment  Sleep  Difficulty   Checkbox   YesNo   No  Patient having difficulty sleeping   Sleep  Severit Textbox    Numeric         No  Severity of Sleep Difficulty  Scale of 0 10    Pediatric Onl  Parent Vanderbilt  Only if ADHD  Parent Vanderbilt 1 9 Textbox      Numeric   No   Parentreported Vanderbilt Questions 1 9  Parent Vanderbilt 10 18 Textbox  Numeric   No   Parentreported Vanderbilt Questions 10 18  Parent Vanderbilt 19 26 Textbox   Numeic         No  Parent reported Vanderbilt Questions 19 26    No      No      No             Parent Vanderbilt 27 40 Parent reported Vanderbilt Questions 27 40  Parent Vanderbilt 41 47 Parent reported Vanderbilt Questions 41 47  Parent Vanderbilt 48 55 Parent reported Vanderbilt Questions 48 55  if ADHD          D  Oo      o  2g  Qo  Bin    lt   SIS  315  oja  E    2      oro       Teacher reported Vanderbilt Questions 48 55      No      No      No      No      No      No    pepe AA    No      No      No      No      No      No      No      4o  o  D  Q     o  TE   lt   D  2  a   e   E   o   p  A  o  cn  nn    A A 2 2  jojolo  wv  v  v  Oo  O   O O  zo y  Ren yd ea ud rn y  OJOJO O  al la sie   lt   lt   lt   lt        Jo  o  2  2 25 2  ajajaja  jojojo    p  13  a toa fea fon          hina       Jdo jo  ALII  NIOJ        ing Scales Sx Dev Score  40   Developmental  Intake Onl  ymptom Rating Scales Sx Dep Score  100   Pediatric Depr
14. e Average Clinic Visit Time with those Patients       Eile Edit View Insert Format Records Tools Window Help    amp  CM Clinic Visits   Select Query        Care Mgr ID   CM Last Name   CM First Name   Total Clinic Visits   Average Clinic Visit Time TET  P      Thomsen     Am ag    1 Thomsen Ann    Record  KIRAI  1  gt   ot  pe  of 1  4          Figure 23    CM Total Encounters by MD    Clicking on the    CM Total Encounters by MD    button will bring up the following query screen  Fig   24   This query displays the number of Care Manager Patient Encounters falling within the entered date  range  sorted by Primary Care Physician     Ed CMT loj x    Eile Edit View Insert Format Records Tools Window Help  i   CM Total Pat Encounters by MD   Select Query   f  Johnson Allen  Mitch   2 Thomsen Benson  George    2 Thomsen Carmen  Julie  2 Thomsen Durham  Terr    Record  14  4 Il 1  gt    gt t   gt   of 4  4          Figure 24    CM Home Visits    Clicking on the    CM Home Visits    button will bring up the following query screen  Fig  25   This query  displays the number of Care Manager Patient Encounters of type Home Visit falling within the entered  date range  and the Average Clinic Visit Time with those Patients     E CMT    Eile Edit View Insert Format Records Tools Window Help    is  CM Home Visits   Select Query Bl xi     Care Mgr ID   CM Last Name   CM First Name   Total Home Visits   Average Home Visit Time  mins   A So d 3D     1 Johnson John 30    Record  14  4    1  gt 
15. en          Figure 30    Page 24 of 26    Admin Time    Administrative Time Information   Module to enter Care Manager time not spent on Patient Encounters such as meeting times  education   and vacation   Fig  31   Enter the Administrative Time Information  The total time for the day will be  automatically calculated  Each day should be entered separately     Click the    Save Day   s Time    Button to save the record and close the window to return to the CMT  Care Management Menu  Main Menu       amp  Administrative Time ES xl     Administrative Time Daily Entry  Date           Care Manager  A      Meetings Time  in minutes   Medical Staff Meeting       Staff Clinic Meeting   Mental Health Integration  Diabetes Education   Case Management Meeting  Geriatric Education  Self Development  Teaching   Drug Rep Meeting   Team Building Meeting    Paid Time Off    TITTEN    Total Meet Time for Day    mins    Save Day s  Time    Record  14  4    191         gt   of 19  Filtered     Figure 31          Page 25 of 26    Administrative Time List   e Clicking on the    Administrative Time List    button will bring up the following Admin Time List  Parameters screen  Fig  32   The Administrative Time List generated is a summary report for all  Care Manager database users generated from the Administrative Time Information module           Figure 32    Click    Run Admin Time List    to run the report  Fig  33         Care Manager Administrative Time List  Var fine Piro  177 2005 to 1 9  20
16. er     or    MH Instruments     etc  button at the bottom left of the  screen  This will pop up an entry screen  All records entered of that type for the Patient you are  currently viewing will be retrieved  Once this screen appears  you will see the latest  most recent  date  entry record of that type for the current patient  Be sure to click the    New    button to clear  the screen  or you will overwrite an existing record  If you wish to  you can navigate through these  records using the navigation arrows next to the Record number on the bottom of the pop up screen if  necessary     Page 7 of 26    Click the    Save    button and close the window to return to the main Patient Information screen  You  will notice that the record you just entered will now automatically appear in the corresponding     windowpane    on the main Patient Information screen for that Patient  if your database has that  specific windowpane      e Diagnosis  Clicking this button will bring up the following Patient Diagnosis screen  Fig  4    Enter the Diagnosis information  Status has a default value of    Active        To enter multiple Diagnoses  enter them separately  even though they may have the same date   instead of combining using the Notes field  That way if one Diagnosis has a Status of    Resolved     and another    Active     they can be tracked separately     Required fields are in blue  Omitting these fields will generate a pop up error message when  you save the form     o Diagnosis 
17. ession  i S  S    m n  lt   s  8  2     S  3  QJ Lnd  sl 8  5 3  a  3   99    pa    zi     0     mptom Rating Scales Imp Dev  YOQ Youth   YOQ Youth Score    Textbox  Free Tet   No  Comments relating to Depression          PEDIATRIC ASSESSMENT  Individual Health Plan   Ped Assess Date Date field Date MM DD YYYY Date of Patient s Pediatric Assessment    core  20   Pediatric Depression    core  20   Developmental  Intake Onl  YOQ Youth administered     No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No  No    RRS  ro   lt  3  g  S        o S  OIO  olo g  IE    3 ka  518  o  9  o 9  D  n  3   o  U   D   o       Page 6 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Consultants Specialty Phone    6 Textbox Free Text No Consultants working with the Patient  includes  fields Consultant specialty and phone    Home Care Nursing    Services Ordered Services ordered from Home Care Nursing  Agenc    Home Care Equipment    Home Care Equipment Company Home Care Equipment Company Name  Name    Trach Tube type size Textbox Free Text No If Patient has trach tube  what is the type and or  size of the tube     Checkbox Is Patient using a cuff   Checkbox Is Patient NOT using a cuff   Checkbox Is Patient on formula     Formula  text  If Patient is on formula  formula name and or  notes    is Patient using Feeding Pump supplies        Page 7 of 10    Data Element  Other  text   Home Care Comments  Developmental Rehab  C
18. f 6 sections  Record Entry and  Modification  General Reports  Mental Health Reports  Diabetes Reports  Queries  and Admin Time     Page 4 of 26    Record Entry and Modification Section  This section includes buttons to access the main Patient Information screen  as well as table information for    Care Managers  Physicians  Diagnoses  etc   which appear as selections in the drop down fields throughout  the database     Entering Values on Main Menu for Care Managers  Diagnoses  Facilities  Insurance Providers   Medications  and Physicians    e Click on the    Diagnosis Table Entry    button or other    Table Entry    button from the main menu  A  pop up window  Fig  2  will appear with all of the values for that category currently in the database  table available in the drop down menus  To add a new one  scroll down the window to the blank  line  Type in the new value and close the window  It will now automatically save to that table and  appear as an alphabetized choice in the drop downs within the database     Please note  If you are looking to add an entry for another category other than those listed on the    Main Menu  please contact your database administrator programmer  These will need to be entered     behind the scenes         amp  Diagnosis Entry x     Diagnosis 4        Scroll to end of list to enter a new item      Trach dependent              WeShux    E       Figure 2    Page 5 of 26    Patient Information    The Patient Information button brings you to the mai
19. fficulty or degree to which depression  Extreme impacts daily activities  ex  doing work  taking  care of things at home  or getting along with other    people     Dysthymia  Checkbox Yes No No Does Patient have Dysthymia  Steadman s defn    A chronic mood disorder manifested as  depression for most of the day  more days than  not  accompanied by some of the following  symptoms  poor appetite or overeating  insomnia  or hypersomnia  low energy or fatigue  low self   esteem  poor concentration  difficulty making  decisions  and feelings of hopelessness      PHQ Suicide Q9 Drop down 0 1 2 3 Suicide Score based on the personal health  questionnaire nine symptom checklist  PHQ 9   calculated by totaling the values for each suicide  question    Suicide State Drop down 1  Thoughts Only  2  The state of risk for Suicide for the Patient   Thoughts and Plans  3   Thoughts Plans Actions    Suicide Risk Drop down No Risk  Low Risk  Medium Potential Patient has in taking his her own life  Risk  High Risk    Mood and Anxiety   Sleep  Score  40 100       Page 5 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Data Element Type Control Definition    ymptom Rating Scales Sx Anx  Textbox  Numerie____________ __ No__   Score  30  60  mptom Rating Scales Imp Mood  Textbox      Numeric         No  Score  10 20   ymptom Rating Scales Imp Anx         Textbox      Numeric       No  Score  10  20  Mood Comments Textbox  Free Tet              No  Comments relating to Patient moo
20. ic  Community No Entity Referring Patient  Organizations  Health Plans   Home Health  Hospital   Medicaid  Other  Physicians    Referred By Name of Person s  Referring Patient  Referral Phone Numeric  000  000 0000 Phone Number of Person s  Referring Patient    Referral Date Date field Date MM DD YYYY Date Patient was Referred Assigned to Care  Manager    Page 1 of 10       Data Element  Primary Insurance    2nd Insur     Care Mgr    PATIENT DIAGNOSIS  Diag  Date    Specialist    tatus  Notes    cheduled Date  cheduled Time  Encounter Type       Care Manager Tracking Database Data Dictionary  Pediatric     Drop down From Insurance Patient s Primary Insurance carrier  Defaults to  Table Values     Unknown  if not entered    Care Manager assigned to Patient    Drop down From Insurance Patient s Secondary Insurance carrier   Table Values    Drop down From Care Manager  Table Values  Date field Date MM DD YYYY Date Diagnosis Management began    No  No  Yes   Drop down From Diagnosis Yes Patient s Active Problem from Problem List   Table Values   From Physician Table Values  No  Physician managing the Diagnosis  No  No  No  Yes    otes relating to the Diagnosis    F  Date field Date MM DD YYYY Yes ate for Patient s scheduled phone call visit  Time field Time HH MM AM PM ime for Patient s scheduled phone call visit      No    Drop down CM Office Visit  Class  MD Type of Care Manager Patient Encounter   Office Visit  Home Visit    Telephone Contact  Group   Visit  MHI Conference  Em
21. ide  O  Suicide Risk  No Risk    Diagnosis   2 28 2005 CHF Specialist  Benson  George Status  Active    Diagnosis   3 30 2004 Depression Status  Active    Diagnosis   3 30 2004 Anxiety Status  Active    Record  14  4 I  11009       gt   of 1       Figure 10    3  To copy the text  as much as you need to transfer to another program    Click inside the box where the summary appears  Highlight the text you want to copy  Right   click and choose  Copy  from the menu   Not highlighting first and just right clicking will  highlight everything and save time if that s what you want to do      4  Paste the text into the other electronic charting location   Open the program into which you wish to paste your Note  Once you choose your Patient in that  system  go to where you normally enter a Note to type in or copy in information and do a  Control V sequence   Hold down the  Cntrl  key in the bottom left of the keyboard and then  press the  V  letter key on the keyboard   This is a shortcut to the Paste command  Your    electronic charting system may not let you Right click and choose  Paste  as we did with   Copy       Please Note  You may also print from this screen by clicking the printer icon on the top right of the  screen     Page 15 of 26    General Reports    Patient List   Clicking on the    Patient List    button will bring up the following Patient List Parameters screen  Fig    11   The Patient List report generated is a list of Patients assigned to the selected Care Manager 
22. indows when you need to  go to another electronic charting method to enter a Note with results from Encounters  Mental Health  Instruments  Diagnoses  etc  just entered into the CMT database     1  Choose a date  Enter a date in the white text box to the right of the button OR click the asterisk  button to the right of the date field to pop up a calendar for reference  In case you are looking for   Last Friday     for example  and don t know the date off the top of your head      2  Click the  Generate Clinical Note by Date  button and a Clinical Note Summary Screen window   Fig  10  will pop up which will summarize all events for the day you selected for that patient   the record you are currently viewing      Any Encounters matching that date  Any MH Instruments recorded matching that date  and  ALL Diagnoses for that Patient  regardless of date  will appear  We included all Diagnoses  for an at a glance reference  you may not wish to copy and paste an earlier Diagnosis that  doesn t relate to the date with which you are concerned     Page 14 of 26     amp  Clinical Note Summary X    gt   Summary for   revens  Daniel ID Number  F  amp             Encounter   Scheduled Date  1 26 2005 Actual Date  1 26 2005 Telephone Contact Depression F U Completed  Call Attempts  2 Call Length  12 min   Notes  PHQ 9 1 3   Doing much better   Not taking Depakote or Klonopin     MH Packet     1 26 2005 PHQ 9 Symptom Count  1 PHQ 9 Severity  3 Funct  Diff  Somewhat  Dysthymia  Yes   PHQ9 Suic
23. inistrative Time Information asszerint e n a a sdana 24  Administrative Linie  1st iet intet ate t eate editus a l ae 25  Tipsfot Entry   Data dte PEIO o oco pU cotidie et oru edes hod eet ata a at Gud tedious 26    Technical Programme  r Us   Dd i eMe 26    Page 3 of 26    Care Manager Tracking  CMT  Software    Installing the Database   To install the database for a single user  download and save the CMT mdb file to the desired folder on a local  drive computer  For multiple users  install the database on a network drive  Users can be given access  rights permissions to that drive  map the drive to their computer  and create a shortcut on their desktop to access  the live database     Opening the Database  To open the database  double click the    Shortcut to CMT mdb    icon on your desktop  The CMT Care  Management Menu will appear  Fig  1     Ed CMT z  n  x     Eile Edit View Insert Format Records Tools Window Help   amp  CMT Care Management Menu    Care Management Tracking    Record Entry and Modification General Reports Queries    Patient List   View Queries    Encounter Tickler    Care Manager Table Entry         Admin Time    Diagnosis Table Entry   eai alak Administrative Time Information      Facility Table Entry   Mental Health Reports Administrative Time List    Insurance Provider Table Entry   eee    Medication Table Entry    Physician Table Entry               Figure 1    The CMT Care Management Menu  The Care Management Tracking Database Main Menu is composed o
24. mation screen to display    Completed    and the Encounter to drop off  the Encounter Tickler    to do    List      amp  Patient Encounter x     Encounter Information    Scheduled Date           Scheduled Time     Encounter Type    X   Enc  Reason    m      Actual Date        Outcome    E    Call Attempts to Pts    Y   Resource Time     in minutes     Total Call Time For Day    in minutes  Climic Visit Time     in minutes   Number of Phone Calls  Home Visit Time     in minutes   Notes           New Encounter   Save Encounter   Delete Encounter      Record  14   4    1119       gt   of 1  Filtered        Figure 5    Page 9 of 26    e Meds     Clicking this button will bring up the following Patient Medication screen  Fig  6   Enter the  Medication information     Required fields are in blue  Omitting these fields will generate a pop up error message when you  save the form    o Medication    Click the    Save Med    Button to save the record and close the window to return to the main Patient  Information screen      amp  Patient Medication x     Patient Medication    Medication Start Date  NENNEN  gt    Medication End Date  pooo       Medication       lc   PRN  Dose                 Motes  i    ji   Save Med   Delete Med      Record  14   4     gt    b   gt   of 2  Filter    IS 6               MH Instruments     Page 10 of 26    Clicking this button will bring up the following Mental Health Instruments screen  Fig  7   Enter the  Mental Health Instruments information  Scores en
25. n data entry screen  Fig  3   Here you will locate enter  new Patients  record new encounters  assessments  and diagnoses  The top portion of the screen displays  Patient demographics as well as information regarding the Patient   s status with the Care Manager  The  middle section of the screen consists of several    windowpanes    which summarize and provide at a glance  data entered via the navigation buttons on the bottom left of the screen  Also indicated within a thick black  box on the right side of the screen is the Patient Search section  The bottom of the screen houses the  navigation buttons for entering data for the selected patient  creating new patients  saving and deleting  patients  and generating clinical note summaries       nixi      Eile Edit Insert Records Window Help Adobe PDF     amp  Patient Information   Form    Patient Information    ID Number    7 Last Name   TEST First Name  rest pog   8 16 1990   Sex   M _y   Medicaid      Parents  Mom    Ginger Parents  Dad    Steve Other Guardian    Email   steve stevensQip com    Patient Phone   soo  800 8000 Cell Phone    Work Phone    Status   active x   Patient Search    ID Number     PCP  fallen  Mitch    PCP Phone   800  888 8888 Facility   asc Clinic    FPP   2 Confused Chaotic ica EOS mz      Referred From   Hospital y   Referred By    Referral Phone    Referral Date   3 30 2004     First Name    mal  Care Mgr    z    Primary Insurance   Maihandlers E   2nd Insur    E   Care Mgr   ohn T     Search for Pa
26. number of New Patients referred to the Care Manager with a Date of  Referral within the entered date range     CMT    Eile Edit View Insert Format Records Tools Window Help  i   CM Total New Patients Referred   Select Query       Care Manager  Care Manager Last Name   Care Manager First Name   Total New Patients Referred  hp Thomsen A 2     2 Thomsen Ann 2    Record  14         1  gt    PL  of 1       Figure 28    Page 23 of 26    CM Total New Patients Referred by MD    Clicking on the    CM Total New Patients Referred by MD    button will bring up the following query  screen  Fig  29   This query displays the number of New Patients referred to the Care Manager with a  Date of Referral within the entered date range  sorted by Patient   s Primary Care Physician     fa CMT    Eile Edit View Insert Format Records Tools Window Help       2  CM Total New Patients Referred by MD   Select Query   _  Care Manager First Name   Care Manager Last Name   Total New Patients Referred  PCP    Thornsen  1 Durham  Terry  Thomsen 1 Carmen  Julie    Record       1  gt    DLP  of 2       Figure 29    CM Resource Time    Clicking on the    CM Resource Time    button will bring up the following query screen  Fig  30   This  query displays the Total Care Manager Patient Encounter Resource Time within the entered date range   and the Average Resource Time for those Encounters     E CMI  loj x   EA Edt Viow keart Format Bwcorde Toob Wxkw Heb        M Resource Time   Select Query    1 Johnson  2 Thoms
27. ogram DDMR     Checkbox Has Patient Family applied for Waiver Program   Checkbox Yes No No Has Patient Family been accepted for Waiver  Program     Page 8 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Waiver Program Denied Checkbox Yes No No Has Patient Family been denied Waiver  Program     Workforce Service Food Stamps Checkbox Workforce Service Food Stamps   Workforce Service Child Care Checkbox Workforce Service Child Care     Service   Service   Service     WIC Applied Checkbox Has Patient Family applied for WIC   WIC Accepted Checkbox Has Patient Family been accepted for WIC   WIC Denied Checkbox Has Patient Family been denied WIC     Assistance   Assistance   Assistance     Medicaid Caseworker Medicaid Caseworker assigned to Patient   Medicaid Caseworker  Phone Numeric  000  000 0000 Patient s Medicaid Caseworker Phone  Medicaid Applied Checkbox Has Patient Family applied for Medicaid     Medicaid Accepted Checkbox Has Patient Family been accepted for Medicaid     Mental Health  Numeric  000  000 0000  Other    UNCTION    Assessment Date Date Field Date MM DD YYYY Date of Function Assessment       Page 9 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Data Element TiveeIControl  Values  Required  Definition   Activities of Daily Living Question 1 Checkbox Yes No No ADL Question  Is Patient able to  Get out of bed  help   Shower  without help   without help   without help   meal  without help      Textbox           Numerie
28. ompany Name  Company  Phone  PT  PT  text    peech  Community Resources  Speech  text  OT  OT  text  Vision  Vision  text  Developmental Rehab Comments    chool  School  Phone  DSPD Case Worker  DSPD Case Worker  Phone  DSPD Applied  DSPD Accepted  DSPD Denied  SSI Applied  SSI Accepted  SI Denied  Waiver Program Technology  Dependent Children  Waiver Program TBI  Waiver Program DDMR  Waiver Program Applied    Waiver Program Accepted       Care Manager Tracking Database Data Dictionary  Pediatric     Other Home Care Equipment items notes  Comments relating to Home Care    Developmental Rehab Company Name   Numeric  000  000 0000 Developmental Rehab Company Phone  Patient in Physical Therapy   Comments relating to Physical Therapy    Patient in Speech Therapy     Comments relating to Speech Therap  Patient in Occupational Therapy   Comments relating to Occupational Therap  Patient in Vision Therapy    Comments relating to Vision Therap  Comments relating to Developmental Rehab    ree Text  Yes No  ree Text  Free Text  Patient s School   Patient s School Phone   Patient s DSPD Case Worker   Patient s DSPD Case Worker Phone   Has Patient Family Applied for DSPD    Has Patient Family been accepted for DSPD   Has Patient Family been denied DSPD    Has Patient Family Applied for SSI    Has Patient Family been accepted for SSI   Has Patient Family been denied SSI     Checkbox Yes No No Waiver Program Technology Dependent  Children     Checkbox Waiver Program TBI   Checkbox Waiver Pr
29. ratory work   minutes  for the Encounter  Face to face   Home Visit Time Textbox Numeric No Time spent on Patient Visit in Home  in minutes     Face to face       Page 3 of 10    Care Manager Tracking Database Data Dictionary  Pediatric     Textbox Free Text No Notes relating to the Care Manager Patient  Encounter    Date Field Date MM DD YYYY  Date Field Date MM DD YYYY    Drop down Medications from  Table Values    i  i  Checkbox Medication PRN    Yes   No   No   No   No   No   No   No   No   No   No   No   No   No    g  S  et  5  m      3  D  5  et    U   gt   E  m  z  par     m  2  O   gt   a  O  z    Date Medication Started  Date Medication Ended    Medication Name    A    ol     lz  O O O  2    ajaja  OOO  uoo  ojojo  e mo Y    mid  ajg  ol      U   zm  O10    Medication Dose  Notes relating to the Patient Medication    Notes    Date Date field Date MM DD YYYY       I     m  Z   gt   rm  I  m   gt   m        z  o      A  c     m  z     o    Date MH Instruments administered recorded  CM Relational Isolation Assess   Patient isolated from available support   Patient unwilling to use available support   Patient exhausted available support   Patient has available support actively using       Yes    Check Support AAA AAA AA  solated from available support  Checkbox       YesNo     1 1 1 1   Mo     Checkbox      YVesiNo       Mo     xhausted available support  Checbox      YesNo     1   Mo    ing  Checkbox       YesNo   No      I  Imicio  D 5  o            fo   vige  D  olo  
30. rt Format Records Tools Window Help         CMT Care Management Menu    Care Management Tracking  Record Entry and Modification General Reports Queries    Patient Information   Patient List   View Queries    Blood Glucose Meter Table Entry   Admin Time  AA   _ GENTES   Iin xl    WEE   Tickler List Parameters  agnosis le Entr     E Start Date    4 1 2005           Facility Table Entry   End Date    4 30 2005       Care Manager   ohni T    Insurance Provider Table Entry        Run Encounter Tickler    Medication Table Entry    Physician Table Entry   Patient Goal Progress Report    Patient Education Progress Report            Figure 13  Click    Run Encounter Tickler    to run the report  Fig  14      CM la    Say Edit yew Too Window Bias       Care Manager Encounter Tickler List  Care Manager  John Johnson    Sehat Di wel fime Encarte Type firman io Member Firet Neen e Led hnne free Hunter PCr Comments    AnACUUS Heontnoowter     Statue Ced 14 Aie wae POU 446 4448 Aen Mit des on tu Appt we Jo  Amaro MD Otten Viet 13 Haai a   RO  644 4444 Casters  Terry  SOO  Tebom  Cort Statue Cnet   Owe Seen  5001 800 8000 Alen  Mte       Figure 14    Page 17 of 26    Encounter Summary   e Clicking on the    Encounter Summary    button will bring up the following Encounter Summary List  Parameters screen  Fig  15   The Encounter Summary report generated is a summary of Encounters  by date range for Patients assigned to the selected Care Manager Diabetes Educator  This report can  be sorted by
31. ssment   Difficulty       Severity     0 10            Only if ADHD     Parent Vanderbilt     B   B   B  3    B   B  5 E  D  44 A  1 9 10 18 19 26 27 40 41 47     49 55  Teacher Vanderbilt   Only if ADHD     LEM M M NN   Vanderbilt Comments  o    Symptom Rating Scales   5x     140     A0   YOQ Youth   7  Imp 220 220  Score     Dew Dep  Developmental   Pediatric   Intake Only  Depression    Develop  Comments     Depress  Comments                Save Instrument  Data    Record  14   4 I  Edi    bl  rl of 7  Filtered     Figure 7    Delete Instrument  Data    xi       Page 11 of 26    Pediatric Assess     Clicking this button will bring up the following Individual Health Plan  Pediatric Assessment   screen  Fig  8   Enter the Pediatric Assessment information  Please note that you may also print a  copy of this screen form by clicking the    Print Ped Assessment    button on the bottom left of the  screen     Required fields are in blue  Omitting these fields will generate a pop up error message when you  save the form    o Ped Assess Date    Click the    Save Ped Assessment    Button to save the record and close the window to return to the  main Patient Information screen       ini x       Eile Edit View Insert Format Records Tools Window Help     amp  Pediatric Assessment SE EE       Contact    Phone     Home Care Equipment  Company Name    Phone         02 stationary portable   02 oximeter  SAT    J Apnea monitor   Suction machine supplies      Trachtube type size    Cuff     
32. t out of bed or chair  Y Y      N  2  Walk VY  M  3  Take a bath or shower P Y    N  4  Get Dressed IVY  MN  5  Go to the toilet VYP NW  6  Feed self a meal  I EM NI    ADL    4    Able to do without help   1  Shop MYP N  2  Use a telephone go sg     3  Cook MYP MN  4  Travel outside the home P Yp N  5  Bills  Checkbook  Finances  7 Y      N  6  Housekeeping I EN BI  7  Take medications MYP N    IADL    3    Total ADL or IADL score is the number of Functions the individual is able to do independently   6   full Function  4   moderate impairment  2   severe impairment    Mini Mental Status Exam Score  MMSE        MMSE    15    Pain Score  0 10    Pain Score    8       Notes     New Function Save Function Print Function  Assess Assess Assess    Record  14  4    it       gt  gt   of 1  Filtered        Figure 9    Delete Function  Assess            Page 13 of 26    e MODIFYING PATIENT INFO   Search for the Patient first to see if he she exists in the database   See above instructions      o To change demographic and status information on the main Patient Information form  modify  fields and click the    Save Patient    button    o On Diagnoses  Encounters  Mental Health Instruments  etc   click the    Edit    button on the  corresponding    windowpane    to get a pop up directly to that specific record  and click the     Save    button before closing the pop up window     e GENERATE CLINICAL NOTE BUTTON     This tool will save you from copying and pasting back and forth between w
33. tered on this screen originate from corresponding  instruments such as the PHQ 9  Patient Health Questionnaire   which are available for download    with the CMT database     Data entered on this screen will display on the Care Conference List Report from the Main Menu   Mental Health version of the CMT database only      Required fields are in blue  Omitting these fields will generate a pop up error message when you    save the form    o Date    Click the    Save Instrument Data    Button to save the record and close the window to return to the  main Patient Information screen     Mental Health Instruments       Check Support      Isolated from available support     Unwilling to use available support    Exhausted available support     Has available support actively using    Date       Check Adherence  Global Severity   j    Following Recommendations   1 7 4    Care Conf    Taking Medication   Referred To MH Off Site      Seeing Therapist    Self Management    Identified Goal       General Comments Plan        PHQ 9  Depression     Mood and Anxiety   Sleep    Pediatric Only       Symptom Count    m    Severity Score     Functional Difficulty    S      Dysthymia        PHQ Suicide Q9    x   Suicide Risk    S      Clinician Aware      Follow Up Required   7  Suicide Comments        Suicide State    y      Mood Screen      mans  vn         1 2    3    Symptom Rating Scales     5x  40  100  30  60  Imp  10  20  103 20  Mood Anx    Mood Comments     Anxiety Comments     Sleep Asse
34. tients      Diag  Date Diagnosis Status   Sched Date Sched Time Encounter Type Status Show all Patients                           edit    2 28 2005  cur  active    Ede    4 30 2005  felephone Contact  Pending          Edit    3 30 2004  anxiety active    Eat   1 30 2005    Homevst           Resolved     Med  Start Med  End Medication  Edit    3 30 2004  Depression  active Edt    1 26 2005  frelephone Contact    Resolved    eat    3 31 2005             pot         Edit   to 1e 200      Telephone Contact  Resolved      Edt fioriafznor TY fresolved      m edit    9 1 2004   Telephone Contact Resolved        En   gt        pp AA AAA              d   Pediatric     New   Save   Delete i rea  Diagnosis   Encounter   Meds arene Assess Function Patient Patient Patient srg    Record  14  4 i      gt I  r  of 1       Figure 3    Page 6 of 26    ADDING A NEW PATIENT    Search for the Patient to see if he she exists in the database    Go to the Patient Search section on the right side of the Patient Information screen  Enter in an ID  Number  Last Name  First Name  or Care Manager Diabetes Educator from the drop down lists to  search  Typing the first letter of a name will bring you to the right place in the list quickly   Click the     Search for Patients    button  You may search using a combination of fields  such as a first and last  name  to further narrow the search  Please note that once you have searched  you will be seeing a  subset of the records in the database  For example  yo
35. to  True     7  Close out of the database  all the way     8  Open it again 2 more times  The 3rd time you should see the database window     After you make your changes     Please go to  Tools  on the main Access toolbar  Choose Database Utilities and  Compact and Repair Database   It may take a few  moments  but then your windows will pop back up     Repeat the earlier steps to get to the code window or in Design view of the Main Menu choose View and  Code  from the main  Access toolbar  In the SetStartUp Properties  change all of the  True s back to    False     Close out of the database and go back in 2  more times  3rd time s a charm   to make sure the database window is no longer visible     Care Manager Tracking Database Data Dictionary  Pediatric     Data Element Type Control Definition    PATIENT INFORMATION    ID Number Textbox Numeric Yes Unique Number specific to a Patient in your  organization    Patient s Last Name    M  Male   F  Female   Numeric  000  000 0000  Numeric  000  000 0000    pO Closed E  Deceased  Moved etc     From Physician Table Values Patient s Primary Care Physician  PCP Phone Numeric  000  000 0000 Patient s Primary Care Physician Phone Number    Care Manager s Facilit    Patient s Family Pattern Profile   An assessment    From Facility Table Values  of the relationship pattern style that is most like    FPP Drop down 1 Disconnected Avoidance   2 Confused Chaotic   3 Secured Balanced the family of the patient      Referred From Drop down Clin
36. u may search on    Brown    as a last name   There may be several Browns in the database  Check the record indicator number at the bottom left  of the main Patient Information form to see which record you are on and how many records you are  viewing  You may see    Record 1 of 4    if 4 Browns have been found  If the current record displayed  isn   t the record you are looking for  you can use the    VCR like    4  back and   forward buttons to  move to the previous and next records  respectively  until you find the record you are looking for     Please note  To get back to viewing ALL Patients  click on the    Show All Patients    button in the  Patient Search area  You are now viewing ALL records in the database instead of just the subset of  Browns     If nothing comes up  the Patient has not yet been entered into the database  so click the    New  Patient    button on the bottom of the screen to clear the screen fields and enter the Patient  information     Required fields are in blue  Omitting these fields will generate a pop up error message when you  save the form     o Full Name  Last and First Names    o ID Number   Number unique to a Patient in your organization   o Care Manager Diabetes Educator   o Date of Referral    Click the  Save Patient  button on the bottom of the screen  You must save the record before any  other data can be entered on pop up screens     ADDING DIAGNOSES  ENCOUNTERS  MH INSTRUMENTS  ASSESSMENTS  ETC     Click the    Diagnosis        Encount
    
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