Viewing Orders

• Orders with CPOE Enabled (also known as CPOE Orders): This module displays the recent orders for the selected patient, including the name of each order, the start date, and the status (such as active, pending, or complete). These orders may be derived from the institution’s source HIM order entry system, or they may have been entered directly in Commure Pro. This module contains substantially more functionality than the Orders module as it allows you to view, enter, modify, hold, resume, renew, or discontinue orders for patients on your patient list. See Viewing CPOE Orders and Entering Orders for more information on the CPOE Orders module.
• Orders: This module displays the recent orders for the selected patient, including the date, time, and status of each order. The orders that are displayed are orders that were entered in your organization’s source HIM system. This is a “view-only” module and does not allow the entry or modification of orders. See Viewing Orders for more information on the Orders module.

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Viewing CPOE Orders

You can access and view CPOE orders in the Orders module if your administrator has enabled this feature for you. The CPOE Orders module displays the recent orders for the selected patient, including the name of each order, the start date, and the status (such as active, pending, or complete). These orders may be derived from the institution’s source HIM order entry system, or they may have been entered directly in Commure Pro. This module allows for viewing, entering, and modifying orders (see also Entering Orders). During rounding, you have ready access to a complete list of the patient’s recent orders so that you can take appropriate action. You can:

• Review the Summary list of new and existing orders. See CPOE Orders at a Glance, Viewing New Orders, or Viewing Existing Orders.
• Identify the type order by its icon. See Viewing Order Type Icons.
• Sort the list of orders. See Sorting the List of Orders.
• Filter the list of orders to view just a subset. See Filtering the List of Orders.
• View the details of one specific order. See Viewing the Details of Orders.

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CPOE Orders at a Glance

The Orders module opens with a Summary of orders for the selected patient. This summary is broken into three sections:

• New Orders: This section contains orders of any type that you have entered on your device but have not yet submitted.
• Existing Orders: This section contains orders of any type that were previously entered in the system. This section always lists all current active orders. However, the number of past inactive orders or future orders that are available for viewing on the Existing Orders list is determined by your system administrator. If the patient has any expiring medication orders, these are always sorted to the top of the list. Use the Orders Summary to get a quick overview of the items that you are in the process of ordering, the medications that are about to expire, and the items that have already been ordered for the patient. From this screen, you can manage the patient’s new or existing orders, and you can also enter additional new orders.

To view the Order Summary, log into the Commure Pro application and then follow these steps:

1. From the Patient List screen, select a patient. The View Modules screen is displayed. If your last viewed module displays instead of the list of modules, tap View Modules at the bottom of the screen.
2. Select Orders on the View Modules screen to open the Orders module. The Orders Summary is displayed. It shows a list of new and existing orders.

From the Orders Summary you can:

• Confirm that you have selected the correct patient. The patient heading row shows the selected patient’s name, age, gender, location, and MRN.
• Review any clinical decision support (CDS) alerts that might be displayed. If any clinical decision alerts are present for the patient, they are listed in yellow, below the patient heading.Alerts can provide clinical data or inform you of issues related to an order. See Reviewing Clinical Decision Support (CDS) Alerts).
• Confirm that the correct visit is selected for any new orders you might enter. The Visit button, located at the top of the body area of the screen, shows the following information for the currently selected visit: the admission or appointment date/time, the location of the visit, and an abbreviation that identifies the type of visit (such as IP for Inpatient or OP for outpatient).

Any new orders that you enter will be associated with this visit. Select the Visit button to choose a different visit for your orders. See Changing the Visit for a New Order.

• Review the new orders that you have entered, but have not yet signed and submitted:
  • The New Orders section, located at the top of the body area of the screen, lists all orders that you have recently added, but have not yet signed and submitted. Each order is displayed on a separate line. See Viewing New Orders for a complete description of the orders in this section. There is also a Sign & Submit button that you can use to sign and submit all of your new orders, or a Discard All button to discard them. If you have not entered any new orders for the patient, this section, as well as the Sign & Submit and Discard All buttons, are not present on the screen.
• Review the patient’s existing orders:
  • The Existing Orders section is located in the body area of the screen, below the New Orders section (if present). This section lists all signed and submitted orders for the patient, including those entered by yourself and others. Expiring medications, if any, are always shown at the top of the list. You may need to scroll down to see the rest of the Existing Order section.
  • At the top of the Existing Orders section, a Filter button provides access to filter and sort options. See Filtering the List of Orders and Sorting the List of Orders.
  • The next heading tells you with which visit the orders are associated. See Viewing Existing Orders for information on how to use this heading to view the orders for various visits. See also Changing the Visit for a New Order.
  • Below the headings, each order is then displayed on a separate line. See Viewing Existing Orders for a complete description of the orders in this section
  • You can view or manage the details associated with any existing order: just select the order row (see Viewing the Details of Orders or Managing New and Existing Orders).
• Add a new order. Tap Add , located at the top right corner of the screen. See Basic Steps: Entering a New Order.
• Exit the Order Summary. Tap Back or tap the View Modules button to go back to the modules list, or tap the Patients at the bottom of the screen to go back to the Patient List.

Settings that control this feature: Remember Last

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Viewing Order Type Icons

All orders, new or existing, have an icon to represent their Order Type. These icons will help you easily identify the types of orders in the New Orders and Existing Orders sections of the Orders Summary, or when searching for orders to add. They are located to the left of the order name. These icons represent each order type as follows:

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Viewing New Orders

The New Orders section, located near the top of the Orders Summary screen, lists all orders that you have recently added, but have not yet signed and submitted. Each order is displayed on a separate line. The left column shows an icon representing the Order Type, followed by the Order Description. To view or manage the details associated with any of these orders, just select the order row. Below the list of new orders are two buttons. Select the Sign & Submit button to sign and submit all of your new orders, or select the Discard All button to discard them. If you have not entered any new orders, the entire New Orders section, including the Sign & Submit and Discard All buttons, is not present on the screen.

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Viewing Existing Orders

The Existing Orders section is located in the body area of the Orders Summary, below the New Orders section (if present). This section lists all signed and submitted orders for the patient, including those entered by yourself and others. At the top of the Existing Orders section, there are a series of headings:

• The first heading tells you about the filters that may be applied. For example, if you are only showing Lab order types, it might say “Filtered By: Lab,Yesterday / Tomorrow.”
• The second heading tells you with which visit the orders are associated. If the patient has orders from multiple visits, the orders for the currently selected visit are listed first under the Current Visit heading (note that the currently selected visit is listed at the top of the screen). If the patient has orders associated with any other visits, those orders are listed next, under the Other Visits heading. You can tap either visit heading to expand or collapse the orders underneath it. Below the headings, each order is then displayed on a separate line. The left column shows an icon representing the Order Type. Next is the Order Description, followed by the Start Date of the order, and then the Order Status (such as Active, Completed, or Pending). If the order is an expiring medication order, there is a comment in red below the description that indicates the date that the medication will expire (for example, Expires tomorrow at 9:30 AM).

If orders entered in the Transfer Order Reconciliation module have been configured to be held for routing until the patient actually transfers, they will display as follows:

• For a new medication order placed in Transfer Order Reconciliation, the order has a Held for Routing status with the label New Upon Transfer, to indicate that the new order is waiting to be sent to the back end system until the patient actually transfers. In Mobile CPOE, the provider cannot modify or discontinue the order.
• For an order that was discontinued in Transfer Order Reconciliation, the order has an Active status with the label Stop upon Transfer, to indicate that it will be discontinued in the back end system once the patient actually transfers. In Mobile CPOE, a provider can modify or discontinue the original active order (prior to the patient being transferred), if necessary.
• For an order that was continued in Transfer Order Reconciliation, the order has an Active status with no additional label. The order will be continued in the back end system once the patient actually transfers. In Mobile CPOE, a provider can modify or discontinue the original active order (prior to the patient being transferred), if necessary. Orders that are entered in Commure Pro CPOE (web or handheld) and that have not yet been processed by your source HIM system are shown in italicized font. Commure Pro orders that have been processed, or orders that were entered directly in your source HIM system, are shown in regular font.

To view or manage the details associated with any existing order, just select the order row.

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Sorting the List of Orders

The Orders Summary has two sections, each with its own default sort order:

• The New Orders section lists the orders in the reverse order that you entered them, with the last order that you entered at the top of the list, and the first order that you entered at the bottom of the list.
• The Existing Orders section always lists any expiring medication orders first. The remaining orders are then sorted as follows:
  • First, the orders are grouped together by order Type, and the types are listed in a specific fixed order: all Medication orders are listed together first, then all Lab orders, all Radiology, Other, Diet, and Nursing.
  • Within each order Type, the orders are then sorted by order Status, which effectively groups orders of the same status together. The statuses are listed in a specific fixed order: Submitted, Queued, Ordered, Held for Routing, Active, Held, In Progress, Pending, DC (discontinued), Complete, and Cancelled.

• Within each Status, the orders are then listed alphabetically by order Description. You cannot change the sort order for the New Orders section. You can change the way the list of Existing Orders is sorted, but keep in mind that expiring medication orders will always be displayed at the top of the list. For example, if you change the sort order to alphabetic by description, the expiring medication orders will be shown at the top of the list in alphabetic order by description, and then all other orders will shown underneath that, also in alphabetic order by description.

1. From the Orders Summary, tap Filter under the Existing Orders section. By default, the button shown is labeled with a description of any filters that are applied. The Filter Orders screen is displayed, showing your current filter and sort selections.
2. Scroll down and set the following sort options as you want them to be applied:
   • Under the Group By section, turn the Group By Type option On or Off as desired. When Group By Type is On, all of the orders of the same type are grouped together, and then the additional sorting options that you choose are applied within each group. For example, if Group By Type is On, and sorting is by Date in Ascending order, you will see all of the Diet orders listed in chronological order by date, and then all of the Lab orders listed in chronological order by date, and so on.
   • Under the Sort By section, select the attribute by which you want to sort.
   • Description sorts alphabetically by order name (A-Z or Z-A).
   • Date sorts by the order’s start date.
   • Status sorts by the order’s status (in a specific fixed order, as described above), with a secondary sort by order Description.
   • For the attribute you selected in the Sort By section, select the order in which you want to sort (Ascending or Descending).
3. Tap Done. The existing orders are displayed in the order that you selected.

The same sort order remains selected until you choose something different.

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Filtering the List of Orders

On the Orders Summary screen, the New Orders section always displays all new, unsubmitted orders. This section cannot be filtered in any way. However, you can use a filter when you want to limit the number of orders that are displayed in the Existing Orders section. For example, you might filter the list of Existing Orders to view only orders of a certain type (such as Laboratory or Radiology), or to view only orders within a certain timeframe. Please note that when you use a timeframe filter, the filter affects only inactive orders (discontinued, cancelled, or completed orders). All active orders are always shown (both current and future active orders), regardless of any timeframe filter that you might choose. When all of the existing orders for the selected patient are displayed, the column heading shows the total number of orders, such as “Existing Orders (20).” When you select filter criteria that excludes some of the orders, the Orders heading changes to show how many from the full list are currently being displayed. For example, you might see “Existing Orders (16 of 20).” To filter orders based on specific criteria:

1. From the Orders Summary, tap Filter under the Existing Orders section. When you first access the Orders module, the button is labeled “Showing All, Active Only, Grouped By Type.” However, if you change the filter, the button might display a different label, such as “Filtered By: Lab, Yesterday / Tomorrow, Grouped By Type.” The Filter Orders screen is displayed, showing your current filter and sort selections.
2. Set the following filter options as you want them to be applied:
   • Set the Active Only option On or Off as desired. When Active Only is On, only active orders will display on the Orders Summary screen and inactive orders (discontinued, cancelled, or completed) are not shown. In addition, the Inactive Orders section of the Filter Orders screen is hidden, to indicate that only active orders will be shown. When Active Only is Off, the Inactive Orders section becomes available, and you can select a timeframe using the From and Thru options. For example, you might choose From Last 5 Days, Thru Tomorrow.

• In the Order Typ e section, select All, or a specific order type such as Lab, Radiology, or Medication. For medication orders, you can select the general Medications filter to see all medication type orders, or you can choose a more specific medication filter such as:
• Expiring Only: Shows only medication orders that are expiring.
• IV Only: Shows only medication orders with Routes that begin with the letters “IV.”
• On Hold Only: Shows only medication orders that are currently on hold.
• Scheduled Only: Shows only medication orders that are not PRN.
• PRN Only: Shows only medication orders that are PRN (given as needed, such as for pain).

3. Tap Done. The Existing Orders list changes to display only the orders that you selected.

The same filter criteria remains selected until you choose something different.

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To show all of the orders for the patient

1. From the Orders Summary, tap Filter under the Existing Orders section. The Filter Orders screen is displayed, showing your current filter and sort selections.
2. Set the following filter options:
   • Set the Active Only option to Off.
   • Under the Inactive Orders section, select the earliest choice as your From option, and select the latest choice as your Thru option.
   • Under the Order Type section, select All.
3. Tap Done. The Existing Orders list changes to display all of the orders within the criteria.

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Viewing the Details of Orders

The Orders Summary lists all the important order information for the selected patient, including the type of order, the name, the start date, the status, and the total number of orders. This Summary might be all you need when you are rounding or checking a patient’s orders. For more information, such as the priority, frequency, or dosing information, go to the Order Details for an order. To review the Order Details for an order, select an order on the New Orders or Existing Orders section. The Order Details screen opens and displays the information for that order. The information that is shown depends on the type of order:

• Newly entered orders that you have not yet submitted are listed in the New Orders section. The Order Details screen shows the same fields that were seen when entering the order. For example, radiology orders might show the priority, frequency, and number of times. The detail fields are shown in edit mode, so that you can make changes if necessary. Or, you can delete the order entirely.
• Once an order is submitted, or if an order was entered directly in your source system, it is listed in the Existing Orders section. For these orders, the Order Details screen shows the same details that you saw when you entered the order, but they are displayed in a slightly different format. For example, the order details such as the dose, frequency, or route are all displayed as part of the order name (or the “order string”), rather than as separate fields. In addition, the order is shown in non-editable mode. Some existing medication orders may also include a Related Orders section. This section can contain either of the following:
• Linked orders (as indicated by the linked chain icon ). Linked orders are orders for medications that are related, typically because they are administered together. For example, Meperidine (Demerol) can be ordered for pain, along with Promethazine (Phenergan) to prevent the nausea that is often caused by the Meperidine. Both drugs are commonly administered together after surgery. You can tap on a linked order to view its details.
• Split orders (as indicated by the split icon ). A split order is a single order that is split into two or more orders. For example, to administer a 100 mg dose of Meperidine, one order can be split into two: one for 75 mg and one for 25 mg. Another example would be when two different medications are combined to form a single order, such as an order for Prinzide comprising one order for 20 mg of Lisinopril plus another for 25 mg of Hydrochlorothiazide. You can tap on a split order to view its details. For existing orders of all types, you may be able to discontinue the order, or order the same item again. Or for existing medication orders only, you may also be able to modify, hold, resume, or renew the order.

From the Details screen you can:

• Move to the Details screen for the next order in the patient’s Summary list. Tap Down Arrow in the upper-right corner. This button is present on the Details screen only for existing orders.

• Move to the Details screen for the previous order in the patient’s Summary list. Tap Up Arrow in the upper-right corner. This button is present on the Details screen only for existing orders.

• Select an order listed in the Related Orders section to view the details of the related order (for existing medication orders only).
• View a history of one specific order. See Viewing the History for an Order.
• Go back to the Orders Summary.
  • From the Details screen for new orders, tap the Cancel button.
  • From the Details screen for existing orders, tap Back .
• Take a variety of actions, depending on the status of the order (new or existing) and the type of order.

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Viewing the History for an Order

You can see the entire history for a particular order from the Order Details screen. For example, you can view information such as the date and time the order was placed, the physician who placed and signed the order, if the order was ever on hold, and the current status of the order. This historical information is available only on existing orders, since new unsubmitted orders do not yet have any history. Please note that if the order was just submitted, there might be a slight delay before the Order History is available. To view an order’s history:

1. In the Order Summary, tap an order to select it. The Order Details screen opens and displays the information for that order.
2. Tap Order History The Order History screen displays a complete history of the order from the time it was placed until the current moment.
3. When you are done, tap Cancel to go back to the Order Details screen and tap Back to go back to the Order Summary.

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Viewing Orders

The Orders module displays the recent orders for the selected patient, including the date, time, and status of each order. The orders that are displayed are orders that were entered in your organization’s source HIM system. This is a “view only” module that does not allow the entry or modification of orders. If CPOE Orders has been enabled by your organization and for your users, see Viewing CPOE Orders.

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Orders at a Glance

The Orders module opens with a summary of all the current orders for the selected patient. From the list, you can see the details for any order.

• The patient heading row shows the selected patient’s name, age, gender, location, and MRN. Use this information to verify that this is the right patient.
• The module heading row shows the number of current Orders for the patient, such as “Orders (21)”. When you apply a filter, this line is updated and the Filter button displays at the top of the list. For example, “Orders (6)” indicates that six orders match the filter, and “Filtered by: Lab” indicates that only Lab orders are displayed.
• Each order is displayed on a separate line that shows the Order name (or brief description), the Date and time of the order, and the Status (such as Final-IP or Pending-Ordered; your institution might use different status names). It may also show the Source of the order information (the hospital or practice from which it was derived).
• From the Summary list, you can select an order and view the details associated with it. To view the details for an order, tap anywhere in the row. The Order Detail screen opens and displays the details. See Viewing the Details of Orders.

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Sorting the Order List

You can sort the Order Summary by Date, Order, or Status.

1. Tap Sort at the top of the screen.

The Sort screen is displayed.

2. In the Sort By section, select how you want to sort the summary list.
   • Order sorts alphabetically by order name (A-Z or Z-A).
   • Order Status sorts by the status so that all the orders with the same status are grouped together (toggles between A-Z or Z-A). The Status is the status used by your order entry system. Some examples of Status includes Canceled, Completed, Deleted, Incomplete, In Process, Ordered, Pending, Suspended, Unscheduled, or Discontinued.
   • Original Order Date sorts by date and time (toggles between listing the most recent orders first, or the oldest first).
   • Department Status sorts by the status from the department that processes the order. This varies by department. An example of a blood bank status could be Blood Drawn.
3. In the Order section, select the order in which you want to sort (Ascending or Descending).
4. Tap Done. The orders are displayed in the order that you selected.

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Filtering the Order List

Use a filter when you want to limit the number of orders that are displayed on the Summary list. For example, you might filter the list to view only Laboratory or Radiology orders. Filters are defined by the institution and might differ than those described here. The module header row keeps track of the number of order statuses currently displayed for the patient. For example, when no filter is applied, you might see “Orders (9)” in the header, and all of the available order statuses displayed in the summary list. If a filter is applied, the Filter button is displayed at the top of the summary list, with a label describing the filter criteria. For example, you might see “Orders (2)” in the module header, and the Filter button labeled, “Filtered by: Lab” to indicate that only the Lab order statues are shown. If you apply more than one filter, the module header counts the combined number, and the Filter button label lists each of the filters that are applied. To apply a filter for Orders, follow these steps:

1. Tap Filter in the upper right corner of the Orders Summary screen. The Filters screen is displayed and shows the following:
   • The top of the screen displays a list of Filter Terms. The currently selected filter(s) are indicated by a checkmark.
   • Below the Filter Terms, you may see additional filters by Source (the hospital or practice from which the order information was derived), if your organization has implemented the Health Information Exchange feature and it is enabled in your user profile. The currently selected filter(s) are indicated by a checkmark.
2. Select or deselect one or more filters from the Filter Terms or Sources. If some but not all of the filters are selected, a Select All button is available at the bottom of the screen; tap Select All to select all of the available filters. If all of the filters are selected, a Deselect All button is available; tap Deselect All to deselect of the filters.
3. Tap Done. The Orders Summary screen displays with the orders that match the filter criteria. The filter(s) remain selected until you choose something different.

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To go back to showing all of the orders for the patient

1. From the Orders Summary list, tap Filter in the top-right corner of the screen.
2. At the bottom of the Filters screen, tap Select All, and then tap Done. All of the available orders are displayed in the Orders Summary list.

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Viewing Order Details

The Order Summary lists all the important status information for the selected patient, including the date and time, the name and number of orders, and the order status. This Summary might be all you need when you are rounding or checking a patient’s orders. For more information, such as the Ordering Physician and Department Status for an order, go to the Details for that order. To review the Details for an order, tap an order to select it. The Details screen opens and displays the information for that order which can include Status, Department Status, Start Date, Stop Date, Ordering Physician, and Details. The fields that are available depend on your source system. If your organization has implemented the Health Information Exchange feature and it is enabled in your user profile, you will also see a field for Source (the hospital or practice from which the order information was derived). The Status field displays the status as it appears with your order entry system. Typically, you will see statuses such as Canceled, Completed, Deleted, Incomplete, In Process, Ordered, Pending, Suspended, Unscheduled, or Discontinued. The Department Status field displays the status from the department system processing the order. This varies by department. An example of a blood bank status is Blood Drawn. From the Details screen you can:

• Move to the Details screen for the next order status in the patient’s Summary list. Swipe right to left.
• Move to the Details screen for the previous order status in the patient’s Summary list. Swipe left to right.
• Go back to the Summary list and select a different order status. Tap Back .