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The configuration and creation of Patient Lists is documented in Managing Patients and Patient Lists Classic Version. This chapter reviews some ancillary functions related to patient lists.

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Relationships Management

By default, the initial set of system relationship types used on the manual registration screens, and the initial set of system relationship types used in the typical source ADT/Registration system are defined automatically when your system is first installed. There are two options on the System Management tab that are used to manage the basic list of relationships in the system.
  • The Relationships option: this option is used to view the list of relationships, and to determine how each type of relationship should affect providers’ patient lists.
  • The Personnel Relationships reference list: this option is used to view the list of relationships or to add new relationship types.

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Working with the Relationships Option

In the Commure Pro system, if a provider has a relationship with a patient visit, that patient appears on the provider’s patient list. For example, a provider might have a consulting relationship, or he might be the admitting, attending, or scheduled provider for the visit. The Relationships option allows administrators to specify how users’ lists should be populated based on those relationships, as well as whether or not users can manually remove visits with specific relationships. To access the Relationships screen:
  1. Click the Admin tab, followed by the System Management tab.
  2. Click the Relationships option. A list of all relationships appears on the right side of the screen. They can be broken into these categories:
    • The MEDITECHLIST relationship (only in systems with a Direct Integration to MEDITECH® with Downtime Solution configuration)
    • System relationships Any time a patient is sent to the Commure Pro system via an interface, a system relationship is created between the provider and the patient. In addition, any time a user selects a provider from a Provider field in the functions listed below, they are creating a system relationship of the same name. System relationships are created in the following manner:
    1. Provider-patient relationships that are generated via an interface from an ADT/Registration system are always system relationships.
    2. On the web:
      • If you manually register a patient, and then select a provider in any of the Provider fields (for example, Attending, Admitting, Primary Care, Scheduled, Consulting, etc.).
      • If you use the Re-Assign Visit function on the Schedule tab or the Patient Search tab, and then select a provider in the Provider field.
    3. On a handheld device:
      • If you manually register a patient, and then select a provider in the Attending, Admitting, or Referring MD fields.
An administrator can make these fields available for handheld manual registration via the setting below:
Admin - Institution - Patient List - Patient Registration Fields
  1. Make your changes:
    • To set or unset either of the flags for a relationship (ADT Autopopulate or Removable), simply click the checkbox(es) that you want to change.
Declarable flags are not used.
ADT Autopopulate: This setting specifies whether to populate users’ patient lists automatically based on provider relationships. If checked, any patient visits that have the relationship to a provider, are added to the patient list of that provider. If unchecked, patients are not automatically added to providers’ patient lists based on relationship.
  • MEDITECHLIST relationship: In the MEDITECH PWM system, a provider can manually add a patient to their patient list. In Commure Pro, we use a special relationship type called MEDITECHLIST to represent this association (see Special Notes about MEDITECH Systems and Patient Lists for more information). If you want these patient visits to appear on providers’ patient lists in the Commure Pro system, you must check the ADT Autopopulate attribute for the MEDITECHLIST relationship.
  • System relationships: you should check the box for any system relationships that you want to appear on your providers’ patient lists. For example:
    • If there are any system relationships sent by the ADT/Registration feed that should cause a patient to appear on a provider’s patient list, then check the box for those relationship types. Leave the box unchecked for any system relationships that should not cause a patient to appear on a provider’s patient list. This might be the case for Primary Care MD, for example.
    • If there are any provider fields on the web or handheld manual registration screens, that when filled in, should automatically add the patient to that provider’s patient list, then check the box for those relationship types. Leave the box unchecked for any provider fields that should not cause the patient to appear on a provider’s patient list.
Removable: This setting specifies whether a relationship is removable. If checked, users can remove patients with this relationship type from their patient list. If unchecked, users cannot remove the patient from their patient list. Our general recommendation is that you check this box for all relationship types.
  • System relationships: you should check the box for any system relationships that you want to allow providers to remove from their patient lists.
  • MEDITECHLIST relationship: we recommend that you check the MEDITECHLIST relationship.
  • To change the sort order for one or more relationships, edit the number in the Sort Order column. The sort order affects the order in which the given relationship appears in the Relationship drop-down list when a user manually adds, sends, or gets a patient. A value of 0 means that it appears at the top of the drop-down list, a value of 1 appears in the second position, and so on. If there are several relationship types with the same sort order number assigned, they appear in random order at that position (e.g., several relationships with a sort order of 1 will all appear in random order after the relationship that was assigned a sort order of 0).
  1. When you are done making your changes, click the Save button to save them. Or click the Cancel button to exit this option without saving your changes.

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Working with the Personnel Relationships Reference List

The Personnel Relationships reference list is found under the Reference Lists option, on the System Management tab. When you first access this option in a newly implemented system, you will see only the initial set of relationships that were defined at the time of your system’s installation. This includes the system relationships found on the standard manual registration screens, and the standard set of system relationships that are derived from a typical ADT/Registration System. We recommend that you do not modify or rename these without assistance from your Commure Pro representative. However, you might add new relationship types for any of the following reasons:
  • Perhaps you want to customize the web manual registration screen by adding a field for a new provider type, such as “Family MD.” You can define a new system relationship type called “Family MD” to be used as the relationship between family MDs and their patients.
  • Perhaps your ADT/Registration system has a non-standard provider type, such as “Care Manager.” You could define a new system relationship type called “Care Manager” to be used as the relationship between care managers and their patients. The steps for adding an entry to the Personnel Relationships reference list are the same as those for any reference list. See Adding Entries to a Reference List.

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Managing Misconfigured Patient Lists

Some patient lists that have been created in the past may be misconfigured, which could result in missing patients, poor performance, or other inaccuracies. The Misconfigured Patient Lists report allows you to find and correct problems proactively, before a provider or another user reports a missing patient or other problems with a patient list. The report identifies any patient list that is currently misconfigured, so you can fix the misconfigurations or delete the lists if they are no longer in use. The report contains the following information for a misconfigured list:
  • Identification number
  • Name
  • Details of the problem
  • Owner When you run this report, Commure Pro searches the database for patient lists that contain the errors or inconsistent data described in the table below.
List TypeError Details
List, AssignmentTime-based or filter criteria is not provided.
List, Assignment, ViewInconsistent dates between Add and Remove dates and dates used in time-based criteria and the visit type settings.
You must be a Level 0 or Level 1 administrator to run a report and the feature must be enabled before you begin. Contact your Commure Pro representative for assistance.
To generate the report:
  1. Click Admin. Then, from the Settings menu, select System Management > Misconfigured Patient List.
  2. Click Generate Report. An informational message displays indicating that the report is being generated. When the report completes, the results are listed in the Misconfigured Patient List window. After you review the results for each list, you can either delete the list from the database, or instruct the owner of the list to correct the errors contained in the report.

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Special Notes about MEDITECH Systems and Patient Lists

The Commure Pro system retrieves the following relationship from the MEDITECH® Orders module (in both Magic and client-server systems) and creates patient-provider system relationships in the Commure Pro system. This relationship can be used to populate providers’ patient lists, and can also be viewed for informational purposes in the Visits display option.
Field Name in MEDITECH Orders ModuleHow Stored in MEDITECH Admissions databaseSystem Relationship in Commure Pro
ConsultingConsultingConsulting
The Commure Pro system also retrieves the following relationships from the MEDITECH® Admissions module (in both Magic and client-server systems) and creates patient-provider system relationships in the Commure Pro system. Again, these relationships can be used to populate providers’ patient lists, and can be viewed for informational purposes in the Visits display option.
Field Name in MEDITECH Admissions moduleHow Stored in MEDITECH Admissions databaseSystem Relationship in Commure Pro
Primary CarePrimary CarePrimary Care
Emergency RoomEmergency RoomEmergency Room
AdmittingAdmittingAdmitting
AttendingAttendingAttending
FamilyFamilyFamily
ReferringReferringReferring
Other Providers (on the Inpatient Admission Edit screen in Magic systems). This field allows the entry of multiple provider names.First entry: stored as Other
Remaining entries: stored as Additional Doctors		First entry: Other
Remaining entries: Consulting
Other (on the Inpatient Admission Edit screen in client-server systems). This field allows the entry of multiple provider names.First entry: stored as Other
Remaining entries: stored as Additional Doctors		First entry: Other
Remaining entries: Consulting
Outpatient visits that come from the MEDITECH Admissions system and are not handled any differently than inpatient visits. These visits are assigned a patient-provider system relationship of Attending in Commure Pro. If the providers associated with a visit are edited in the MEDITECH Admissions module, that change is reflected in Commure Pro. For example, if the Admitting field in MEDITECH originally had Dr. Jones’ name, and it is changed to Dr. Smith, that same change occurs in Commure Pro. Dr. Jones’ admitting relationship is removed, and a new admitting relationship is created for Dr. Smith. Outpatient visits that come from the MEDITECH Community Wide Scheduling Module (in both Magic and client-server systems) are assigned a patient-provider system relationship of Scheduled in Commure Pro. Operating Room visits that come from the PICIS application (a Magic system) are also assigned a patient-provider system relationship of Scheduled in Commure Pro. In the PWM module of a MEDITECH Magic system, a provider can also manually create a relationship with a patient. In Commure Pro, we use a special relationship type called MEDITECHLIST to represent this association. If the manually associated patient has multiple visits, then this translates into multiple visits in the Commure Pro system, each of which has a system relationship of MEDITECHLIST between the provider and the patient. If you check the ADT Autopopulate attribute for the MEDITECHLIST relationship, those visits would appear on providers’ patient lists in the Commure Pro system. When a provider manually removes a patient from their list in MEDITECH, the system relationship ends and they are also removed from the patient list in the Commure Pro system. If a patient is on a provider’s list in MEDITECH for any reason other than those already described, they are assigned the MEDITECHLIST relationship in Commure Pro. This might include, for example, a patient that is on a provider’s list due to a “courtesy notice.” In the EMR module of a MEDITECH client-server system, if a provider manually creates or removes a relationship with a patient, that information is not sent to the Commure Pro system. The Commure Pro system does not create or use the special MEDITECHLIST relationship in this case.

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Additional Security for Confidential Patients and Data

Some organizations limit user access to specific patient records and data. For example, they might limit access to a patient record if the patient is a well-known public figure. Or they might limit access to clinical data if it is of a sensitive nature, such as HIV status. Support for securing this type of confidential information is built into the Commure Pro system and is implemented only for organizations whose source system is MEDITECH®. In the MEDITECH system, data can be flagged as confidential, and patients can be flagged as either confidential or sealed. The Commure Pro system automatically detects these flags and handles access to this information as follows:
  • Confidential data: Commure Pro displays confidential data to only those users who have been granted the right to view confidential data in MEDITECH.
  • Confidential patients: Commure Pro ensures that confidential patients do not appear on a user’s patient list unless they have been granted access to confidential patients from within MEDITECH.
  • Sealed patients: Commure Pro ensures that a sealed patient is made available to only those users that are explicitly configured in MEDITECH to have access to a particular sealed patient record. Please note that a patient’s records are typically sealed only after they have been discharged, which means they would not normally appear on a user’s patient list anyway. You can find out whether or not a user has been granted access to this type of data by viewing their access rights in the User Permissions option, which is found on the User tab. Each permission that has been granted for the selected user displays at the end of the user’s permissions list, along with the LIS access group to which this user belongs. The facility name space (defined in MEDITECH) associated with each of these permissions is included among the read-only data that displays on the User Permissions screen. For more information, see Standard, Sealed, or Other Permissions.
In addition to the security restrictions above, the following two reports track user activity:
  • The Self-Assignment Report logs each instance a user manually adds a patient from the census list to their patient list. However, this report does not distinguish confidential or sealed patients from other patients.
  • The Audit Report logs each instance a user manually adds a patient to their patient list, and views a specific patient’s data, as well as the type of data they viewed (for example, clinical notes, tests results, charges, and so on). However, the audit report does not distinguish confidential or sealed patients from other patients, nor does it distinguish confidential data from non-confidential data.