Configuring ePrescribing

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ePrescribing Configuration Overview

1. Do the preliminary configuration groundwork by configuring all ePrescribing properties in the Configuration Editor
2. Enable the ePrescribing application for your institution.
3. Register authorized users as prescribers and then enable these users for ePrescribing. For more information, see Registering and Enabling Users for ePrescribing.
4. Configure ePrescribing routing to route prescriptions to printers and pharmacies. Configuring routing involves creating Destination Groups, Destinations, and Route Actions that are dedicated to transmitting ePrescribing orders to the pharmacy or to a specific printer.

5. Configure ePrescribing routing for updates that are made to a patient’s assigned pharmacy. Configuring routing for pharmacy updates involves creating a Destination Group, Destination, and Route Action that are dedicated to transmitting any updates that are made to a patient’s default pharmacy.

6. Configure your facility group to determine whether ePrescribing will restrict provider order entry to only those facilities in which the provider has ordering privileges (obtained from the back-end system). For more information, see Restricting Order Entry to a Provider’s Authorized Facilities.
7. Configure one or more locations for use of the ePrescribing feature. For more information, see Configuring Locations to Use ePrescribing.

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Prerequisites for Enabling and Configuring ePrescribing

• The connection between the mobilizer and eRx servers
• The connection to the Medication Data Service (MDS)
• The location of the digital signatures needed to secure communication between the mobilizer and eRx servers
• (optional) If you plan to enforce reviews as part of the prescription drug monitoring program (PDMP), the connection to the Appriss PMP Gateway After obtaining all data needed to configure these resources, authorized administrators can complete all such configuration directly from the Configuration Editor (Admin dashboard > System Management > Configuration Editor). Configuration of each is described in the sections that follow.

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Configuring eRx Communication

1. From the Admin dashboard, select System Management, then click Configuration Editor.
2. Click the Add Configuration to Override Default button.
3. Locate and click the Applications.ERx properties grouping.
4. Select the following properties and click Add to make your configuration changes for each:
   • ErxAccountId — The unique ID used to identify the eRx server.
   • ErxServiceLocation — The URL for accessing the eRx server.
   • GoogleMapsJavaScriptApiKey — The key for authenticating to Google for its geolocation service, which is needed to locate nearby pharmacies.
   • RxNorm — Set to true to enable mapping of RxNorm values to FDB codes by leveraging MDS (for the purposes of allergy interaction checking in CPOE), which is needed for back-end systems (such as MEDHOST) that do not have FDB codes.
5. Click Save, specify a reason for the change, and click Yes.
6. You must restart the mobilizer for your configuration changes to take effect.

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Configuring MDS Communication

1. From the Admin dashboard, select System Management, then click Configuration Editor.
2. Click the Add Configuration to Override Default button.
3. Locate and click the Applications.MDS properties grouping.
4. Select the following properties and click Add to make your configuration changes for each:
   • mdsUser — The unique ID referencing your Medication Data Service (MDS) account.
   • mdsPassword — The password needed for authenticating to MDS.
   • MdsServiceLocation — The URL for accessing the Medication Data Service.
5. Click Save, specify a reason for the change, and click Yes.
6. You must restart the mobilizer for your configuration changes to take effect.

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Configuring Access to the Digital Certificates

1. From the Admin dashboard, select System Management, then click Configuration Editor.
2. Click the Add Configuration to Override Default button.
3. Locate and click the Applications.DigSig properties grouping.
4. Select the following properties and click Add to make your configuration changes for each:
   • digsigClientid — The unique ID referencing the host where the digital certificates reside.
   • digsigClientSecret — The password needed for authenticating to the host where the digital certificates reside.
   • digsigServiceLocation — The URL (including the path to) where the digital certificates are stored.
5. Click Save, specify a reason for the change, and click Yes.
6. You must restart the mobilizer for your configuration changes to take effect.

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Configuring PDMP Communication

1. From the Admin dashboard, select System Management, then click Configuration Editor.
2. Click the Add Configuration to Override Default button.
3. Locate and click the Applications.PDMP properties grouping.
4. Select the following properties and click Add to make your configuration changes for each:
   • pdmpUser — The unique ID needed to access Appriss for obtaining all PDMP data.
   • pdmpPassword — The password needed for authenticating to Appriss.
   • pdmpServiceLocation — The URL for accessing the Appriss PMP Gateway.
5. Click Save, specify a reason for the change, and click Yes.
6. You must restart the mobilizer for your configuration changes to take effect.

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Enabling ePrescribing

1. Under the Admin tab, select the Institution tab.
2. From the Edit Settings drop-down menu, select Site Administration.
3. Locate and enable the ePrescribing setting.
4. Click Save. ePrescribing is enabled institution-wide and is activated for use at locations where the product is configured and enabled.

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To enable ePrescribing for a specific location

1. Under the Admin tab, select the Location tab.
2. Select the location to configure on the left and click Edit.
3. Locate the Enable ePrescribing setting and set to Yes.
4. Click Save.

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Configuring Routing for ePrescribing

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Configuring the System for Routing Prescriptions to Pharmacies

1. Create a new Destination Group to be used for the ePrescribing service. From the Destination Group Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination Group and complete the following fields to configure the new Destination Group:
   • Abbreviation: Create an abbreviation for the ePrescribing service (such as eRx).
   • Name: Create a name for the ePrescribing service (such as ePrescribing).
   • Route Type: Select ePrescription Service from the drop-down menu.
   • Route Output Format Type: Select XML from the drop-down menu. Click Save.
2. Create a new Destination to be used for the ePrescribing service. From the Destination Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination and complete the following fields to configure the new Destination:
   • Abbreviation: Create an abbreviation for the Destination (such as eRx).
   • Name: Create a name for the Destination (such as ePrescribing).
   • Destination Group: Select the Destination Group that you configured for the ePrescribing service.
   • Available: Make sure that this Destination is configured to be available (the default).
   • Support Mode: Configure the support mode to be Full Alerting (the default). Click Save.
3. Create a new Route Action for routing prescriptions to pharmacies via the ePrescribing service. From the Route Action Maintenance pane (Admin > Facility Group > Route Actions), click Add Route Action and complete the following fields to configure routing for your new Destination Group:
   • Interface Id: (not used in the ePrescribing Route Action configuration)
   • Name: Create a name for this Route Action (such as eRx).
   • Route Type: Select the Discharge ePrescribing Route Type.
   • Route Action Type: Select the Route Action type Route (the default setting).
   • Destination Group: Select the Destination Group that you configured for the ePrescribing service.
   • Route as Group: Set to No (the default configuration).
   • Completes Routing for Commure Pro Only Orders: Set to No (the default configuration).
   • Completes Routing for Commure Pro Orders with Corresponding BackEnd Orders: Set to No (the default configuration).
   • Display order set additions, changes, and omissions on print out (Requires supporting template to work): Set to No (the default configuration).
   • Location: Click Add Location and select the facility or facilities that you are configuring to use the ePrescribing feature.
   • Start time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions
   • End Time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions.
   • Max Hold Timeframe: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Hold for Route Actions: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Start Conditions: (optional, used only if you want to define conditional routing rules.)
   • Hold Conditions: (optional, used only if you want to define conditional routing rules.)
   • Filter: Enter a valid filter value. For more information, contact your Commure Pro representative.
4. Click Save. The routing configuration is complete for routing electronic prescriptions to the ePrescribing service.

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Configuring the System for Routing Prescriptions to a Printer

• The patient record is missing important demographic data (gender, date of birth, first or last name)
• The prescription is for a controlled or scheduled medication order
• The prescription is for a free-text medication order
• The prescription is for a medication that has a source other than the drug database (such as a medication that was manually created by the facility)
• The prescription is canceled. All cancellations are routed to a printer Destination, including canceled orders that were originally submitted to the pharmacy electronically. When orders are canceled, the printed order sheet is updated with instructions informing clinicians of the need to call the pharmacy directly. When you configure ePrescribing routing for one or more local printers, it is recommended that you create a dedicated Route Action, since ePrescribing uses a specific template for prescriptions when displaying in printed form. Depending on your state requirements, you might actually be required to dedicate a route for prescription printing. Some states are more restrictive than others, so depending on the location of your facility, you might be legally required to print your prescriptions in a restricted area (such as behind a locked door).

1. Unless you plan to use an existing printer in your configuration, create a new Destination Group with a Route Type of Printer. From the Destination Group Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination Group and complete the following fields:
   • Abbreviation: Create an abbreviation for the ePrescribing printer (such as Rx Printer).
   • Name: Create a name for the ePrescribing printer (such as Rx Printer).
   • Route Type: Select Printer from the drop-down menu.
   • Route Output Format Type: Select PDF from the drop-down menu. Click Save.
2. Add printer Destinations to this new Destination Group. Typically, you must configure one printer (Destination) for each location using the ePrescribing feature. From the Destination Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination and complete the following fields:
   • Abbreviation: Create an abbreviation for the Destination (such as eRx St. Jude W).
   • Name: Create a name for the Destination (such as ePrescribing Printer St. Jude W).
   • Destination Group: Select the Destination Group you recently created for ePrescribing printing.
   • Available: Make sure that this Destination is configured to be available (the default).
   • Support Mode: Configure the support mode to be Full Alerting (the default).
   • Location: Click Add Location and configure the specific location of the ePrescribing printer (facility, unit, room, and bed).
   • Address: Enter a valid network address for the printer.
3. Click Save. Repeat this step for additional printers that you are adding (one for each location enabling ePrescribing).
4. Create a new Route Action for routing prescriptions to one or more printers configured as part of the ePrescribing Destination Group. From the Route Action Maintenance pane (Admin > Facility Group > Route Actions), click Add Route Action and complete the following fields:
   • Interface Id: (not used in the ePrescribing Route Action configuration)
   • Name: Create a name for this Route Action (such as Rx Printer).
   • Route Type: Select the CPOE Route Type.
   • Route Action Type: Select the Route Action type Route (the default setting).
   • Destination Group: Select the Destination Group that you configured for the Rx printers.
   • Route as Group: Set to No (the default configuration).
   • Rx Needed: Set to Yes (the default configuration).
   • Completes Routing for Commure Pro Only Orders: Set to No (the default configuration).
   • Completes Routing for Commure Pro Orders with Corresponding BackEnd Orders: Set to No (the default configuration).
   • Display order set additions, changes, and omissions on print out (Requires supporting template to work): Set to No (the default configuration).
   • Locatio n: Click Add Location and select the facility or facilities that you are configuring to use the ePrescribing feature.
   • Start time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions
   • End Time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions.
   • Max Hold Timeframe: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Hold for Route Actions: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Start Conditions: Configure this field to include the following XML entry:

<Condition Operator="and">
<Condition Operator="equal">
<Exp AttName="OrderSession. OrderSessionObject.SessionType"/>
<Exp Const="MEDS_REC_DISCHARGE"/>
</Condition>

<Condition Operator="isnotnull">
<Exp ChildEntity="OrderSession. OrderSessionObject.L_OrderList">
<DataValue>
<DataValue Const="rx">
<Condition Operator="true" AttName="RxNeeded"/>
<Condition Operator="isnull" AttName="Ncpdpid"/>
<Condition Operator="equal">
<Exp AttName="OrderType.Name"/>
<Exp Const="Medication"/>
</Condition>

<Condition Operator="equal">
<Exp AttName="UsageType"/>
<Exp Const="OP"/>
</Condition>

<Condition Operator="in">
<Exp AttName="TransactionType"/>
<Exp Const="CREATE,COPY,REPLACE"/>
</Condition></DataValue></DataValue></Exp></Condition></Condition>

• Hold Conditions: (optional, used only if you want to define conditional routing rules.)
  • Format Template: Navigate to and select the correct template for prescription printing in the current release. Note that prescriptions use their own template, which is typically updated with each new product version. For more information, consult your Commure Pro representative.
  • Filter: Configure this field to include the following XML entry:

<Condition AttName="Ncpdpid" Operator="isnotnull"/>

5. Click Save. The routing configuration is complete for printing prescriptions to one or more ePrescribing locations.

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Configuring Routing for Pharmacy Updates

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Configuring a Route for Interfacing Pharmacy Updates

1. Create a new Destination Group to be used for the pharmacy updates. From the Destination Group Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination Group and complete the following fields:
   • Abbreviation: Create an abbreviation for the pharmacy updates (such as Rx_updates).
   • Name: Create a name for the Destination Group (such as Pharmacy_bridge_updates).
   • Route Type: Select Interface (WebService) from the drop-down menu.
   • Route Output Format Type: Select XML from the drop-down menu. Click Save.
2. Create a new Destination to be used for the pharmacy updates. From the Destination Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination and complete the following fields:
   • Abbreviation: Create an abbreviation for the pharmacy updates (such as Rx_updates).
   • Name: Create a name for the Destination (such as Pharmacy_bridge_updates).
   • Destination Group: Select the Destination Group that you configured for the pharmacy updates.
   • Available: Make sure that this Destination is configured to be available (the default).
   • Support Mode: Configure the support mode to be Full Alerting (the default). Click Save.
3. Create a new Route Action that will be dedicated to sending the pharmacy updates over the interface. From the Route Action Maintenance pane (Admin > Facility Group > Route Actions), click Add Route Action and complete the following fields:
   • Interface Id: (not used in the ePrescribing Route Action configuration)
   • Name: Create a name for this Route Action (such as Pharmacy_bridge_updates).
   • Route Type: Select the CPOE Route Type.
   • Route Action Type: Select the Route Action type Route (the default setting).
   • Destination Group: Select the Destination Group that you configured for the pharmacy updates.
   • Route as Group: Set to No (the default configuration).
   • Completes Routing for Commure Pro Only Orders: Set to No (the default configuration).
   • Completes Routing for Commure Pro Orders with Corresponding BackEnd Orders: Set to No (the default configuration).
   • Display order set additions, changes, and omissions on print out (Requires supporting template to work): Set to No (the default configuration).
   • Location: Click Add Location and select the facility or facilities that you are configuring to use the ePrescribing feature.
   • Start time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions
   • End Time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions.
   • Max Hold Timeframe: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Hold for Route Actions: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Start Conditions: Configure this field to include the following XML

<Condition Operator="equal">
<Exp AttName="OrderSession. OrderSessionObject.SessionType"/>
<Exp Const="PHARMACY_UPDATE"/>
</Condition>

• Hold Conditions: (optional, used only if you want to define conditional routing rules.)
  • Format Template: [should include the most recent version of the order form]
  • Filter: Enter a valid filter value. For more information, contact your Commure Pro representative.

4. Click Save. The routing configuration is complete for interfacing pharmacy updates over an outbound bridge to a back-end system (such as MEDITECH).

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Configuring a Route Action to Send Pharmacy Updates to a Printer

1. From the Destination Group Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination Group and complete the following fields:
   • Abbreviation: Create an abbreviation for the pharmacy update printer (such as Rx_update_printer).
   • Name: Create a name for the pharmacy update printer (such as Pharmacy_update_printer).
   • Route Type: Select Printer from the drop-down menu. (Alternatively, you could select File Server as an option).
   • Route Output Format Type: Select PDF from the drop-down menu. Click Save.
2. Add a printer Destination to this new Destination Group. From the Destination Maintenance pane (Admin > Facility Group > Destination Groups), click Add Destination and complete the following fields:
   • Abbreviation: Create an abbreviation for the Destination (such as Rx_update printer St. Jude E.).
   • Name: Create a name for the Destination (such as Pharmacy update printer St. Jude W).
   • Destination Group: Select the Destination Group for pharmacy updates that you created above.
   • Available: Make sure that this Destination is configured to be available (the default).
   • Support Mode: Configure the support mode to be Full Alerting (the default).
   • Location: Click Add Location and configure the specific location of this printer (facility, unit, room, and bed).
   • Address: Enter a valid network address for the printer.
3. Click Save.
4. Create a new Route Action that is dedicated to sending pharmacy updates to this printer. From the Route Action Maintenance pane (Admin > Facility Group > Route Actions), click Add Route Action and complete the following fields:
   • Interface Id: (not used in the ePrescribing Route Action configuration)
   • Name: Create a name for this Route Action (such as Pharmacy_update_printer).
   • Route Type: Select the CPOE Route Type.
   • Route Action Type: Select the Route Action type Route (the default setting).
   • Destination Group: Select the Destination Group that you created for the pharmacy update printer.
   • Route as Group: Set to No (the default configuration).
   • Rx Needed: Set to No.
   • Completes Routing for Commure Pro Only Orders: Set to No (the default configuration).
   • Completes Routing for Commure Pro Orders with Corresponding BackEnd Orders: Set to No (the default configuration).
   • Display order set additions, changes, and omissions on print out (Requires supporting template to work): Set to No (the default configuration).
   • Locatio n: Click Add Location and select the facility or facilities that you are configuring to use the ePrescribing feature.
   • Start time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions
   • End Time: (optional, used only if you want to define restrict the time range for your Route Action to take effect.) For more information, see Defining an Effective Period for Route Actions.
   • Max Hold Timeframe: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Hold for Route Actions: (optional, used only if you want to define and use hold conditions.) For more information, see Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions.
   • Start Conditions: Configure this field to include the following XML:

<Condition Operator="equal">
<Exp AttName="OrderSession. OrderSessionObject.SessionType"/>
<Exp Const="PHARMACY_UPDATE"/>
</Condition>

• Hold Conditions: (optional, used only if you want to define conditional routing rules.)
  • Format Template: Navigate to and select the pharmacy update template.

• Filter: Configure this field to include the following XML entry:

<Condition Operator="equal">
<Exp Const="x"/>
<Exp Const="x"/>
</Condition>

5. Click Save. The route configuration is complete for sending all pharmacy changes to a printer for someone to manually update these changes in the back-end system.

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Registering and Enabling Users for ePrescribing

• Demographic data — Includes basic demographic data about the user. Administrators can respond to missing demographic data by entering data into the following fields in the user’s Commure Pro profile.
  • First, Middle, and Last names: Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 35 characters in length. Note that any suffixes that are used to form a provider’s first name (such as Jr., Sr., MD, or DO) are suppressed during the provider registration process.
  • Suffix: Any suffixes associated with the user’s name (such as Jr). Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 10 characters in length. Several commonly-used suffixes are allowed (but suppressed) during provider registration, including AA, AA-C, ACNP, AANP, AGACNP, AGACNP-BC, AGNP, ANP, ANP-C, APN, APRN, APRN-BC, FACOG, FACS, F-FNP, CNM, CNNP, CPNP, CNS, CRNA, DDS, DMD, DO, DPM, ENP, FNP, FNP-C, JD, Jr., MD, MPA, MPH, MSN, NNP, NP, NP-C, NP-BC, PA-C, PhD, RNFA, Sr., WHNP, and WHNP-BC.
  • Prefix: Any surname associated with the user’s name (such as Mr, Mrs, Dr). Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 10 characters in length.
• NPI — The user’s national provider identifier (NPI) is obtained from the back-end system. Administrators should ensure that all users have been assigned a valid NPI in MEDITECH (or other back-end system) prior to registering these users as prescribers in Commure Pro ePrescribing. (You can check a provider’s account for its NPI assignment from the Provider Information screen (Admin > User > [select user] > Edit > Edit Settings [Provider Info]).) Also, you must specify a complete hospital address for each of the user’s affiliated locations before the user can be registered at a given location. Make sure to complete all address fields that are associated with the location preference ePrescription Hospital Address (Admin > Location > [select location] > Edit), including the following fields:
• Address (line 1): Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 35 characters in length.
• Address (line 2): Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 10 characters in length.
• City: Only letters and the dash character are permitted as valid data; numbers, spaces, and special characters other than dashes are not allowed. This field is truncated when data exceeds 35 characters in length.
• State: Only letters are permitted, and are restricted to the 2-letter state abbreviation.
• Zip code: Only numbers and the dash character are permitted. The zip code must be a 5-digit or 9-digit number.
• Phone number: The work number is required; home and/or other numbers are optional. The phone number must be a 10-digit number and there must be some variation among the digits used (all 10 digits cannot be identical). Prefix cannot use the string ‘555’. If the phone number includes an extension, the number must use the prefix “X”.
• Fax number: The work fax number is required; home and/or other numbers are optional. The phone number must be a 10-digit number and there must be some variation among the digits used (all 10 digits cannot be identical). Prefix cannot use the string ‘555’. If the phone number includes an extension, the number must use the prefix “X” Note that you can always register users for additional locations should the user’s list of affiliated locations change by updating the prescriber’s registration status. For more information, see To Update a User’s Registration Status.

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To Register Individual Users for ePrescribing

1. From the CPOE Settings screen (Admin > User > [select user] > Edit > Edit Settings = CPOE), locate the Enable ePrecribing preference and click the associated Register prescriber link. As registration involves completion of a background process, note that it may take a couple of minutes before you are notified with a success message. Unless you are prompted to complete missing data, you can proceed with enabling ePrescribing for this user.
2. Set Enable ePrescribing to Yes.
3. (optional) If there are co-signature rules that apply to this user (and if Discharge Med Rec has been configured to require this user to co-sign discharge med rec orders), configure how these co-signature rules will be enforced for ePrescribing activity. Locate DMR Co-Signer Sent in ePrescribing as (also on the CPOE Settings screen) and set this preference to:
   • Supervisor: The current user is identified as the prescriber and the co-signing provider is identified as the supervisor in the electronic prescription sent to the pharmacy and also the prescription print-out sent to printer Destinations. Users requiring a co-signer are informed with the message “One or more discharge orders requires approval. Select a supervisor.” On the prescription sent to the pharmacy, the co-signing provider displays above the provider signature, identified by the label “Supervising Physician”.
   • Prescriber: The current user is identified as the prescribing agent and the co-signing provider instead is identified as the prescriber in the electronic prescription sent to the pharmacy and also the prescription print-out sent to printer Destinations. Users requiring a co-signer are informed with the message “One or more discharge orders requires co-signature. Select co-signing provider:” On the prescription sent to the pharmacy, the co-signing provider is used as the provider name (instead of the mid-level provider required to obtain co-signature), which is printed below the Provider Signature line. For more information about configuring DMR to require co-signature of one or more users, see Requiring Users to Obtain Co-Signature When Submitting DMR Orders.
4. Check to ensure that Enable Discharge Med Rec is enabled.
5. Click Save. The selected user has been registered as a prescriber and is granted permission to electronically prescribe medication orders during Discharge Medication Reconciliation.

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To Update a User’s Registration Status

1. From the CPOE Settings screen (Admin > User > [select user] > Edit > Edit Settings = CPOE), locate the Enable ePrecribing preference and click the associated Update prescriber link. Unless you are prompted to complete missing data, you can proceed with enabling ePrescribing for this user.
2. Click the Update Prescriber button. DEA information from the back-end is sent to Surescripts to register the user provided the DEA is not expired. Clicking Update Prescriber also updates the DEA number in Surescripts if it has changed in the back-end system.
3. Check to ensure that all DMR co-signature rules are configured correctly for this user. For more information, see Requiring Users to Obtain Co-Signature When Submitting DMR Orders.
4. Check to ensure that Enable Discharge Med Rec is enabled.
5. Click Save. The selected user’s prescriber registration status is updated for one or more qualifying locations.

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Restricting ePrescribing to a Provider’s Authorized Facilities

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Configuring ePrescribing for Controlled Medications

• When the system registers prescribers with the Surescripts network
• When displaying the DEA or NADEAN within the Review Prescriptions screen, and
• When sending prescriptions to the Surescripts network Patient phone numbers are also pulled from page 1 of the MAGIC MIS provider dictionary for all markets. This is accomplished by adding a facility prefix to the phone or fax number of every facility in the market where a bridge has been configured. This approach is used to ensure that the facility-specific phone and fax numbers remain current and accurate. (Note that this information does not yet show on the Provider Info screen but is stored in the database).

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Patient Data Requirements for Compliance with NCPDP Standards

• Vital to be used for Height in cm
• Vital to be used for Weight in kg (Note that this setting is also used for weight-based dosing of patients) Providers are notified in the event that data is insufficient or incorrectly formatted so that they can respond to and correct the data needed to complete their submission in accordance with the latest NCPDP standards.

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Creating EPCS Administrators

1. Login to the Commure Pro portal (you should already be configured for the Revenue Reports mode, as described in the introduction to this section).
2. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
3. Locate and select the user, click Edit, and (under Personal Preferences) select Screens.
4. Set Data View Type to Revenue Reports and EPCS Config and click SAVE.
5. Select CPOE (also under User settings), set EPCS Administrator to Yes and click SAVE.
6. Locate Multi Factor Authentication Credentials (also under CPOE user settings) > Manage > +ADD CREDENTIAL.
7. On the Manage Credentials window enter the following data:
   • Credential Name — Create a name to help easily identify this EPCS administrator’s device.
   • ID — Enter the Credential ID from the Symantec VIP Access application on this administrator’s device.
8. Click SAVE and then DONE to save the credentials, then SAVE to complete the CPOE configuration. The EPCS administrator is created and has authority to approve users for controlled medications.

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Pre-Configuring Users for Controlled Medications

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Preparing Users for Two-Factor Authentication

1. Login to the Commure Pro portal (as an EPCS administrator, you should already be configured for the Revenue Reports mode). For more information, see Creating EPCS Administrators.
2. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
3. Locate and select the user, click Edit, and (under Personal Preferences) select CPOE.
4. Locate Multi Factor Authentication Credentials (also under CPOE user settings) > Manage > +ADD CREDENTIAL.
5. On the Manage Credentials window enter the following data:
   • Credential Name — Create a name to help easily identify this user’s device.
   • ID — Enter the Credential ID from the Symantec VIP Access application on the user’s device.
6. Click SAVE and then DONE to save the credentials, then SAVE to complete the CPOE configuration.

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Adding the EPCS Service Level to a User’s Surescripts Account

1. Login to the Commure Pro portal (as an EPCS administrator, you should already be configured for the Revenue Reports mode). For more information, see Creating EPCS Administrators.
2. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
3. Select the user to update, click Edit, and (under Personal Preferences) select CPOE.
4. Scroll down to the Eprescribing settings and click the link Add EPCS to Registration.
5. Click SAVE. The user’s Surescripts registration is updated with the EPCS service level and the user is ready to be approved for controlled medications.

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Granting User Permissions for Order Entry of Controlled Medications

1. Login to the Commure Pro portal (as an EPCS administrator, you should already be configured for the Revenue Reports mode). For more information, see Creating EPCS Administrators.
2. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
3. Select the user to approve, click Edit, and (under Personal Preferences) select CPOE.
4. Locate and enable the setting Grant EPCS Permissions: Approver 1.
   If there is an Add EPCS to Registration link to the right of this setting, you must click this link to register the EPCS service level to this user’s Surescripts registration before proceeding. Depending on your site, this step might have been completed by another administrator.
5. Click SAVE. The second EPCS administrator must complete the following:
6. Login to the Commure Pro portal (as an EPCS administrator, you should already be configured for the Revenue Reports mode). For more information, see Creating EPCS Administrators.
7. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
8. Select the user to approve, click Edit, and (under Personal Preferences) select CPOE.
9. Locate and enable the setting Grant EPCS Permissions: Approver 2.
10. Enter your password when prompted (the same PIN you use to login to Commure Pro), then enter the Symantec security code from your device to complete the approval process.
11. Click SAVE. The approval process is now complete and the selected user can enter controlled medications provided the user has been configured for two-factor authentication. For more information, see Preparing Users for Two-Factor Authentication.

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Enforcing MEDITECH Facility Restrictions on Order Entry of Controlled Meds

1. Navigate to CPOE admin settings (Admin > Institution > CPOE settings.
2. Locate and enable the Respect Backend EPCS Enabled Property setting.
3. Click Save. Providers must have MEDITECH facility authorization to enter controlled medications in addition to being granted permission within Commure Pro ePrescribing.

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Enforcing Provider Schedule Restrictions from MEDITECH

• CPOE_SCH_RESTRICTIONS—for any CPOE schedule restrictions in effect
• DMR_SCH_RESTRICTIONS—for any DMR schedule restrictions in effect For more information, consult with your Commure Pro representative.

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Adding Campus Locations to Support Campus DEA Authorization

1. From the Campus Definition pane (Admin > Facility Group > Campus Definition) click Add Campus.
2. In the Add CPOE Campus window, complete the following fields to define the campus:
   • Abbrev: the campus abbreviation or short name
   • Name: the complete name used to identify the campus
   • Status: determines whether the campus is active. Note that clinicians with campus DEA authority cannot enter controlled medications when their campus is inactive.
   • ePrescribing Hospital Address: The complete campus address. All address fields are mandatory and you cannot add a campus definition without a complete address.
3. Click Save.
4. From the Location tab (Admin > Location), select the unit associated with this campus and click Edit.
5. Locate and configure the Campus setting to associate this unit with a specific campus definition.
6. Click Save. When clinicians with campus DEA authority order controlled medications within this specific nursing unit, all necessary DEA information (including campus DEA number and expiration date) is included as part of their ePrescribing submission.

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Configuring the EPCS Prescriber History Report

• Patient details—Patient demographic data includes the patient’s name, age, gender, MRN, and diagnosis
• Medication details—Including the medication name, the dispense units and refills, and patient instructions
• Prescribing activity—Including the date/time of order entry, the pharmacy used, indication of routing to a printer, and any additional notes

1. Login to the Commure Pro portal (as an EPCS administrator, you should already be configured for the Revenue Reports mode). For more information, see Creating EPCS Administrators.
2. From the Admin tab, select User from the Settings drop-down menu. (If the Admin tab is not showing, click the ‘+’ tab and select the Admin dashboard to open it.)
3. Locate and select the user, click Edit, and (under Personal Preferences) select CPOE.
4. Locate and enable the Enable EPCS Prescriber History Report setting (found among ePrescribing settings).
5. Click SAVE. The EPCS History tab will now display among the tabs available to the selected user so that this user can view a summary of their own controlled medication activity over a defined period of time.

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Requiring PDMP Review of Users Submitting Controlled Medications

1. Under the Admin tab, select the Location tab.
2. Select the location to configure on the left and click Edit.
3. Locate and configure the Enforce PDMP Review setting to Yes. If this setting does not display among the available location settings, check the selected location to make sure that it has been enabled for ePrescribing.
4. Locate the Facility NPI setting and enter the NPI associated with the selected location.
5. Click Save. The PDMP report most appropriate for this location’s state will display within the DMR workflow at this location whenever ePrescribing providers enter orders that include one or more controlled medications.

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Routing Restrictions of Submissions with Controlled Medications

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Configuring ePrescribing for Providers Practicing in Multiple States

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Configuring ePrescribing to Obtain Hospital DEAs for Use by Residents

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Configuring Locations to Use ePrescribing

1. From the Location pane (Admin > Location), select the location and click Edit.
2. Locate Enable ePrescribing and set to Yes.
3. Locate ePrescription Hospital Address and enter the street, city, state, and zip code into the address fields. Note that this address is used as the basis for selecting all pharmacies that are made available to physicians upon selecting the Nearby Hospital option when searching for local retail pharmacies from the Select Pharmacy window.
4. (optional) While still on the Location tab, check the following additional preferences to ensure that these are configured correctly:
   • Printing Mode: Make sure that this preference is set to Production Mode for this location. Setting this preference correctly is an important prerequisite for testing your printer Destinations, and inadvertent changes to this configuration can be overlooked during initial testing if route submissions fail to print at their expected Destination.
   • Enable Medication Reconciliation: As prerequisite to configuring ePrescribing, the Discharge option should also be enabled for using DMR at this same location.
   • Additional ePrescribing Transactions: You can activate two additional ePrescribing features:
     • Cancel—Enables the ePrescribing cancel workflow so that ePrescribing users can cancel prescriptions from the Discharge Med Rec (DMR) screen. When users stop, delete, or modify any existing discharge order in a facility enabling the cancel workflow, any associated prescriptions that were previously routed to the pharmacy are also canceled. In addition to enabling the Cancel workflow, note that several other conditions must be met for cancellations to succeed:
       • The original prescription must have been created and submitted using Commure Pro ePrescribing.

• The original prescription must have been created and submitted in the same hospital visit.
• The pharmacy Destination for electronically routing prescriptions must allow for orders to be canceled electronically. (This is determined by the pharmacy’s Surescripts service level.)
• The user deleting or modifying the discharge order must be the same registered user who created and submitted the original order. Users are instructed to call the pharmacy whenever electronic cancellation of prescriptions is not allowed, which is typically for one of the following reasons:
  • The Cancel workflow is disabled for the current facility (this location preference is set to “no”).
• The pharmacy Destination for electronically routing prescriptions does not allow for orders to be canceled electronically.
• The user attempting to delete or modify the discharge order is different than the user who submitted the original order. In such cases, a window displays the following message along with a list of the canceled prescriptions that the user must call in to the pharmacy: “You must call the pharmacy directly to cancel the following prescription(s).”
  • Med History—Lets clinicians access a patient’s medication history. When this setting is enabled for a specific location, clinicians can access the selected patient’s recent (6 month) external medication history from the DMR screen by clicking a link (‘External med History’) and confirming the patient’s consent to display this history to the clinician.

5. Click Save. Repeat this step for additional locations where you plan to use ePrescribing.

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Configuring ePrescribing to Include Diagnosis Code Entry

1. Click the Admin tab and then the Facility Group or CPOE tab.

2. If your institution uses multiple Facility Groups, select the Facility Group you want to configure from the Facility Group drop-down list.
3. Click the Display Overrides link.
4. From the CPOE Order Display Override Maintenance window, search for and select the Discharge Med Display Override, and click Edit.
5. From the Edit CPOE Order Display Override Maintenance window, locate the Diagnosis field (PK.HC.Medication.Diagnosis) and disable the associated Hidden setting.
6. (optional) You can enable the Required setting to make selection of a diagnosis mandatory whenever users submit discharge orders with the RxNeeded option selected.
7. Click Save. When a registered ePrescribing user selects RxNeeded for discharge orders in a DMR sesssion, the Order Detail window shows a Diagnosis field allowing the user to select or search for any diagnosis code from the IMO dictionary.

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Adding Medication Frequency Values for Use by Pharmacy

1. Click the Admin tab and then the Facility Group or CPOE tab.
   In deployments where Facility Groups are not enabled, the Facility Group tab is replaced by the CPOE tab.
2. If your institution uses multiple Facility Groups, select the Facility Group you want to configure from the Facility Group drop-down list.
3. Click the Med Frequency Definition link.
4. From the Med Frequency Definition pane, click the Search button to see all of the medication frequency values that have been pulled in from the back-end system.
5. From the list of search results, check each frequency to make sure that it includes a valid patient-facing name under the Patient Instructions Name column.
6. For frequency values missing a pharmacy-facing name, select the entry from the list, click Edit, and use the Patient Instructions Name field to specify a pharmacy-facing name to map to the medication frequency.
7. (optional) You can create additional medication frequency entries to supplement the med frequencies that are pulled in from the back-end system. Click the Add Med Frequency Definition button and complete the following fields:
   • Abbrev: The abbreviated name for identifying the frequency. This field is restricted to 20 characters in length and checking is performed to ensure that the specified value is unique (names differing by case alone are considered equivalent and are not allowed).
   • Name: The name used to reference the frequency within the institution or facility. This field is restricted to 30 characters in length.
   • Patient Instructions Name: The description of the frequency that displays to patients as part of the medication description. This field is restricted to 60 characters in length.
   • Num Hours to First Dose: Specifies how many hours can elapse between the initial order entry and the next scheduled dose before the clinician is notified to give a dose with a time value of “now”. This 2-digit field is restricted to numeric values.
   • Day Schedule: Indicates the schedule for administering the medication. This field is restricted to 12 characters in length. Valid entries for this field include the following values:
     • QD—Indicates that the medication is to be administered daily (at the time(s) specified by Med Times or Non-Med Times below).
     • QND—Indicates that the medication is to be administered every N days (at the time(s) specified by Med Times or Non-Med Times below), where N is a valid integer value.
     • [specific days of the week]—You can specify any combination of 2-letter codes (Mo, Tu, We, Th, Fr, Sa, Su) to indicate which days of the week. For example, enter TuTh to administer the medication on Tuesdays and Thursdays (do not use commas or spaces between codes). The default schedule pulled from the MIS directions dictionary typically displays in this field.
   • Med Times: Indicates the time(s) at which the medication is to be administered. Specify a list of (comma-separated) time values in military time format only (other time values are automatically converted into military time). For example, to indicate that a medication is to be administered at 8 AM, noon, and 4 PM, you would enter the following value: 0800,1200,1600. Medication times pulled from the MEDITECH pharmacy module (PHA) typically display in this field (or the default (.DFT) facility, if the PHA module is undefined).
   • Non-Med Times: Indicates the time(s) at which the order(s) are to be administered. Specify a list of (comma-separated) time values in military time format only (other time values are automatically converted into military time). For example, to indicate that an order is to be administered at 10 AM, 2 PM, and 6 PM, you would enter the following value: 1000,1400,1800. Order times (other than medication orders) pulled from the MEDITECH order entry module (OE) typically display in this field (or the default (.DFT) facility, if the OE module is undefined).
   • Med # of Times per Day: Indicates how many times a medication is to be administered over the course of a single day. When this field is populated, the system automatically calculates the dispense value (the number specified in the Disp field on the Order Detail window) using values in the Dose, Strength, and # of Doses fields. Note that this calculation is done automatically only for medications of certain forms (capsules, caplets, lozenges, and tablets) and only for medication doses that are administered in whole units (or the value one-half if a fractional value). Users can overwrite this value if needed.
8. Click Save. The pharmacy-facing name will be used instead of the medication frequency whenever this medication is sent to the pharmacy.

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Excluding Medications without RXM Mnemonics from DMR Workflows

1. Click the Admin tab and then the Facility Group or CPOE tab.
   In deployments where Facility Groups are not enabled, the Facility Group tab is replaced by the CPOE tab.
2. If your institution uses multiple Facility Groups, select the Facility Group you want to configure from the Facility Group drop-down list.
3. Click the CPOE Preferences link and click Edit.
4. Locate and enable the Restrict discharge search and ePrescribing Alternatives to Order Defs with RXM Mnemonics preference.
5. Click Save. When clinicians are presented with a list of alternative medications, this list will only include clinically-equivalent medications with one or more associated RxM mnemonic.

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Settings Pertaining to Handling of Medications without RXM in DMR Workflows

• Yes—Medications without any RXM mnemonics are excluded from order searches that occur in the DMR and ePrescribing workflows.
• No—All medications are available during order searches in the DMR and ePrescribing workflows, including medications without any RXM mnemonics.

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Configuring ePrescribing to Use Conditional Routing Rules

1. Click the Admin tab and then the Facility Group or CPOE tab.

2. If your institution uses multiple Facility Groups, select the Facility Group you want to configure from the Facility Group drop-down list.
3. Click the Route Actions link on the left-hand side of the screen.
4. From the Route Action Maintenance pane, enter your search criteria and click the Search button. Use the search filter settings to refine your search criteria so that only the route action(s) you want are displayed.
5. Select the Route Action that you are configuring to remain held and click the Edit button. The Edit Route Action screen displays.
6. Locate and configure the following two settings:
   • Hold for Route Actions: Select ERX from the lookup field. Routing of submissions over the selected Route Action will be suspended until all submissions with the specified Route Actions are resolved, unless the time to wait for these interfaced submissions exceeds the threshold specified by Max Hold Timeframe.
   • Max Hold Timeframe: Specifies the time limit for awaiting the resolution of pending submissions. When this threshold is reached, order submissions over the selected Route Action are routed to their Destination(s) regardless of whether all interfaced submissions have been received and considered complete. In such cases, the status of these orders is reported in the HL7 (for example, ‘Failed to Interface’ or ‘Delayed to Interface’).
7. Click Save.

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Monitoring ePrescribing Submission Activity

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Monitoring ePrescribing Services

1. Click the Admin tab and then the System Management tab.
2. Click the Self Test link.
3. Locate the relevant section of the Self Test screen to check on availability of a specific service:
   • ePrescribing Data Service—Displays the service URL and indicates availability.
   • Medication Data Service—Displays the MDS URL, the specific service (such as Med or Screening) and indicates availability.
   • MultiFactor Authentication Provider—Displays URL of the (Symantec) service, the service name and the status of the Symantec two-factor authentication service. In the event of a service outage, contact your Commure Pro representative.

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Auditing Activity Involving Controlled Substances

• User login (including unsuccessful attempts)
• Order creation in DMR that involves any controlled medication (including adding, continuing, changing orders, Order Sets, or favorites).
• Order modifications and deletions in DMR prior to or after order submission
• Order reconciliation and submissions in DMR, including the complete list of discharge orders
• User authentication in DMR (including successful and unsuccessful two-factor authentication attempts)
• Emulation of users, including both the user doing the emulation and the emulated user Auditing of administrator activity includes details for the following activity:
• Administrator login, including both successful and unsuccessful attempts
• Authorizing users for controlled medications by both EPCS administrators, including granting and revoking permissions
• Authorizing users for controlled medications by second EPCS administrator (including successful and unsuccessful two-factor authentication attempts)
• Emulation of administrators, including administrator doing the emulation and emulated administrator

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Auditing Database Changes

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Auditing of Controlled Medication Submissions

• Successful submissions that include one or more prescriptions for a controlled substance
• Submission failures that include one or more prescriptions for a controlled substance

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ePrescribing Promoting Interoperability Compliance