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Sites participating in the CMS Appropriate Use Criteria (AUC) program with selected AUC vendors can fully integrate AUC clinical decision support into the provider workflow in Commure Pro CPOE. You can configure AUC by facility group, defining which financial classes, specific visit types, Order Groups, and Order Definitions are available to guide the provider into an Appropriate Use Check.

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Configuring Communication with AUC Vendors

The AUC configuration is typically accomplished in two general phases. The first of these is configuring how AUC communication occurs between CPOE and your specific AUC vendor. The second of these phases (which is common to all supported vendor types) involves configuring your facility groups and order catalog so that the AUC workflow is triggered for the correct data and in the correct workflows according to your definition. In the sections that follow, instructions are provided for configuring communication between Commure Pro CPOE and all AUC vendors that are currently supported. Once you establish communication with your specific AUC vendor, see Configuring Facility Groups for Appropriate Use.

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Configuring AUC for Medicalis

The preliminary work needed to configure Commure Pro for Medicalis integration is simple and primarily involves establishing a secure channel of communication between the Commure Pro CPOE and Medicalis environments. In the case of Medicalis, this configuration work involves defining the service location and configuring the access credentials needed, confirming that digital certificates have been added and configured correctly, and adding Commure Pro CPOE to the Medicalis site’s white list to establish communication through the firewall. Once you configure and verify this communication, any remaining AUC configuration is mostly common among the various supported AUC vendors.

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Configuring Medicalis Communication

To configure communication between the Commure Pro CPOE and Medicalis servers:
  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.AUC properties grouping.
  4. Select the following properties and click Add to make your configuration changes for each:
    • AucServiceLocation — The URL for accessing the Medicalis server.
    • aucPassword — The password needed for authenticating to Medicalis.
    • aucUser — The unique ID referencing your Medicalis account.
    • aucVendor — The vendor name (in this case, Medicalis).
  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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Checking the Medicalis Certificates

As a prerequisite to this process, an authorized administrator should already have set up the digital certificate on the required servers. For confirmation that this step is complete, consult with your Commure Pro representative. To confirm that the Medicalis certificate has been installed correctly:
  1. From the Admin dashboard, select System Management, then click Configuration Editor.
  2. Click the View All Certificates link.
  3. Locate the certificate named siemens healthineers and make sure it remains valid. If you do not find this certificate, contact your Commure Pro representative for assistance.
  4. Once you confirm that the certificate has been installed and remains valid, you can navigate away from the View All Certificates pane.

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Configuring the Medicalis IP Whitelist

The IP (or range of IP addresses) of any server communicating with a Medicalis site must be added to this site’s white list so that communication from Commure Pro CPOE is allowed by the site’s firewall. For more information, contact your Commure Pro representative or an authorized Medicalis administrator to ensure that this white list is configured correctly.

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Monitoring Medicalis Communication

You can verify and continue to monitor the status of communication between the Commure Pro CPOE and Medicalis servers from the self test screen.
  1. From the Admin dashboard, select System Management, then Self Test.
  2. Locate the CDSM Service section and check the URL and status from the Medicalis vendor row.
  3. If Medicalis is reported as unavailable, make any needed configuration changes and click Refresh to check the current status. Once you verify that communication is established between CPOE and Medicalis, you are ready to proceed with configuring your facility groups. For more information, see Configuring Facility Groups for Appropriate Use.

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Configuring AUC for NDSC

The preliminary work needed to configure Commure Pro for integration with an NDSC environment involves establishing a secure channel of communication between the Commure Pro CPOE and NDSC environments by defining the service location, configuring the access credentials needed, and verifying that this communication has been established correctly. Once you configure and verify this communication, any remaining AUC configuration is mostly common among the various supported AUC vendors.

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Configuring NDSC Communication

To configure communication between the Commure Pro CPOE and NDSC servers:
  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.AUC properties grouping.
  4. Select the following properties and click Add to make your configuration changes for each:
    • AucServiceLocation — The URL for accessing the NDSC server.
    • aucPassword — The password needed for authenticating to NDSC.
    • aucUser — The unique ID referencing your NDSC account.
    • aucVendor — The vendor name (in this case, NDSC).
  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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Validating NDSC Communication

You can verify and continue to monitor the status of communication between the Commure Pro CPOE and NDSC environments from the self test screen.
  1. From the Admin dashboard, select System Management, then Self Test.
  2. Locate the CDSM Service section and check the URL and status from the NDSC vendor row.
  3. If NDSC is reported as unavailable, make any needed configuration changes and click Refresh to check the current status. Once you verify that communication is established between CPOE and NDSC, you are ready to proceed with configuring your facility groups. For more information, see Configuring Facility Groups for Appropriate Use.

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Configuring AUC for MedCurrent

The preliminary work needed to configure Commure Pro for integration with a MedCurrent environment involves establishing a secure channel of communication between the Commure Pro CPOE and MedCurrent environments by defining the service location, configuring the access credentials needed, and verifying that this communication has been established correctly. Once you configure and verify this communication, any remaining AUC configuration is mostly common among the various supported AUC vendors.

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Configuring MedCurrent Communication

To configure communication between the Commure Pro CPOE and MedCurrent servers:
  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.AUC properties grouping.
  4. Select the following properties and click Add to make your configuration changes for each:
    • AucServiceLocation — The URL for accessing the MedCurrent server.
    • aucPassword — The password needed for authenticating to MedCurrent.
    • aucUser — The unique ID referencing your MedCurrent account.
    • aucVendor — The vendor name (in this case, MedCurrent).
  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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Validating MedCurrent Communication

You can verify and continue to monitor the status of communication between the Commure Pro CPOE and MedCurrent environments from the self test screen.
  1. From the Admin dashboard, select System Management, then Self Test.
  2. Locate the CDSM Service section and check the URL and status from the MedCurrent vendor row.
  3. If MedCurrent is reported as unavailable, make any needed configuration changes and click Refresh to check the current status. Once you verify that communication is established between CPOE and MedCurrent, you are ready to proceed with configuring your facility groups. For more information, see Configuring Facility Groups for Appropriate Use.

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Configuring Facility Groups for Appropriate Use

Once you configure communication between Commure Pro CPOE and your specific vendor, you can proceed with the facility group configuration (which is common to all supported AUC vendors). Besides enabling the AUC feature, facility group configuration involves defining the AUC financial classes, defining the patient exam fields that trigger AUC, and defining which of the Commure Pro visit types qualify for the AUC workflow. Before proceeding with configuration of your facility groups, you should already have established communication between Commure Pro CPOE and your AUC vendor. For more information, see Configuring Communication with AUC Vendors.

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Enabling AUC

Configuration of the AUC feature occurs at the facility group level and when you enable AUC it becomes available to all locations and units within the selected facility group. To enable the AUC feature across your entire facility:
  1. From the Admin dashboard, select Facility Group, then CPOE Preferences.
  2. Click Edit.
  3. Scroll down and set Enable Appropriate Use Check to Yes.
  4. Click Save.

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Configuring Financial Classes for Appropriate Use

For Appropriate Use Criteria to display as part of a clinician’s workflow, the patient must belong to a financial class that qualifies for appropriate use. For this to occur, administrators must first define all financial classes that determine appropriate use eligibility. Upon enabling the AUC feature, administrators have access to configure which financial classes will trigger the appropriate use workflow within a particular facility group. To configure financial classes for appropriate use:
  1. Navigate to the CPOE Preferences pane (Admin > Facility Group > CPOE Preferences) and click Edit.
  2. Locate the preference Financial Classes for Appropriate Use. (Note that this preference only displays when AUC is enabled).
  3. Select one or more financial classes that patients must belong to in order to trigger the AUC workflow.
  4. Click Save. Patients belonging to any of these financial classes will trigger the appropriate use workflow during order entry provided all other appropriate criteria is met.

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Configuring Fields to Obtain Reason for Exam from Clinicians

When all conditions are met during order entry to trigger the appropriate use workflow for qualifying orders, the qualifying orders must be configured with a field prompting clinicians to enter the reason for the exam which is mandatory to obtain and send as part of the appropriate use workflow. To configure a field to obtain reason for exam from clinicians:
  1. Navigate to the CPOE Preferences pane (Admin > Facility Group > CPOE Preferences) and click Edit.
  2. Locate the preference Reason for Exam Field(s) for Appropriate Use.
  3. Click Select Field, navigate to and select the field(s) that are defined to obtain all necessary information from clinicians during the appropriate use workflow.
  4. Click Save.

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Configuring the Exam ID for the Correct Facility

Before you can use Commure Pro’s Appropriate Use Check functionality, you must map the exam catalog in your environment with the Clinical Decision Support Mechanism (CDSM) vendor. This task results in exam IDs that map a procedure from the customer’s backend to the corresponding exam in the CDSM. Commure Pro uses that same mapping for Radiology order definitions. The exam ID configuration in Commure Pro is a free text field to define the facility/database identifier to be pre-pended as part of a complete exam identifier. To configure the Exam ID for a specific facility:
  1. Navigate to the CPOE Preferences pane (Admin > Facility Group > CPOE Preferences) and click Edit.
  2. Locate the preference Appropriate Use Exam ID Prefix and enter prefix that identifies the back-end facility. For example, OE.MDC
  3. Locate the and preference Appropriate Use Exam ID Abbreviation to set the exam ID format to match the specific back-end vendor in use:
    • Order Definition Abbrev, Order Group Abbrev: Formats the exam ID for MEDITECH back-ends.
    • Order Definition Abbrev: Formats the exam ID for MEDHOST back-ends.
The exam ID is usually a combination of a facility/database specific code (defined by the Exam ID Prefix) followed by either the order definition abbrev, or the order definition abbrev and order group abbrev.
  1. Click Save. All submissions formed to include appropriate use data will identify and will use the correct formatting conventions for the correct back-end facility.

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Configuring Appropriate Use Visit Types

The type of patient visit is another factor that is evaluated when determining whether the appropriate use workflow is made available to clinicians during order entry. In some cases, appropriate use criteria might be restricted to outpatient visits only, for example. Administrators must enable the AUC workflow for each visit type prior to using this feature (AUC is disabled for visit types by default). To enable the appropriate use workflow for a specific visit type:
  1. Navigate to the Commure Pro Visit Type Maintenance pane (Admin > System Management > Commure Pro Visit Types).
  2. Select the visit type(s) that are applicable to the appropriate use workflow and click Edit.
  3. Locate and enable the setting Check Appropriate Use during CPOE.
  4. Click Save. Only patient visits of this type / these types will trigger the appropriate use workflow (provided all other appropriate use criteria is met).

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Configuring Orders for Appropriate Use

Appropriate use is only applicable to radiology orders. Administrators must configure which of their radiology orders will trigger the appropriate use workflow. Configuration options are provided at both the Order Group and Order Definition level. MEDITECH customers, only: All values for “Check Appropriate Use” set at the order group and order definition levels are pulled by means of the bridge and are thereby managed by the backend. The most effective approach to configuration is to first configure orders at the group level, then proceed with Order Definitions that need to be configured with more granularity (those with configuration requirements that differ from their group). Note that Order Definition configurations are always given precedence over their Order Group configuration unless these orders remain not yet configured (or are otherwise not set); in such cases, the Order Group configuration takes precedence.

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Configuring Order Groups for Appropriate Use

When appropriate use rules are applicable to an entire Order Group or to the majority of orders within a group, enable AUC for the entire group and you can configure any individual orders within the group that are exceptions to the rule. Order Definition configurations take precedence over Order Group unless the Order Definition has not been explicitly set. To configure the (radiology only) Order Groups requiring appropriate use:
  1. Navigate to the CPOE Order Group Maintenance pane (Admin > Facility Group > Order Groups).
  2. Set Order Type to Radiology to narrow search scope to qualifying orders only.
  3. Select the qualifying Order Group and click Edit.
  4. Locate and enable the option Check Appropriate Use.
  5. Click Save. The appropriate use workflow will be triggered when clinicians enter orders that include any radiology order belonging to this Order Group, provided all other appropriate use criteria is met and unless the specific order from this Group has been configured as an exception to the rule at the Order Definition level.

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Configuring Order Definitions for Appropriate Use

When appropriate use rules are applicable to a single Order Definition or the minority of orders within a larger Order Group, configure these orders individually. Order Definitions take precedence over Order Group unless the Order Definition has not been explicitly set. To configure the (radiology only) Order Definitions requiring appropriate use:
  1. Navigate to the CPOE Order Definition Maintenance pane (Admin > Facility Group > Order Definitions).
  2. Set Order Type to Radiology to narrow search scope to qualifying orders only.
  3. Select the qualifying Order Definition and click Edit.
  4. Locate and enable the option Check Appropriate Use.
  5. Click Save. The appropriate use workflow will be triggered when clinicians enter orders that include this specific radiology order, provided all other appropriate use criteria are met.