Configuring Locations

Configuration of your Facility Groups includes setting the preferences for each of your locations. In the CPOE application, each of the facilities within your institution is considered to be a location. The units belonging to each of these facilities are also considered to be locations. The location preferences enable you to:

• Schedule the meal times for each unit belonging to each of your facilities
• Define contact lists for any communication failures that might occur at each of your locations, and
• Maintain data about the printers used at each of your locations Although configuration of these settings normally occurs as part of configuring your Facility Group settings across your institution, the location preferences are organized on a separate tab in the user interface. This organization provides an efficient way to configure all location settings for each of your institution’s facilities and units. Configuration of locations normally begins with configuration of each of your facilities.

Administrators do not have access to edit location preferences for Facilities that have no Facility Group association; in this scenario, the Edit button is disabled for the Facility and all units belonging to it. Starting at the facility level is recommended because all units typically inherit their location settings from their facility by default. Once you complete the configuration of each facility’s location preferences, you can configure each unit simply by modifying any unit location preferences that differ from the settings inherited from the unit’s facility. For the complete list of location preferences, see Location Settings. Locations can also play a role in determining how orders from each order session are routed through your facility to a particular destination or set of destinations. For more information, see Configuring the Locations for Route Actions.

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Configuring Facilities

The location settings used to configure each of your facilities can be grouped into the following categories:

• Meal time settings
• Printer-related settings
• Morning blood draw times for labs
• Recipients list for sending alerts relating to routing failures When you set location settings at the facility level, these settings are applied to each of the units belonging to a facility. If there are one or more units whose settings differ from the settings of their facility, you can configure these units individually, setting individual preferences to override any configurations made at the facility level.

To configure a facility’s location settings:

1. Click the Admin tab and then the Location tab. The complete list of your facilities displays on the left-hand side of the screen. Each facility is represented by a top-level directory that expands to display all of the facility’s units.
2. Select the facility you want from the list and click the Edit button at the bottom of the screen.
3. On the Edit Location Prefs screen, enter the following settings for your selected facility:
   • CPOE Enabled
   • Breakfast Time (mandatory)
   • Lunch Time (mandatory)
   • Dinner Time (mandatory)
   • Time for AM tests (mandatory)
   • Printing Mode (mandatory)
   • Test Printer
   • Recipients for CPOE Configuration Error Alerts
   • Recipients for Print Alerts
   • Recipients for Interface Alerts
   • Recipients for File Server Alerts
   • Default Route Sender Address
   • Allow Hold for Admissions
   • Enable Medication Reconciliation
   • Home Med Hard Coded Fields Display
   • Patient Diagnosis Order Definition
   • Enable Continue Home Meds
   • General Medication Search
   • Add Home Medication Search
   • Clinical Data Form
   • Auto-Expire Unsubmitted Orders for Non-Discharged Visits after N minutes
   • Auto-Expire Unsubmitted Orders for Discharged Visits after N hours For more information about these settings, see Location Settings.
4. Click Save. You are returned to the screen that displays the location preferences for your selected facility.

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Configuring Units

The location settings used to configure each unit within your facility are identical to the settings for your facilities. As with the facility settings, most of the settings for configuring units can be grouped into these three categories:

• Meal time settings
• Printer-related settings
• Morning blood draw times for labs
• Recipients list for sending alerts relating to routing failures By default, all units inherit their location settings from their “parent” facility (the facility to which they belong). However, you can configure the location settings for each unit individually, so that one or more of a unit’s settings override the corresponding configuration that the unit inherited from its parent facility.

To configure a unit’s location settings:

1. Click the Admin tab and then the Location tab. All of your facilities and units display on the left-hand side of the screen. Each unit displays under its parent facility; to see all units for a particular facility, expand the folder associated with the facility.
2. Select the unit you want from the list and click the Edit button at the bottom of the screen.
3. On the Edit Location Prefs screen, for each setting that you want to edit:
   • Click the Override check box associated with the preference’s table row.
   • Enter the new preference setting(s) as the text box(es) (or radio buttons) display to the right of the Override column. For more information about these settings, see Location Settings.
4. Click Save. You are returned to the screen that displays the location settings for your selected facility. Any changes made to settings that were established at the facility level are overriden at the unit level.

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Adding the Location to Scanned Order Sheet Names

For each location and unit throughout your facility, you can configure your system so that file names of scanned order sheets identify the specific scanner that clinicians use when they scan and send order sheets to another department (for example, to the pharmacy). When you add scanners for any of your locations, you can configure the scanner name. Typically, this name will include information to help identify the precise location of the scanner you are adding (facility, unit, room and even bed location). This name will then be used as part of the file name that is assigned to the TIFF image that is sent by a particular scanner. In addition to the (user-created) scanner name, file names of the TIFF images produced by scanned order sheets also include information to identify the source of the scanner (“Commure Pro”), as well as the associated submission record number. To add and configure a scanner so that the file name of scanned order sheets identifies the scanner location:

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. From the list of available options on the left-hand side of the screen, click the Scanner Names link.
4. Click the Add Scanner button at the bottom of the screen. The Add CPOE Scanner Name window displays.
5. Use the following two fields to name and identify the scanner based on its location:
   • Name: Enter a name that accurately identifies the scanner location. This name will be used as part of the file name assigned to all images that clinicians scan and send from this printer. Note that scanner names are restricted to 20 characters in length in order to ensure manageable and concise file names. The complete file name syntax assigned to scanned images uses the following convention:**[scanner name]PK[submission record #]**For example:memorial-ICUA-2G-C_PK_157829where:memorial-ICU-2G-C: is the scanner name (created by this setting). In this example, the scanner name identifies the facility (memorial), the unit (ICU A), the room (2G) and the bed (C).

Commure Pro: is used to identify Commure Pro CPOE as the source of the scanned image.157829: is the submission record number used to identify the associated submission.

• Description: Enter a description to provide additional information that can help to identify the scanner, or for any supplementary information. Use of this field lets administrators elaborate on information that they provide for the Name field. Descriptions are limited to 99 characters in length.

6. Click the Add Location link and use the drop-down menus (facility, unit, room, and bed) to configure the location of the scanner.

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Location Settings

The following settings are used to configure all of your institution’s locations, including both facilities and units. When you configure these settings for a facility, they are applied to all units belonging to the facility. When you configure one or more of these settings at the unit level, they override their corresponding settings that they inherited from their “parent” facility. These settings are available to level 1 administrators only. CPOE Enabled Determines whether the CPOE application is enabled or disabled at a specific facility. Note that when providers select among patient visits, the most recent patient visit determines which facility to evaluate in determining whether CPOE is disabled or enabled. When one or more patient visits are found that are associated with a CPOE-enabled facility, the system then searches for any more recent visits that have orders or medications associated with them and if the most recent visit occurs in a facility with CPOE disabled, the screen then indicates that CPOE is disabled (the same behavior as if no CPOE-enabled visits are found). Breakfast Time Specifies the cutoff time for each breakfast order to be received by dietary for each facility or unit. You must specify a value for this field. Lunch Time Specifies the cutoff time for each lunch order to be received by dietary for each facility or unit. You must specify a value for this field. Dinner Time Specifies the cutoff time for each dinner order to be received by dietary for each facility or unit. You must specify a value for this field. Time for “in AM” Labs Determines the cutoff time used for distinguishing between “today” and “tomorrow” when providers select the option “AM” (for the When field) during entry of lab orders. When providers select “In AM” for lab orders prior to this cutoff time, “tomorrow” is appended after “In AM” when displaying this order. Interface AM Time?: Determines whether to use the AM time from the back-end system to populate the value of lab tests when providers select the value “AM” for the “When” field. When this preference is set to:

• Yes — The Time for “in AM” Labs setting is used as expected; the AM time is interfaced and used on the selected order when providers select the option “AM” for the “When” field during entry of lab orders.
• No — The Time for “in AM” Labs setting is not interfaced. Any AM time that had been set is cleared and this value is not required when providers select the option “AM” for the “When” field during entry of lab orders. Time for other AM tests Indicates the specific time to include on a selected order when providers select the option “AM” for the “When” field during entry of all order types other than lab orders.

Time for Early AM Lab tests Indicates the specific time to include on a selected order when providers select the option “Early AM” for the “When” field during entry of lab orders. Time for “in AM” Meds Determines the cutoff time used for distinguishing between “today” and “tomorrow” when providers select the option “AM” (for the When field) during entry of medication orders. When providers select “In AM” for medication orders prior to this cutoff time, “today” displays after “In AM” with this order. When providers select “In AM” for medications after this cutoff time, “tomorrow” is appended after “In AM” when displaying this order. Printing Mode Determines how print operations are conducted in a particular facility or unit. You can select from the following options:

• Production Mode: Indicates that all print jobs are to be sent to the regular printer, which is configured using one or more destinations (along with an affiliated route action and a destination group).
• Print-outs Saved as PDFs (for testing): When this option is selected, all print jobs are completed as PDFs only, rather than being sent to one or more printers. This configuration supports testing scenarios in which a facility may opt to do soft-copy test runs of its print jobs prior to sending these jobs to the printer.
• Print-outs Send to Test Printer: When this option is selected, all print jobs are sent to the test printer only. Test Printer Specifies the name of the test printer that is used by the selected facility or unit.

Recipients for CPOE Configuration Error Alerts Defines the list of recipients to be informed when routing-specific configuration errors are encountered. These error alerts are sent to the specified list of recipients only when an order is not assigned to a meaningful Order Route. Routing alerts identify the routing location to help administrators identify any underling problems that are preventing route submissions from completing successfully. In addition to the standard alpha-numeric characters, this field supports the use of all (ascii) characters that might be use to form brackets, which are the following: (, ), [, ], {, }, <, and >. The setting that determines when these alerts are sent in relation to errors is configured under Destination Group settings, using the setting Generate destination unavailable alert after NN minutes. Recipients for Print Alerts Defines the list of recipients to be informed when communication failures occur with the printer(s) associated with the selected facility or unit. The setting that determines when these alerts are sent in relation to errors is configured under Destination Group settings, using the setting Generate destination unavailable alert after NN minutes. Recipients for Interface Alerts Defines the list of recipients to be informed when problems are encountered involving the interface associated with the selected facility or unit. The setting that determines when these alerts are sent in relation to errors is configured under Destination Group settings, using the setting Generate destination unavailable alert after NN minutes. Recipients for File Server Alerts Defines the list of recipients to be informed when problems are encountered involving the file server associated with the selected facility or unit. The setting that determines when these alerts are sent in relation to errors is configured under Destination Group settings, using the setting Generate destination unavailable alert after NN minutes. Default Route Sender Address Specifies the name of the sender to use in e-mail orders. When orders are routed using the e-mail route action, this address is used to specify the sender’s name in the “From:” field of the e-mail message. Allow Hold for Admissions Determines whether providers can enter orders to be held. When providers select this option, all outpatient orders that they enter are flagged when they are sent to the back-end system. You can configure a receiving interface to hold all of these flagged orders until a patient is admitted to an inpatient visit, and then release these orders into the CPOE system to be added to the patient’s record. You can select from the following options:

• Yes: Providers can choose whether to hold orders for a patient until the patient is admitted to an inpatient visit.
• No: Providers are unable to hold orders for a patient prior to being admitted to an inpatient visit.
• Always: Orders entered by providers for a patient are automatically held until the patient is admitted to an inpatient visit. Instead of giving providers the choice, the interface displays a message indicating that these orders are to be held for admission. Enable Medication Reconciliation Determines whether the Medication Reconciliation application is enabled or disabled at the selected facility. When you configure this setting to specify the value “Admission”, the Medication Reconciliation application is enabled for patient admission only.

Home Med Hard Coded Fields Display Enables you to configure a Field Display Override for specific locations that specifically defines the Field properties for all home medications that are entered as part of the Admission Medication Reconciliation (AMR) process. Outpatient Med Hard Coded Fields Display Enables you to configure a Field Display Override for specific locations that specifically defines Field properties for discharge medications that are entered as part of the Discharge Medication Reconciliation (DMR) process. Patient Diagnosis Order Definition (Do not use / configure this setting; this setting is deprecated starting in the 8.4 release.) Determines whether to display the Patient Diagnosis Order Definition at the top of the Pre-Admission Meds column on the Medication Reconciliation form. When this setting is enabled for a particular location, the Patient Diagnosis entry displays on the Medication Reconciliation form of all patient visits associated with this location. When providers choose to enter a patient’s diagnosis by selecting Enter in the associated Action column, they are prompted to enter the patient’s diagnosis using one or more problem list drop-down settings. For more information, see the Commure Pro CPOE User’s Guide and the Commure Pro Medication Reconciliation Quick Reference. Enable Continue Home Meds Grants or denies providers at the selected facility the ability to order home medications through the Medication Reconciliation interface. Add Home Medication Search Determines the behavior of the Medication Reconciliation user interface that is used to perform search operations on medication orders. The configuration options are: Split on Formulary The Home Medication Search screen distinguishes between all of the selected facility’s formulary and non-formulary medications. Split on Formulary, hide Non-Formulary by default The Home Medication Search screen distinguishes between formulary and non-formulary but hides non-formulary medications unless configured to be shown. Omit Non-Formulary Excludes all non-formulary medication orders from the search results. Do not distinguish Does not discriminate between formulary and non-formulary medications when returning medication orders from order search on the Medication Reconciliation user interface. Additional ePrescribing Transactions Lets you enable the following additional ePrescribing workflows:

• Cancel—Enables the ePrescribing cancel workflow so that users registered for ePrescribing can cancel prescriptions from the Discharge Med Rec (DMR) screen. When registered users in a facility enabling this workflow stop, delete, or modify any existing discharge order, 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. When electronic cancellation of prescriptions is successful, any printed order sheets that include the prescription are updated with the label “Electronic cancellation requested.”

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. This can occur when pharmacies are not authorized by Surescripts to support cancel operations.
• 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).” When electronic cancellation of prescriptions is not supported or not successful, the following note is added to the printed order sheet whenever it includes one or more stopped or deleted medications that was previously prescribed electronically. Note: Pharmacies are not notified of electronic prescription cancellations. You must call the pharmacy directly for all cancellations including cancellations due to modifications. As an additional safeguard, the following additional note is added below each stopped or deleted medication: Canceled - MD to Call pharmacy Or in the case of failure: Cancellation failed. Call the pharmacy

• 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 medication history from the DMR screen by clicking a link (‘External med History’) and confirming the patient’s consent allowing the clinician to view this data. The External Med History screen displays a recent (6 month) summary of the patient’s claims history as reported by the Surescripts network. Clinical Data Form Specifies the name of the Patient Metrics form in use at the specified location. You can create a Patient Metrics form to display a variety of data about the selected patient so that physicians can reference this data in a convenient manner. After you create a form using the Forms application, you can navigate to and select this form to assign a Patient Metrics form to a particular facility or unit location.

For more information about creating a Patient Metrics form, contact a Commure Pro representative. Auto-Expire Unsubmitted Orders for Non-Discharged Visits after N minutes Sets the duration after which orders held in a session are discarded. This duration specifies the time (minutes) for orders to remain in an open order session, for visits in which the selected patient has not been discharged from your facility. You can specify any number from 10 up to a maximum of 9999 minutes. Auto-Expire Unsubmitted Orders for Discharged Visits after N hours Sets the duration after which orders held in a session are discarded. This duration specifies the time (minutes) for orders to remain in an open order session, for visits in which the selected patient has been discharged from your facility. Illegal Abbreviation Form Defines a list (in the form of an XML file) of illegal abbreviations, words, and phrases that providers cannot use when entering a Dose or Frequency value in free text form. This list is also used during medication reconciliation, whenever free-text values from the Dose or Frequency Fields are continued and copied forward from a home medication order to create a new hospital medication order. Management of the illegal abbreviation form is achieved from within the Commure Pro Forms application, where authorized administrators can import a custom form that defines all rules pertaining to abbreviations. In addition, this form can be used to define custom messages that inform users when they enter invalid values for the Dose or Frequency field. For more information about obtaining and customizing an illegal abbreviation form, consult your Commure Pro representative.