Configuring Order Routing

After providers in your institution sign and submit orders, these orders need to be routed to the appropriate areas within your facility or institution. In CPOE, configuration of this routing is accomplished through configuration of Route Actions. A Route Action is an activity that is performed for a specific grouping of orders meeting a specific criteria. Route Actions can exist in many forms, but often they involve sending orders to a printer (as a hard copy document), file server (as a soft copy document), or interface to a back-end system. One aspect of route configuration involves defining route destinations and grouping these destinations so that route actions defined for a particular grouping of orders can be directed to multiple destinations in your facility or institution. Another aspect of route configuration involves specifying the physical locations in your facility that you want to include as part of a route action, as well as specifying any physical locations that you want to exempt from each route action.

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Establishing Route Actions and Destinations

In the CPOE application, all orders that are submitted are routed to destinations throughout your facility according to route actions and destinations that you define. Route actions determine how to send orders belonging to your various order groups to the various destinations in your facility. Destinations determine the place where these orders are sent, as well as the form for orders to take when they arrive at each of their intended places. There are four route actions that you can assign to orders in the CPOE application:

• Printer: You can send a particular grouping of orders to a network printer.
• File server: You can send a grouping of orders to a file server.
• E-mail: You can send a grouping of orders to an e-mail address.
• Electronic interface: You can send a grouping of orders to an interface to be integrated with a back-end system. Your facility may have already established a plan to route all of your orders to destinations that you have defined for your facility. If so, you can use your existing assignments to configure route actions and destinations in the CPOE application.

For more information, see Configuring Order Routing.

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Planning Your Route Actions and Destinations

If your facility has not established a plan around order routing, you must plan how you want orders to be routed throughout your facility. Establishing route actions and destinations should be part of a carefully-executed plan that involves key decision-makers providing representation across all of the areas and departments involved in the ordering process. Although there is some flexibility around how you approach this planning, it is recommended that you proceed in the following order when establishing how to route orders through your facility:

1. Assess your order groupings based on where they need to go in your facility. Evaluate your groupings of orders to determine who in your facility needs to receive the information when orders are placed. There is flexibility in how these rules are applied, so you can establish rules that route orders based on their Order Definition, Order Group, or Order Type.
2. Determine the type of route action that is best suited for each Destination. It is likely that you will want some types of orders to be integrated into a back-end system through an electronic interface. There are other groupings of orders that you might want to send to a file server in the form of a specific type of document (such as .pdf) that are stored in a specified directory on your network. Route submission files that are sent to a file server are created using the syntax DATE_SESSIONID_ACCOUNT#. (If there is no patient account number associated with the submission, only the first two values are used to form the file name.)

In addition to these two route actions, you might also decide to send a copy of all of these orders to be printed on one or more of your network printers.

3. Determine how orders from various Locations should be routed to each of your Destinations. When defining your Destinations, it is important to note that Destination assignments reference a place in your network or file system where orders are to be sent.

Locations describe the physical area within your facility or institution from which the orders are derived. These are the specific floors and units where the patient is staying.

4. Identify any orders that should be exempt from routing to an electronic interface. Your facility may need to manually create some orders that will not have any corresponding order on your back-end system. For example, you may have defined several manually-created Order Definitions or Order Groups that do not have corresponding Definitions and Groups in your back-end system. If these orders exist among a larger group of orders that you are routing to an electronic interface, you must configure these orders individually or as sub-groups to identify these as exempt from this route action.

The setting Corresponding Backend Order enables you to configure your route actions with more granularity, since there may only be a handful of specific instances among a larger order grouping where you will not send to an electronic interface. After you develop a complete plan, it is strongly recommend that you consult with your team, in conjunction with a Commure Pro representative, to thoroughly evaluate your plan to ensure that it is accurate and comprehensive. It is also recommended that you periodically review this plan on a routine basis to ensure that it remains current.

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Sample Route Assignment

As part of your deployment, your facility may plan to integrate Commure Pro CPOE into a hybrid solution that includes routing of electronic records for some types of orders and routing to a printer to maintain paper records for other types of orders. For example, you might decide to route orders belonging to most of your Order Types to an interface, to be integrated with an external system that creates electronic records for these types of orders. However, your facility may use and require print copies of all lab and medication orders that your physicians enter into your ordering system. To achieve this routing plan, you could plan to configure the following route actions for the different types of orders that physicians will enter into your CPOE system. After configuring your Route Actions and Destinations (with the assistance of a Commure Pro representative), you must determine which locations should have their orders sent to each of the Destinations that you define. For more information, see Configuring the Locations for Route Actions.

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Configuring Order Routing

Configuration of order routing is a process involving several steps. In general, the steps for configuring order routing occur in the following sequence:

1. Define the Destination Groups for each of your facilities.
2. Define the Destinations for each of your facilities.
3. Associate each of your Destinations with a Destination Group.
4. Define the Route Actions for each of your facilities.
5. Define the Locations for each of your facilities. Although these steps suggest a configuration sequence that follows a rigid work flow, there is some fluidity in how you approach configuration of your facility’s routing. For example, you might choose to define your Route Actions first, and then create Destination Group assignments to link these actions to your facility’s Destinations. You can determine the work flow that is best suited to your particular facility as part of the planning process. For more information, see Establishing Route Actions and Destinations.

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Creating Destination Groups

In order routing, Destination Groups are used to link each Route Action to one or more Destinations. In many routing scenarios, this “group” will include a single Destination. Note that this results from the mandatory nature of group assignments; you cannot “bypass” a group to assign a Route Action to a single Destination. Note that when a Destination Group includes more than one Destination, each of these Destinations must be differentiated by specifying a distinct location. To create a Destination Group:

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

The CPOE Preferences page displays by default.

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 Destination Groups link on the left-hand side of the screen.
4. Click the Add Destination Group button.
5. Use the Abbreviation and Name text fields to enter the Destination Group names. For more information, see Destination Group Settings.
6. Configure the remaining mandatory settings:
   • Use the Route Type setting to choose a route type from the list of available types.
   • Use the Route Output Format Type setting to choose a format type from the list of output format types.

7. (optional) When selecting the Interface (WebService) Route Type only, the setting One Order Per HL7 Message/Submission is used to determine how data is transmitted. When this setting is enabled, a single HL-7 message is transmitted for each order belonging to an order submission, which enables you to monitor individual orders within an order submission. For more information, see One Order Per Charge or HL7 Message/Submission.
8. Click Save. The Destination Group is added. You can add one or more Destinations to this group.

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Defining Destinations

Each Destination Group that you create must include at least one valid Destination. Without an association to one or more specific Destinations, Destination Groups do not serve any practical purpose in routing configurations. To create a Destination for a Destination Group:

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

The CPOE Preferences page displays by default.

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 Destinations link on the left-hand side of the screen.
4. Click the Add Destination button.
5. Use the Abbreviation and Name text fields to enter the Destination names. For more information, see Destination Settings.
6. Click the Select Destination Group button, select the Destination Group to which you are adding this Destination, and click OK.
7. Use the Address setting to specify a path to the printer or file server affiliated with this new Destination. (This setting is not required for Route Type Interface.)
8. (Optional) You can specify one or more locations to associate with this Destination.
9. Click Save. The Destination is added to the Destination Group.

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Defining Route Actions

Route actions define rules that are used to direct orders to a particular destination or set of destinations based on a set of specific conditions. The conditions used in establishing how orders are routed can be based on several factors:

• Filters: Filters use DXML code to restrict orders for a particular route action. You can use filters to obtain a smaller grouping of orders, which can then be evaluated using a set of start conditions. Do not make any modifications to this setting without consulting a Commure Pro representative.
• Locations to include: You can specify all of the Locations in your facility (from which orders are derived) that you want to be applicable to a particular route action.
• Locations to exclude: You can specify all of the Locations in your facility (from which orders are derived) that you want to be exempt from a particular route action.
• Start and End times: You can specify when a route action should begin to be applied to a grouping of orders and when the route action should cease to apply to this order group.
• Start conditions: Like filters, start conditions use DXML code to specify a set of criteria for evaluating whether an order or grouping of orders qualifies for a particular route action. You can define your start conditions with flexibility, so that they route orders from a session according to a variety of criteria, such as properties of an order, order definition, or order session, properties of a patient or visit, or age of an order (for example, all orders older than 6 hours). Do not make any modifications to this setting without consulting a Commure Pro representative.

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Rules Determining Routing Priority Among Order Sessions

A couple of rules are used to ensure that order sessions are routed efficiently and completed in order of their priority. Among multiple pending order sessions that are all from different patients, priority is always given to order sessions that include one or more STAT orders. When processing these sessions with STAT orders, priority is given to sessions entered first. Once processing of sessions with STAT orders is completed, the remaining sessions with no STAT orders are processed, with priority given to sessions entered first. Among multiple pending order sessions pertaining to the same patient, priority is always given to the order session entered earliest, even if this session has no STAT orders (and a later session has one or more STAT orders). This rule (‘FIFO’, or first in, first out) is intended to process orders in a sequence that is consistent with actions taken for this patient, thereby ensuring that any actions taken on previously-entered orders are always received in the proper sequence on the back-end system. Note that these rules are applied on a per-Destination basis, preventing any submission delays at one Destination from affecting routing of orders for this same patient that are sent to other Destinations, either within the same session or in any subsequent order sessions. For customers using the Commure Pro ePrescribing product, note that prescription orders to be routed electronically to a nearby pharmacy are exempt from these FIFO rules, as are any ePrescribing submissions that are sent to a printer at a specific location within your facility or institution. In the event that submissions routed to a particular Destination are delayed due to a submission undergoing processing, the Submission Status pane (Admin > Tracking/Reporting > Submission Status) provides the following status information under the Failure Reason column for all delayed submissions: “Delayed until submissions from previous order sessions [ order session ID ] are complete”. When submission failures occur, processing continues under FIFO rules and administrators are advised to monitor failure alerts to investigate whether the submission failure compromises the integrity of the order entry sequence.

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Configuring Route Action Settings

Because configuration of some route actions is complex and requires specialized knowledge in multiple areas, it is strongly recommended that you consult a Commure Pro representative before making configuration changes to some of these settings (especially any of the settings involving DXML code). In addition, you should approach configuration of route actions in its larger context, which includes identifying and grouping destinations, and planning the set of route actions for your facility or institution. For more information, see Establishing Route Actions and Destinations. To configure one or more of the Route Action settings:

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

The CPOE Preferences page displays by default.

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 you want and click the Edit button that displays in the lower-right portion of the screen. The Edit Route Action window displays.
6. You can use the following settings to configure each of your route actions:
   • Name
   • Route Type
   • Route Action Type
   • Destination Group
   • Route as Group
   • Completes Routing for Commure Pro Only Orders
   • Completes Routing for Commure Pro Orders with Corresponding BackEnd Orders
   • Location
   • Start Time
   • End Time

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Defining an Effective Period for Route Actions

Once you complete the definition of a route action using filters or start conditions (or some combination of the two), you can define a window period during which a particular route action should be effective (or, by implication, ineffective). An effective period is defined by specifying a start and end time in a 24-hour cycle, so that a route action’s effective and ineffective periods are always recurring on a daily basis. For example, if your pharmacy closes between the hours of 8 PM and 8 AM, you might want to define an effective period for the pharmacy printer route action that has a start time of 8 AM and an end time of 8 PM. When data from an order session is received outside of this defined window period, no route action is taken on the data, regardless of whether the orders meet the specified route criteria as defined by the filter or start conditions. When data from an order session is received within this window period, the data is evaluated as usual, according to either the filter(s), start condition(s), or both. The Route Action template can also be configured to support conditional route actions. For example, you can defer a specific route action until a patient’s visit status changes from an ER to an Inpatient visit. For more information, contact your Commure Pro representative. To define an effective period for a route action:

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

The CPOE Preferences page displays by default.

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 you want and click the Edit button.
6. Locate the Start Time setting and enter the time that you want the route action to become effective. For example:2:00 PM.
7. Locate the End Time setting and enter the time (using a 12-hour clock in the format xx:xx AM/PM) that you want the route action to become ineffective.
8. Click Save. The selected route action will be effective during the specified window period only.

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Configuring Orders to Route to Temporary Locations

In sites using MEDITECH as their back-end system, authorized administrators can configure CPOE to route order submissions to a patient’s temporary location (such as endoscopy) when one has been set in MEDITECH. When this feature is enabled, order submissions will be routed to the patient’s temporary location whenever one has been set for the patient. When the patient’s temporary location is removed or if none is found, the system routes the order submissions to the patient’s permanent location (the default behavior). To route order submissions to a patient’s temporary location (if set in MEDITECH):

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

The CPOE Preferences screen displays by default.

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 Edit button in the lower portion of the screen.
4. Locate and enable the setting Route to temporary location instead of permanent location.
5. Click Save. Whenever patients are assigned a temporary location in MEDITECH, CPOE will route order submissions to this temporary location. When a the temporary location is removed or is not found, CPOE routes all submissions to the patient’s permanent (default) location.

You can confirm whether order submissions are routed to a patient’s temporary or permanent location by checking the location specified by the Routing Location (Route Submission) property on the Submission Record Details window (Admin > Tracking/Reporting > Submission Status > [click entry under Submitted column]).

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Using Filters to Narrow the Scope of Orders in Route Actions

Filters use DXML code to define rules that restrict how route actions are applied to all orders in an order session meeting a specific criteria. The data that is sent from an order session for routing is filtered prior to evaluation for start conditions.

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Defining Start Conditions to Define Route Actions

Like filters, start conditions use DXML code to define rules for determining how route actions are applied to one or more groupings of orders. Generally, start conditions use a more detailed set of criteria, and in so doing they further restrict a particular grouping of orders that is routed to one or more specific destination(s). When a Route Action is configured with a start condition, routing of all orders using the Route Action is suspended until the conditions of the associated start action are met. For example, you might define a start condition specifically to await the reconciliation of all orders belonging to an Admission Medication Reconciliation session. In this case, all AMR submissions are suspended until all medications belonging to the AMR session are reconciled.

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Configuring Routing of Printed Order Sheets to Await Pending Interfaced Submissions

You can configure your system to prevent against routing printed orders to a Destination before all interfaced orders associated with each order session are resolved. You can define a list of all Route Actions needing to be resolved before the printed order sheet for a particular Route Action is generated and sent off to its Destination. For a Route Action to be considered “resolved”, all interfaced order submissions from the session must be completed unless they are confirmed to have failed. Safeguards have been put in place to prevent against the risk of Route Actions remaining in an unresolved state indefinitely. You can configure a maximum wait threshold to ensure that printed order sheets are always eventually routed to their Destination, even if they are routed prior to the completion of all interfaced order submissions. In such cases, any incomplete orders that are included on the printed order sheet are marked with the status “Failed to Interface”. Note that when you configure a print Route Action to await pending interfaced submissions when a Hold Condition has already been defined (using DXML) for this Route Action, the maximum wait threshold takes effect only when the Hold Condition criteria is met. For example, if you configure a 10 minute window (for the Max Hold Timeframe setting) to await pending submissions for a Route Action that has a Hold Condition requiring that a particular visit type be created in the back-end system, the 10 minute window period starts once the visit type is created (meeting the Hold Condition criteria). To hold routing of printed order sheets until all orders are interfaced:

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

The CPOE Preferences page displays by default.

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 you want and click the Edit button. The Edit Route Action screen displays.
6. Locate and configure the following two settings:
   • Hold for Route Actions: Select one or more Route Actions from the lookup field. Routing of printed orders will be suspended until all interfaced submissions associated 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, the printed order sheet is routed to its Destination(s) regardless of whether all interfaced submissions have been received and considered complete. In such cases, all incomplete orders are marked on the printed order sheet with the status “Failed to Interface”
7. Click Save.

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Notifying Providers when Orders Continue Beyond Current Page of Printed Order Sheet

You can configure the standard printed order sheet to indicate when orders and order sets continue beyond each of the numbered pages. When you enable this option, the text “Orders continue on next page” displays at the bottom of each page except the last of the printed order sheet. This update requires an update to your standard template. For more information, contact your Commure Pro representative.

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Defining the Output Format of Routed Orders

Part of route configuration involves configuring how orders appear when they reach their destination. This configuration is accomplished through the use of DXML, which defines the display of orders, whether they are routed to an application server, a printer, or to the web service that serves as a waiting area before orders are delivered to the back-end system in the form of HL-7 messages. Do not make any modifications to the output formats setting Format Template (on the Edit Route Action screen) without consulting a Commure Pro representative.

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Clearing Stored CPOE DXML Templates from the Database

Authorized administrators (level 0 only) can clear the back-up version of each compiled CPOE DXML template that is stored in the database. One back-up copy of each compiled template is stored in the database so that the template can still be loaded quickly without the need to be re-generated (such as after the web cache is cleared). This option (Clean Compiled CPOE Templates) is available under System Management (Admin > System Management > Misc). You should only plan to clear templates after making changes to one or more templates in use, since each of your templates must be re-generated the first time it is selected after you clear the database. If you are updating one template, you should consider updating any other CPOE DXML templates at the same time in order to minimize how often these templates need to be re-generated.

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Display of Medication Mnemonics on Printed Orders

(MEDITECH only) By default, the CPOE application is configured to display the mnemonic value for all medication orders. Each mnemonic is now included on the printed order sheet along with its associated medication order, as in the following example: mnemonic123 - Acetaminophen 325 MG BID The specific mnemonic to use is determined by the following:

• The dosage of the particular order instance that is entered
• The strength that corresponds to this dose
• The Order Definition that corresponds to this strength
• The mnemonic that corresponds to this Order Definition (based on the NDC code)

Display of the medication mnemonic is determined by configuration of your facility or institution’s print output, which is determined by DXML configuration. You can optionally configure this output to exclude the mnemonic. For more information, contact your Commure Pro support representative.

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Configuring How Routing Responds to Printer Problems

How route success is defined in relation to certain printer problems varies by site and is partly determined by a specific site’s capacity to monitor the printers in their network. At sites with a robust infrastructure for monitoring printers, successful routing to a printer can be assumed by CPOE even in cases where a print Destination is not immediately available (such as due to a paper jam or out of paper), since the site’s monitoring capability can be trusted to adequately identify and report the source of these problems. However, at sites lacking such an infrastructure, CPOE routing can be configured to respond to such problems by re-directing Route Actions to the queue and reporting the printer state on the Submission Record Details window (Admin > Tracking / Reporting > Submission Status tab > [select from Submitted column]). When you configure CPOE to report when printers are unavailable and re-queue all submissions associated with the print Route Actions, printers meeting the criteria for “unavailable” include printers reporting the following states: printer error, paper jam, printer out of paper, printer offline, printer not available, printer out of toner, user intervention, printer out of memory, and printer door open. To configure how routing responds to printer problems:

1. Navigate to Site Administration (Admin > Institution > Site Administration).
2. Scroll down to the Routing section and set Allow Queuing Print Jobs to Printer Regardless of Printer State to
   • Yes: To ignore when printers report an unavailable state and send Route Actions to the printer queue, relying on the site’s monitoring infrastructure to identify and respond to printer problems.
   • No: To re-direct Route Actions for re-processing when printers report an unavailable state and report the specific printer problem on the Submission Record Details window (Admin > Tracking / Reporting > Submission Status tab > [select from Submitted column]).
3. Click Save. Your changes are saved and problematic printer states are either reported or ignored, depending on your configuration.

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Configuring Route Actions for Use by Charge Capture

In addition to defining Route Actions for routing orders, Route Actions can also be defined for the charge transactions that providers enter using Commure Pro’s Desktop or Mobile Charge Capture applications. Charge Capture route actions are used to transmit charge transactions to an external billing system. Please do not modify any Destinations, Destination Groups or Route Actions that are implemented for charge routing in your system; only Commure Pro staff should make changes to these settings. For more information about the routing of charge transactions, see the section “Configuring Charge Routing to External Systems” in the Commure Pro Administration Tools User’s Guide.

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Configuring Route Actions for Use by NoteWriter

In addition to defining Route Actions for routing orders, you can define Route Actions for notes that providers create and submit using Commure Pro’s NoteWriter application. Configuring notes to be routed to printers is very similar to configuration of orders in CPOE, except that routing notes requires you to select the NoteWriter Route Type. There are also a few other differences to consider when configuring NoteWriter Route Actions, which involve configuration of templates and layout IDs. For more information about these differences, see the section “Configuring Notes to be Routed to Additional Printers” in the Commure Pro NoteWriter User’s Guide.

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Configuring the Locations for Route Actions

You might decide that Route Actions should only be applied to orders that were derived from specific patient Locations in your facility. You can configure which patient Locations should (and should not) result in a particular Route Action. Configuration of your initial location settings typically occurs during configuration of your institution settings, although you may find the need to update these settings periodically, as changes occur to the units in your facility. For more information, see Configuring Locations.

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Adding Locations to a Route Action

You can associate any number of patient Locations in your facility with each of the Route Actions you define. You can also associate part (or most) of a patient Location with a route action. This is accomplished by adding the facility as a location to your Include list, and then specifying one or more of the units (within that facility) that you want to exempt from the route action to your Exclude list. For more information, see Excluding Locations from a Route Action. To add a Location to a Route Action:

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

The CPOE Preferences page displays by default.

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 you want and click the Edit button.
6. Locate the Location setting and, for each location that you want to add to the selected route action:
   • Click the Add Location link in the Include region of the screen.
   • Use the drop-down menus to select the facility and unit that you want to add to the selected route action.
7. If there are units within your facility that you want to exempt from this particular route action, you can exclude these units. For more information, see Excluding Locations from a Route Action.
8. Click Save. Orders derived from these patient Locations will now use the selected Route Action.

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Excluding Locations from a Route Action

You can exclude any number of patient locations in your facility from a particular route action. When you specify a Location on the Exclude list without specifying any Locations on your Include list, then orders from all facilities and units in your institution will use the Route Action except the location(s) you specified on your Exclude list. When you add one or more facilities to your Include list, then you can exempt any of the units that belong to each of these facilities by putting those units on the Exclude list. Using these two lists together along with your filters and start conditions, you can configure with some granularity the locations in your facility that should qualify for each of the route actions that you define. To exclude a location from a Route Action:

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

The CPOE Preferences page displays by default.

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 you want and click the Edit button.
6. Locate the Location setting and, for each location that you want to exempt from the selected route action:
   • Click the Add Location link in the Exclude region of the screen.
   • Use the drop-down menus to select the facility and unit that you want to exempt from the selected route action.
7. Click Save when you are done configuring the locations you want to exclude. Orders derived from these patient Location(s) will not use the selected Route Action.

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Route Settings

This chapter describes the settings that are provided to enable configuration of order routing through your facility or institution. Route settings are grouped into the following categories:

• Destination settings
• Destination Group settings
• Route Action settings The following administration settings are provided for configuring how orders entered in the CPOE application are routed through your facility. These settings are available to level 1 administrators.

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Destination Settings

The following settings are used to configure route destinations in your facility. These settings are available to level 1 administrators only. Commure Pro Key Specifies a unique value that the CPOE application uses to identify a Destination. The system defines this value to associate a Destination with a particular Destination Group and Route Action. Abbreviation The short name or identifier used to identify the Destination; for example, 4th Floor Printer. Name The full name of the Destination. This name identifies each route Destination to Administrators, so it should be sufficiently descriptive to distinguish the Destination from all other Destinations in your facility. Destination Group Specifies the Destination Group to which the selected Destination belongs. In addition to organizing Destinations, Destination Groups serve to unify a set of route Destinations so that you can route orders meeting specific criteria to a particular location. Available Select Yes if this Destination is available for use at this time. Set it to No if the Destination is not currently available for routing actions (but you are configuring it for future use). Support Mode Enables alerting within third-party monitoring applications (such as Argus) to be disabled or reduced for test Destinations or Destinations requiring a less urgent response to these monitoring alerts. Note that this preference controls alerting within the monitoring solution only and has no impact on the standard rules for (e-mail) alerting that govern alerting within the CPOE application. You can configure Destinations to trigger the following alerting levels within your third-party monitoring solution:

• Full Alerting: The Destination is assumed to be fully operational and alerting within monitoring applications should be handled with the standard severity that applies to alerting within a typical production system.
• Test Mode: The Destination is assumed to be operational, but alerting within the monitoring application does not require the level of severity that applies to alerting within a typical production system. This mode might be used in a staging environment, where alerts can be deferred to and addressed within a specific time frame (such as daytime business hours).
• No Alerting: The Destination might not require any additional alerting within the third-party monitoring application. Destinations that are operating in ‘demo’ mode or which are used for testing purposes only might be configured with this mode. Location Specifies the physical location(s) of patients that will have their orders routed to a particular route Destination. You can add multiple locations to correspond with a single Destination. Then, when you define route actions for your facility, you can include or exclude selected locations on an individual basis.

Address Specifies the address (including directory path) of the specified resource that is set as the Destination. The syntax used to specify this address is determined by the Route Type that applies to the Destination Group to which the selected Destination belongs. For example, you might specify the address to a local file system as D:\SEHospital\RoutedPDFs\tomcat. Note that when you select a Destination Group of type “printer”, a drop-down menu provides a list of all printers that are currently available. Do not send document to this destination if no review needed: Determines whether to route order sheets to the selected Destination when all medication orders successfully interface with MEDITECH. When this setting is enabled and all medications from a session interface successfully, the PDF reports this status with the text “All medication orders were interfaced to MEDITECH” (NOTE: to make use of this feature requires an updated template from the Commure Pro integrations team). When this setting is disabled, order sheets are routed to the selected Destination regardless of whether all medications from the session are interfaced to MEDITECH, which can sometimes result in blank order sheets being routed to the Destination. All Success Address (med HL7) Specifies the address for Destinations dedicated to handling completed printed pharmacy order sheets (those containing medication orders that all interfaced successfully). Creating ‘success’ Destinations is especially useful when the group tasked with acting upon completed printed pharmacy order sheets in your facility differs from the group tasked with troubleshooting problems with interfacing medications to the pharmacy scripter. As prerequisite to configuring success Destinations, you must configure the Hold for Route Actions setting for at least one of the Route Actions associated with the Destination Group to which this Destination belongs. When this field is populated, validation is performed during save of the Edit Destination window to ensure that this prerequisite has been met. If not, you are instructed to clear the value of this field. Send to Alternate Destination Determines whether to route submissions to the primary address (that of the associated Destination Group) or to a different (temporary) address that you specify once this field is enabled. Alternate Address Specifies a secondary address to use instead of the primary address. Note that any value you enter for this field overrides the primary address; this Destination does not serve as a back-up Destination in the event of problems routing submissions to the primary address. Also note that upon enabling the Send to Alternate Destination field, the Alternate Address field displays as a mandatory field to ensure that you enter a valid address before saving your changes. Last Updated By Displays the most recent date and time that edits were made to this data, as well as the user name of the person responsible for this change.

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Destination Group Settings

The following settings are used to configure Destination Groups in your facility. These settings are available to level 1 administrators only. Commure Pro Key Specifies a unique value that the CPOE application defines and uses to identify a Destination Group. Each Destination Group defines a set of Destinations that are grouped by use or function so that you can define route actions that route orders to multiple locations. Abbreviation The short name or identifier used to identify the Destination Group; for example, East Wing Printers. Name Specifies the full name of the Destination Group. This name identifies each Destination Group to Administrators, so if the group name does not convey its meaning in a self-evident way, it should reference its Destinations explicitly to avoid ambiguity around which Destinations belong to a particular Destination Group. One Order Per Charge or HL7 Message/Submission Determines how HL-7 messages are used to transmit data for orders belonging to an order submission, or for charges within a charge transaction. When this setting is enabled, a single HL-7 message is used to transmit each order belonging to an order submission or each charge within a charge transaction, enabling monitoring of individual orders or charges. When this setting is disabled, multiple orders belonging to an order submission, or all charges withing a charge transaction, are included in a single HL-7 message. Retry for NN minutes prior to failure Specifies a time limit (minutes) for re-attempting submissions that fail. This configuration option lets administrators configure Destination Groups to allow for additional time beyond the re-try attempts threshold set by the property Applications.CPOE.Routing. ReprocessAttempts in the Configuration Editor (Admin > System Management > Configuration Editor > Add Configuration to Override Default). It is expected that administrators will use the time-based configuration option (Retry for NN minutes prior to failure) specifically to configure printer destinations, as printers can be held up due to low toner or need to re-stock paper. Note that when re-try submission thresholds are configured both in duration and number of attempts, submission re-tries will occur for the longer of the two limits. Route Type Specifies the method to use for routing orders to the selected Destination in your facility. The order routing options are:

• Electronic Mail: Routes orders (in the form of an e-mail) to a specific e-mail address, as specified by Destination.
• Priority Electronic Mail: Routes only priority orders (in e-mail form) to a specific e-mail address, as specified by destination. Priority e-mail orders are those identified as high priority (through an identifier flag such as those used in Microsoft Outlook e-mail clients).
• File Server: Routes orders (as formatted documents, such as .pdfs) to a specific file server or group of servers, as specified by Destination (using one or more Destination’s address fields).
• Interface (WebService): Routes orders to a queue, where they are delivered to the back-end system via HL-7 messages. You can direct route actions to a particular HL-7 interface by assigning an interface ID value to one or more route actions. For example, your configuration might use one interface to handle all medication orders and a separate interface to handle all other types of orders.
• Printer: Routes orders to a specific printer or printers, as specified by Destination (using one or more Destination’s address fields). Supported printers include any standard office printer used to produce printed order sheets (of standard size 8.5 x 11, 8.5 x 13, or 11 x 17). You can also configure your system to include your pharmacy printer* as a routing destination, but note that a specific template is required for this kind of route action due to the unique formatting considerations and specific information that displays on pharmacy print-outs.

(* Currently the CPOE application supports the Star Micronics TSP800ii Reports & Receipt printer only.) For more information about obtaining the latest pharmacy print-out template, contact your Commure Pro representative. When configuring destinations belonging to an e-mail Destination Group, you must specify a valid e-mail address using either the format localName@domainName.com (.net, etc.) or localName@domainName, if your institution’s mail domain excludes the .xyz component of the domain name. Domain names must be at least 3 characters in length. Route Output Format Type Specifies how formatting of the order data takes place when it is routed to the selected Destination Group in your facility. The options for output format are:

• PDF: Specify this output format for Destination Groups with a Route Type of File Server or Printer.
• PDFMT: This output format is provided for some sites that use a MEDITECH back-end only. Do not choose this setting without first contacting your Commure Pro representative.
• XML: Specify this output format for Destination Groups that have a Route Type of Interface (WebService).
• TIFF: Specify this output format for Destination Groups that are used to store images in TIFF format.
• TIFFCT4: Specify this output format for Destination Groups that use an uncompressed TIFF format (revision 4.0 of CCITT Group 4 fax encoding).
• TIFFCT6: Specify this output format for Destination Groups that use an uncompressed TIFF format (CCITT Group 4 fax encoding). Typically this output type is preferable in a Windows XP environment.
• TIFFLZW: Specify this output format for Destination Groups that use lossless TIFF format.
• XML_TEXT: Specify this output format for Destination Groups that use Text format for documents needing to be routed over an outbound HL7 interface. For example, if your template supports it, you can configure medication reconciliation reports to use this format and then configure the associated Destination Group so that it uses the Interface Route Type.
• XML_PDF: Specify this output format for Destination Groups to which you plan to route printed order sheet PDFs over an outbound HL7 interface. If you choose this option for one or more Destination Groups, you must also configure these Destination Groups to use the Interface (WebService) Route Type. For more information about updating your Order Form template, contact your Commure Pro representative.

Last Updated By Displays the most recent date and time that edits were made to this data, as well as the user name of the person responsible for this change. Generate destination unavailable alert after NN minutes Specifies the threshold (in minutes) that attempts are made to establish communication with an unreachable destination belonging to the selected Destination Group before sending an alert. When this time period is exceeded, an e-mail alert is sent to a configurable group of recipients. The list of recipients for these e-mail alerts is specified by a location preference (Recipients for Print Alerts, Recipients for Interface Alerts, or Recipients for File Server Alerts) as determined by the route action type of the submission. Note that an alert is sent to all recipients on one or more of the above lists when submissions that are routed to a Destination remain in a state of “queued for processing” or “queued for re-processing” for a duration exceeding this threshold. Alerts are also sent to one or more of these lists when submission failures (specifically those involving process failures and destination unreachable failures) occur pertaining to the associated type of route action. For example, when a failure occurs with a submission that was routed to a File Server, an alert is sent to all users specified by the Recipients for File Server Alerts location preference. Also note that no alerts are sent concerning activity related to test patients. Functionality for flagging test patients is accomplished through an XML customization. If your site has implemented this functionality, the setting Test Patient is provided on the Edit Visit and Edit Patient screens. When you mark patients as test patients by enabling this setting, then submission failures involving this patient do not trigger alerts to any of the recipient lists described above. For more information about installing this XML customization, contact your Commure Pro representative. Generate held submission record alert after NN days Alerts are sent to a list of recipients (as defined by the location settings for various Route Actions (such as Recipients for Print Alerts, Recipients for File Server Alerts, etc.) when submission records associated with this Destination Group remain in held status beyond a configurable threshold (in days). Note that you can configure held submission record alerts in either days or hours (not both). Generate held submission record alert after NN hours To allow for alerting in timeframes that are shorter than a day, this configuration lets you send alerts to a list of recipients (as defined by the location settings for various Route Actions (such as Recipients for Print Alerts, Recipients for File Server Alerts, etc.) when submission records associated with this Destination Group remain in held status beyond a configurable threshold (in hours). Note that you can configure held submission record alerts in either days or hours (not both). For best practices, you should configure this value to exceed (or equal) the duration specified by the Route Action property Maximum Hold Timeframe (minutes). Hold conditions are released automatically as soon as their hold condition is met or the maximum hold timeframe is met (whichever comes first). Should the hold condition become stuck for any reason, this alert is then sent after the specified duration. The following setting applies to Interface (Web Service) Destination Groups only. Create Submission if No Orders in the Session (for customers using DMR with MEDITECH only) This setting controls which interfaced Destination Groups are specifically intended to receive submissions (formed in a specific way) to transmit the status of finalized DMR plans. You should only enable this setting when a Destination Group (and its associated Route Action) are used for interfacing finalized DMR plans to a MEDITECH back-end system. For all interfaced Destination Groups other than the intended (MEDITECH) recipient of finalized DMR plans, this value should always be set to No (the default value).

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Route Action Settings

The following settings are used to configure all of the route actions used by your facility or institution. These settings are available to level 1 administrators only. Id The unique identifier that is used to represent a particular Route Action in the CPOE application. Interface Id The identifier that is used to represent a specific HL-7 interface. You can assign one or more route actions an interface ID value to direct web service requests to a particular outbound interface. For example, you might assign some of your route actions to an outbound interface dedicated to handling medication orders, and assign one or more other route actions to an outbound interface dedicated to handling orders belonging to all other order types. Last Updated By Displays the most recent date and time that edits were made to this data, as well as the user name of the person responsible for this change. Name : The full name of the Route Action. This name identifies each of the available Route Actions to Administrators, so it should be sufficiently descriptive to distinguish each Route Action that you define in your institution or facility. For example, “Printing on the Nursing Unit”. Route Type Determines whether the Route Action is defined for orders in the CPOE application, for notes in the NoteWriter application, or for charge transactions in the Charge Capture application. Unless you are configuring the Commure Pro NoteWriter product to route notes to one or more of your facility’s printers, or the Commure Pro Charge Capture product to route charges to an external system, you should always select CPOE for this setting (the default). For more information about configuring Route Actions for NoteWriter or Charge Capture, see the topics below.

• For NoteWriter: “Configuring Notes to be Routed to Additional Printers” in the Commure Pro NoteWriter User’s Guide.
• For Charge Capture: “Configuring Charge Routing to External Systems” in the Commure Pro Administration Tools User’s Guide. Route Action Type Determines the type of activity to use to define a particular route action. In the current release, Route Actions of type Route are supported only.

Destination Group Specifies the Destination Group that is affiliated with the selected Route Action. You can only configure one Destination Group per Route Action, so you should define your Destination Groups to be as inclusive as possible without compromising your facility’s need for granularity in defining route actions to accommodate your work flow. Note that administrators are prevented from deleting Destination Groups that retain an association with a Route Action. Route as Group Determines what criteria to use when determining whether to route a group of orders in an ordering session. When this setting is set to:

• No: Each order belonging to an ordering session is evaluated individually in determining whether to perform the specified route action. For example, if two orders in a session of five orders meet the start conditions, then the selected Route Action is performed on these two orders only.
• Yes: All orders belonging to an ordering session are evaluated as a group in determining whether to perform the specified route action. For example, if only four orders in a session of five orders meet the start conditions, then the selected Route Action is not performed on any of the orders belonging to the session.

Completes Routing for Commure Pro Only Orders Ensures that each Order Definition associated with the orders in an ordering session has been assigned to at least one Route Action. This setting is applied to all orders with Order Definitions that have no corresponding back-end order (their Corresponding Back-end Order setting is set to No). Completes Routing for Commure Pro Orders with Corresponding Backend Orders Ensures that each Order Definition associated with the orders in an ordering session has been assigned to at least one complete Route. This setting is applied to all orders with Order Definitions that have corresponding back-end orders (their Corresponding Back-end Order setting is set to Yes). Display order set additions, changes and omissions on print out Determines whether or not to identify any/all changes to Order Sets on the printed order sheet. When this preference is set to Yes, the printed order sheet is updated each time an Order Set is modified, including whenever orders are added to, modified in, or deleted from an Order Set. When this preference is set to No, the printed order sheet does not change to indicate when modifications are made to an Order Set. Location Specifies a list of locations that are affiliated with the selected Route Action. You can specify both inclusion and exclusion criteria, which enables you to define Route Actions for an entire facility while exempting specific locations within the facility. For example, you might want to define a facility-wide Route Action that routes all Stat orders to a particular file server in your facility, but you might want to exclude the entire south wing of the facility. To accomplish this result, you could add the facility to your Include Location list and add the south wing to your Exclude Location list. Start Time Specifies the time at which the selected Route Action will go into effect. For each Route Action that you define, you can set the time at which you want to begin routing orders according to the Route Action’s filter and start condition rules. End Time Specifies the time at which the selected Route Action expires. This setting enables you to establish a set of filter and start condition rules to define a Route Action that remains valid for a limited time. Filter Further defines the criteria used in establishing which orders are subject to a particular Route Action. You can specify a Filter to narrow down the scope of orders before you evaluate them against a defined set of Start Conditions. Format Template Defines the output format display to be used for the selected Route Action. This field uses XML to define the format type that you specify during configuration of a Route Action’s associated Definition Group. For more information, see Route Output Format Type. Start Conditions Defines the criteria used in determining whether an order or group of orders is a candidate for the selected Route Action. This field uses XML to define how each Route Action is applied to a single order or group of orders (as determined by the setting Route as Group). WaterMark Defines standard text that is applied across the front of all printed order sheets sharing a particular Route Action. Use of watermarks lets you convey important information pertaining to all order sheets that are expected to be routed to a common destination. For example, you could use a watermark to identify all printed order sheets that will be routed to a specific department printer, such as the nurses’ station.