Entering Orders

The Commure Pro CPOE application is a complete order-entry system that simplifies the process for physicians and nurses. You can enter orders for your patients from anywhere in your workflow.

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Entering Orders: Basic Steps

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Starting An Order

Commure Pro CPOE allows you to begin adding orders for your patients using any of the following ways after you select your patient from the Patient List: When you use any of these methods to start an order, you might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order.

• Click Add located next to the Orders link in the center column.
• Click the Enter Orders button from the Orders link in the center column.
• Click Order Again located in the details pane while viewing a test or lab result from the Patient Data Display window.
• On the Patient Search tab, selecting the Actions drop-down while a patient visit is selected from the search results, and then selecting Enter Orders under the Document header.

The Order Entry window displays for the patient with the most recent visit selected in the Order for Visit: field.

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Adding an Ordering Provider and Source

If you are a nurse who is entering orders on behalf of a provider, you will need to add the ordering provider and the source of the order(s) provided as follows:

1. Enter the name of the ordering provider into the Ordering Provider text box, and then press the Enter key or click Search . You can also select the ordering provider by using the Recently Selected link if you have previously submitted an order for the ordering provider.
2. Select the source type from the Source drop-down. For example, if the ordering provider called the order in, then you would select Telephone Order. You are now ready to start adding orders. See Adding New Orders for more information.

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Adding New Orders

You can add new orders for your patient using several different approaches:

• Adding a Favorite Order
• Searching for an Order to Add
• Repeating an Order
• Adding an Order Set
• Adding a Free Text Order

While adding an order, you can also do the following:

• Adding a Reason to a New Order
• Specifying “Now” as the First Dose Time for a Medication Order

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Adding a Favorite Order

Commure Pro CPOE allows you to designate frequently used orders as Favorites so they are quickly and easily available to use in your order entry process. You can find your Favorites list below the Add Order search field on the left side of the Order Entry window. You might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order.

1. Select an order from your Favorites list.
   You may need to click on a category, such as Radiology, to display the desired order for selection.
   If no additional information is required, the order is added to New Orders list; otherwise the order is not added until after any required information is completed. If more information is required, proceed to the next step to complete the order.
2. Review any CDS alerts that display, complete any required information (highlighted in red) if the Order Details window displays, and then click Done.
3. (Optional) Some Radiology orders require an Appropriate Use Criteria (AUC) check. If the new order requires an AUC check, then the Check AUC button displays at the bottom of the Order Details screen. Click Check AUC to check the appropriateness of the exam for the patient. If alternate exam options are available, review the options to determine if a more appropriate exam is available, or proceed with the current order (might require a reason if an alternate exists). For more information about evaluating AUC Check results, see Appropriate Use Check for Radiology Orders.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.

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Searching for an Order to Add

If the order you wish to add is not part of your Favorites list, you can search for it using the Add Order search field. This search capability will begin displaying matches as you enter the order name. You do not need to enter the entire order name to start receiving possible matches. You might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order.

1. Enter the name of desired order into the Add Order search field located below the Problems: field in the upper left corner of the Order Entry window. As you enter the order into the Add Order search field, a list of possible matches displays.
2. (Optional) Select a tab for the desired category to narrow the search results. If you choose the Medication tab, you may see only Formulary results or both Formulary and Non-Formulary results depending on how your administrator configured the search. If only Formulary results display and you want to see Non-Formulary results, check to see if there is a link in the upper right corner called Show Non-Formulary (must be configured by administrator for availability). Click the Show Non-Formulary link to display Non-Formulary results. Click the Hide link to toggle back to Formulary only results.
3. (Optional) Select the Weight Based Medications Only checkbox if you only want to see this type of medication order.
   The Weight Based Medications Only checkbox only displays if your facility has weight based dosing functionality enabled.
4. Select the order from the search results. The order is added to the New Orders list unless the order requires more information to complete it. Proceed to the next step, if the Order Details window displays.
5. Review any CDS alerts that display, complete the required information (highlighted in red), and any other desired information in the Order Details window, and then click Done. Note the following:
   • If you choose a Non-Formulary medication, you might get prompted for a reason. Either select the reason for using the Non-Formulary medication, and then click Continue to add the order or click Cancel to choose a different medication.
   • Numerical dosage values: Any zeros that trail a decimal point are removed. Zeros are added at the beginning of a number if there is a decimal point with no numbers before it.
   • Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.

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Repeating an Order

You can repeat an existing order from within the order entry window or repeat a completed lab or test order while viewing clinical data if the Order Again functionality is enabled. You might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order. For example, if your organization has multiple hospitals and designates each hospital as a facility group with its own distinct set of order definitions and you have privileges to more than one hospital, you cannot use the Order Again, Hold, or Discontinue functions for an order that your patient had during a visit at a Hospital A (part of Facility Group A with its own set of order definitions) for your patient’s visit in Hospital B (part of Facility Group B with a different set of order definitions).

Repeating an Existing Order

1. Enter the Order Entry window (see Starting An Order).
2. (Optional) Select the desired timeframe from the Show Order From: and thru: drop-down menus. Active, pending, future, and completed orders display in the Existing orders for this visit list.

You can also select any existing orders from a previous visit if available. Click the Expand icon in the upper right corner of the Existing orders for other visits pane to view and select an order.

3. Select the desired order from the Existing orders for this visit list.

You cannot repeat an active medication order. You can only Discontinue, Modify, or Hold the order.

The Order Status window displays.

4. Click Order Again to begin the enter order process.

The availability of the Order Again functionality is dependent on your system setup. See your system administrator for details on what functionality is available.

The Order Details window displays.

5. Review any CDS alerts that display, complete any required information (highlighted in red) in the Order Details window as needed, and then click Done.

This repeated order is added to the New Orders list.

Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.

Repeating a Completed Lab or Test Result

1. View your patient’s clinical data in the Patient Data Display window using either of the following ways:
   • Click Show Clinical Data in the Order Entry window.
   • Select a patient from your Patient List.
2. Click the Test Results or Lab Results link in the center column to view the list of completed lab or test results.
3. Select the desired test or lab result.
4. Click Order Again in the detail pane of the test or lab result. For a lab, proceed to the next step. For a test result, proceed to Step 6 unless the Add Order search is executed, then select the correct order before proceeding to Step 6.
5. (Labs only) Select either the entire panel or individual components. If you select several individual components at the same time, click OK to add them. If you select an entire panel, it will be added automatically. The Order Entry window displays and the lab order is added to the New Orders list.
   If the Add Order search executes, select the appropriate lab to add to the New Orders list.
6. (Test Results only) Complete the Order Details window as needed, including any required information (highlighted in red), and then click Done. The repeated test is added to the patient’s New Orders list.

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Adding an Order Set

Your organization may have created order sets for your use. An order set is a list of suggested orders for a particular procedure or diagnosis. You can quickly select some or all of the orders from the order set and enter them all at once. You might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order. To use an order set:

1. Select the order set from either:
   • Favorites (see Adding a Favorite Order)
   • Order Search (see Searching for an Order to Add)
   The order set form displays.
2. Select some or all the orders listed in the order set. The Order Details window will display if the order needs any required field completed.
3. Review any CDS alerts that display, fill in the information for the required field, and then click Done to return to the order set form.
   Your administrator might have configured admin criteria fields or field sets. Admin criteria is data derived from an additional field set contained in an order string that defines the specific requirements for that particular string. For example, admin criteria might display default values and other data required for successful titration of a medication on an order string. These fields might also have default values that you can edit as you complete the order entry process.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   In some cases, when you select a particular order in the order set, one or more in the set are then also automatically selected for you. For example, there might be two or three items are always ordered together at your organization. If so, your administrator might set them up so that when you order one of the items (known as the “parent” order), the orders for the additional items (known as the “child” orders) are automatically selected for you. If you unselect a parent order, all of the child orders are unselected as well. Regardless of this automated selection/unselection feature, you can always select or unselect any child order individually.
   You must include any highlighted, pre-selected orders. Do not remove these orders as they are required to complete the order set.
4. After you complete your selections, click Done with Order Set. The New Orders list displays all the selected orders from the order set form.

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Adding a Free Text Order

You may need to add a custom order or free text order if the desired order is not on your Favorites list, and you cannot find it using the Add Order search.

1. Search for an order using the Add Order search (see Searching for an Order to Add). The search window with the available orders matching your search criteria appears.
2. Click Add as free text in the search window if no order matches your requirements. A dialog box appears with the possible order types available for custom orders.
3. Click the correct order type, such as Med for Medications. A blank Order Details window displays.
4. Complete the order details, including required information (highlighted in red), and then click Done.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   The free text order is added to your New Orders list.

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Adding a Reason to a New Order

Some orders, such as radiology orders, may require that you provide a reason for needing it in the Order Details window. You can use an existing problem if available, add a new problem which will be added to the patient’s problem list, or enter a reason just for that order.

1. On the Order Details screen, click the Select Problem link. The Select Problem window opens. It contains a Search for Problem field, and also a list of all of the patient’s existing problems (if any). You may see a Select Recent Problem list. This list displays problems that were selected within the ordering session but were not submitted. Submitted problems will display in the Select Existing Problem list.
2. Select a problem using either of these methods:
   • Use an existing or recently used problem: In the Select Existing Problem or Select Recent Problem section, click on any problem that is listed.
   The problem is added to the Order Details window.
   • Add a new problem: Search for a new problem by just typing in the Search for Problem field. This field uses a medical vocabulary called Intelligent Medical Objects (IMO^®) to provide an alternate set of diagnosis descriptions in the search results. IMO is a patient-centric terminology database that is licensed through Commure Pro and it provides extensive mappings of disease states to ICD-9 or ICD-10 codes and any applicable HCC codes. Search queries involving IMO terms show the most relevant 100 results based on their IMO ranking.
   You can type a complete or partial ICD-9 code, ICD-10 code, SNOMED CT^® code, or diagnosis description. As you are typing in the Search for Problem field, any diagnoses that match what you type are immediately displayed. The number of characters that you must enter to trigger these matching search results is configurable (the default is two characters). For more information about configuring the number of characters necessary to trigger the search results, contact your Commure Pro representative.
   • Complete Code Example: If you enter “I10” in the Search for Problem field, the system automatically adds the code I10, since it is a complete code and has a single, exact match in the list.
   • Partial Code or Text Example: If you enter “I1” in the Search for Problem field, the system displays all codes (along with their text descriptions) that start with those numbers, such as I10, I11.0, and so on. Or, if you enter “diabetes,” the system displays all diagnoses that contain the word “diabetes” in the description.
   In addition, if you enter an ICD-9 code, the corresponding ICD-10 codes are returned in the results. This can be very helpful if you are not yet familiar with ICD-10 codes. After typing some numbers or text into the Search for Problem field, there are several filter options available to help you refine the search results down to the specific diagnosis code that you want. By default, the system automatically applies the Age and Gender filters, so that the result list shows only those diagnoses that are appropriate for the patient, based on their age and gender. However, you can turn off these filters if necessary. For example, you might turn off the gender filter when searching for a diagnosis for a patient who is transitioning from one gender to another. You can use any combination of the filters below, all of which are located to the right of the search results (some filters may not be available). To unselect a filter, click the X icon to the right of the filter name.
   • Filters by Patient Demographics (Age and Gender): Both of these filters are turned on by default. To turn them off, click the small blue x icon to the right of the filter name.
   • Filters by IMO Classification: You may see IMO classifications by disease for the terms by which you are searching. For example, when searching for diabetes, you would see filters for trimester classifications for gestational diabetes.
   • Filters by Common Terms: A series of filters are automatically created based on commonly used terms found in the results. Select any of these filters to view only those diagnoses containing a specific term.
   • Filters by Clinical Area: Select a Clinical Area filter to view only those diagnoses that are used by a specific specialty.
   After searching for a problem and selecting one, the problem is either added to the Order Details window or a dialog box is displayed with two options:
   • Problem List: Select this option to add the problem to the patient’s Problem List (in addition to this order). The problem is automatically assigned a Type of “Acute” and a Status of “Active.” In addition, the current date is used for the Last Used date and the Onset date.
   • Rule Out: Select this option to use the problem for this particular order only. The problem is not added to the patient’s Problem List but the order will display RULE OUT [Problem description] in the description of the order.
   The problem is added to the Order Details window.

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Specifying “Now” as the First Dose Time for a Medication Order

Medication orders have several fields and selections that determine the schedule for a patient’s medication:

• Priority radio buttons (for example: Routine, STAT, Now)
• Frequency field (for example: Daily, QAM, QPM, Q4H, etc.)
• Start First Dose field (for example: In AM, Today, In (mins), etc.)

The values you select for these fields determine the medication start time, based on the organization’s scheduled administration times for the selected Frequency. In some cases, if the number of hours to the patient’s first scheduled dose is more than half the total number of hours between doses for the selected Frequency, you may see a warning message in red: “Next scheduled dose in 18 hours 15 mins (04/12 09:00 AM).” For example, if medications with a Frequency of “Daily” are administered at 9:00 AM (24 hours between doses, 12 hours is half), and the current time is 3:00 PM, then it will be 18 hours until the patient’s first scheduled dose. Since 18 is more than 12, you would see the warning message. In this case, if you prefer that the first dose be given now, then you can easily change the priority to “Now,” either on the Order Details screen, or from the Order Entry screen.

1. Enter a new order for the patient using any of the standard methods:
   • Adding a Favorite Order
   • Searching for an Order to Add
   • Repeating an Order
   • Adding an Order Set
   • Adding a Free Text Order
2. After selecting the order using any of the above methods, the Order Details screen may be displayed:
   • If the Order Details screen is displayed after you select the order:
   1. Review the Dose, Frequency, and Start First Dose fields, and make any changes as necessary.
   2. If the number of hours to the patient’s first scheduled dose is more than half the total number of hours between doses (based on the Frequency you selected), you may see the following message is displayed in the Priority field: “Next scheduled dose in nn hours nn mins (mm/dd hh:mm AM/PM).”
   3. If you want the first dose to be given now, select the Now radio button under the Start First Dose field.
   4. Select Done to save the Order Details.
   5. Sign and submit the order as normal (see Managing New and Existing Orders).
   • If the Order Details screen is not displayed after you select the order:
   1. On the Orders Entry screen, locate the order on the New Orders list. If the number of hours to the patient’s first scheduled dose is more than half the total number of hours between doses (based on the Frequency you selected), you may see the following message displayed below the order name: “Give first dose now?” A Now button is also shown to the right of the red message. If you hover over the Now button, the following message is displayed: “Next scheduled dose in nn hours nn mins (mm/dd hh:mm AM/PM).”
   2. If you want the first dose to be given now, click the Now button.
   3. Sign and submit the oder as normal (see Managing New and Existing Orders).
   The order is submitted with a priority of “Now.”
   If the order is saved as a draft and opened a later order session, the notification for First Dose will recalculate based on current order session.

Settings that control this feature:

• Admin - Facility Group - [select facility group] - CPOE Preferences - Enable First Dose Now Notification
• Admin - Facility Group - [select facility group] - Med Frequency Definition - Num Hours to First Dose

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Appropriate Use Check for Radiology Orders

When ordering an Advanced Diagnostic Imaging Service (ADIS), such as CT, PET, MRI, or Nuclear Med exam, an appropriateness consultation will be required for Medicare patients during an Outpatient visit. To meet the consultation requirement, CPOE includes an Appropriate Use Criteria (AUC) Check when qualifying ADIS are ordered. An AUC Check is a way to evaluate the appropriateness of a selected exam for a particular patient based on their clinical condition. When an ADIS is selected that requires an appropriateness consultation, the CPOE refers to a qualified, third-party Clinical Decision Support Mechanism (CDSM) to determine if the exam requires an AUC check and, if it does, whether or not the selected exam is the most appropriate for the scenario. If an ADIS is not the most appropriate for the scenario, the CDSM displays alternate exam options for consideration as more appropriate for the patient. To perform AUC Check:

1. On the Order Details screen, click Check AUC in the bottom-right corner. If the selected exam is the most appropriate for the patient’s clinical condition, click Done to save the order and proceed with signing and submitting, or adding additional orders If alternate options are available, you might be prompted with questions about the exam and the patient to identify alternate exam options. Respond to the questions until the CDSM displays alternate exam options, and then proceed to Step 2. For details on the CDSM statuses, see Supported Clinical Decision Support Mechanisms.
2. If an alternate exam(s) is suggested, choose how you want to proceed:
   1. Change/Replace Current Order: Select a recommended exam that is more appropriate for the patient’s clinical condition. Then, click Done to return to the Order Entry screen. When you return to the Order Details screen, the Reason and Appropriate Use Criteria sections are updated.
   2. Keep Current Order: Proceed with the original order. When you return to the Order Details screen, the Appropriate Use Criteria section is updated.
   If all of the order details are correct, click Done to return to the Order Entry screen.
   Depending on CDSM vendor configurations, you may be prompted to specify an override reason when selecting an exam that is not recommended, or when selecting an unscored exam.
   3. Cancel Order: You can cancel the order altogether and return to the Order Entry screen.

To continue adding orders, see Adding New Orders. To complete order entry, see Managing New and Existing Orders.

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Bypassing AUC Check for an Emergency Order

If a provider needs to enter an order for a patient with a suspected or confirmed emergency medical condition, then the AUC Check can be bypassed during order entry. If STAT is selected on the Order Details screen, an option to select Emergent AUC Bypass becomes available. When this option is selected, the Check AUC buttons changes to a Done button so the provider can proceed with the order without launching and requiring interaction with the CDSM.

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Supported Clinical Decision Support Mechanisms

The icon that displays in CPOE for indicating Appropriate Use varies depending on the Clinical Decision Support Mechanism that is configured. The table below shows the Appropriate, Moderate, and Inappropriate statuses that display for supported vendors.

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Requesting Notifications when Results are Available

You can request a notification when the results are available for a specific lab or test that you ordered for a specific patient. This feature is available only if implemented by your organization, and only for certain types of orders, as configured by your system administrator. When you place the patient’s order, simply indicate that you want to be notified when the results are available. To request a result notification:

1. Enter a new order for the patient using any of the standard methods:
   • Adding a Favorite Order
   • Searching for an Order to Add
   • Repeating an Order
   • Adding an Order Set
   • Adding a Free Text Order
2. After selecting the order using any of the above methods, the Order Details screen may be displayed:
   • If the Order Details screen is displayed after you select the order:
   1. Select the checkbox next to the Notify when order resulted field at the top left of the Order Details screen.
   2. Select Done to save the Order Details.
   3. Sign and submit the order as normal (see Managing New and Existing Orders).
   • If the Order Details screen is not displayed after you select the order:
   1. in the Orders Entry screen, select the order from the New Orders list to open the Order Details screen.
   2. Select the checkbox next to the Notify when order resulted field at the top left of the Order Details screen.
   3. Select Done to save the Order Details.
   4. Sign and submit the order as normal (see Managing New and Existing Orders).

When the lab or test results are ready, a new notification is sent to your Commure Pro Messaging module. Notification messages include a patient link and a summary of the result. For test results, the test name and the date/time of the test result displays. For lab results, the lab components display with highlighting for critical and abnormal results and the date/time for the lab result. Click the test name or the lab result to view the result details in the Test Results or Lab Results module, respectively. See Viewing and Responding to Unread Messages or Notifications Messages for more information.

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Signing and Submitting An Order

Once you’ve added all the orders and resolved any alerts, you are ready to complete the order entry process to route all the orders.

1. Click Sign and Submit to route your orders to the appropriate place(s) for processing.
   You may see the Clinical Decision Support warning window display. This happens if any new medication order was placed before you submitted your orders and the order conflicts with one or more of your submitted medication orders. You need to resolve these issues (see Resolving Medication Interaction Pop-up Warnings) and then re-submit your orders.
   If your facility requires you to enter an additional electronic signature and/or if Co-Signature is implemented, you will see a Signature dialog display. Proceed to the next step; otherwise the Order Entry window closes and you are returned to the Patient Data Display window. Your patient’s orders are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list.
2. Enter one of the following depending on what Signature dialog displays:
   • Enter your password or PIN, and then click OK.
   For nurses submitting orders for a provider, you will also see the Orders Read Back and Verified checkbox. Select this checkbox to confirm validation of the orders prior to entering your password.
   The Order Entry window closes and you are returned to the Patient Data Display window. Your patient’s orders are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list.
   • Enter the name of the provider who can co-sign the orders for you (using either the Search field or Recently Selected link), and then click OK.
   If only one provider can co-sign orders for you, this name will automatically populate in the co-signing field. You cannot search for another provider.
   The Order Entry window closes and you are returned to the Patient Data Display window. Your patient’s orders are then routed to the co-signing provider for signature, and they are also added to the patient’s Existing orders for the current visit list.
   When orders are routed to a co-signing provider they are routed as either a printed order sheet or made available in whatever system your facility uses for managing order deficiencies, depending on how your system is configured. In some cases, the order deficiency system may then route the order to Commure Pro’s eSignature application for the co-signing provider. Contact your Commure Pro representative to implement the eSignature workflow, as this requires work by the Commure Pro Integrations team.
   • Enter your password or PIN, enter the name of the co-signing provider (using either the Search field or Recently Selected link), and then click OK.
   If only one provider can co-sign orders for you, this name will automatically populate in the co-signing field. You cannot search for another provider.
   The Order Entry window closes and you are returned to the Patient Data Display window. Your patient’s orders are then routed to the co-signing provider for signature. The orders are also added to the patient’s Existing orders for the current visit list.
   When orders are routed to a co-signing provider they are routed as either a printed order sheet or made available in whatever system your facility uses for managing order deficiencies, depending on how your system is configured. In some cases, the order deficiency system may then route the order to Commure Pro’s eSignature application for the co-signing provider. Contact your Commure Pro representative to implement the eSignature workflow, as this requires work by the Commure Pro Integrations team.

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Viewing Patient Details while Entering Orders

At the top the Order Entry window, you can view the following patient information:

• Personal information such as date of birth, age, sex, room location, MRN, and weight
• Allergies
• Problems

You can also view vitals information such as weight, heart rate, and temperature in the Patient Metrics window as follows.

1. Click Patient Metrics next to the patient personal information. The Patient Metrics window displays.
2. Close the window to return to the Order Entry window.

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Viewing a Patient’s Clinical Data while Entering Orders

If you need to view a patient’s clinical data while entering your orders, you can temporarily exit the Order Entry window to view this required information and then return to the Order Entry window.

1. Click Show Clinical Data to exit the order entry process, which is located at the top-right corner of the following windows:
   • Order Entry window
   • Order Set window
   • Order Detail window
   • Interaction window
   The Patient Data Display window for your patient displays.
2. Click a display option in the center column to display the desired information. For example, if want to see the results of a lab, you would click Lab Results. See Displaying Patient Information for more information on displaying a patient’s clinical data.
3. Click Return to Order Entry, located at the top-right corner next to the Actions drop-down, to resume your order entry process.

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Understanding Order Alerts

When entering orders for patients, the application may display one or more alerts to notify you of possible issues with the order, or to recommend additional action by you. These alerts could occur during any workflow where you are entering orders, such as:

• When Entering Orders for Pre-Admission
• When Continuing Home Medication
• When Reconciling Medications for Admission
• When Reconciling Medications for Transfer
• When Reconciling Medications for Discharge
• When Reconciling Medications for Discharge with eR
• When Entering Orders from the Patient List/Patient Search > Orders display option.
• When Entering Orders while writing a note in NoteWriter

Alerts can be broken into three broad categories:

• Clinical Decision Support (CDS) Alerts: These alerts are based on a combination of the patient’s demographic data (such as age or smoking status) and/or clinical data (such as lab results or vital signs), in conjunction with the orders you are placing. The alert could be any of these types: it might be purely informational, it might suggest an order or an order set, it might require you to enter an override reason before proceeding with a specific new order, or it might prevent you entirely from entering a specific new order. For more information, see Reviewing Clinical Decision Support Alerts.
• Interaction and Duplicate Alerts: These alerts compare the new orders you are about to enter with the patient’s allergies and all other new and existing orders for the patient. If a new order would cause a drug-drug interaction, a drug-allergy interaction, or if it is a duplicate of an existing order, you will receive an alert. Depending on the severity of the alert, you might be presented with any of these options: cancel the new order, discontinue an existing order, proceed anyway, proceed after entering an override reason. For more information, see Reviewing Medication Interaction and Duplicate Order Alerts.
• Appropriate Use Criteria (AUC) Alerts: When ordering an Advanced Diagnostic Imaging Service (ADIS), such as CT, PET, MRI, or Nuclear Med exam for Medicare patients during an Outpatient visit, a third-party Clinical Decision Support Mechanism (CDSM) will determine if the service requires an AUC check and, if it does, whether or not the selected service is the most appropriate for the scenario. If an ADIS is not the most appropriate for the scenario, the CDSM displays alternate options for consideration as more appropriate for the patient. For more information, see Appropriate Use Check for Radiology Orders.

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Reviewing Clinical Decision Support Alerts

Clinical Decision Support alerts use clinical data and other patient information to evaluate orders and generate an alert. CDS alerts can display during any of the following workflows:

• Order Entry
• Re-ordering from any of the following modules:
  • Medications
  • Lab Results
  • Test Results
• Medication Reconciliation, including:
  • Continue Home Medications
  • Admission
  • Transfer
  • Discharge (session type alerts, only)

Your administrator has configured CDS alerts for your facility based on rules that define the type of alert to be shown, and when to show them. The alert you see might be informational for your reference, or require you to take specific actions so that you can continue the workflow. A CDS rule might also prevent you from submitting an order based on criteria used by that rule. CDS alerts display with text and buttons contained in a yellow banner at the top of the Order Details screen and at the bottom of the Order Summary screen. When an alert is first displayed, the box containing the alert is fully expanded to ensure that you read it. Once you read it, you can collapse it. If you exit and return to the same screen, the alert may be presented again, in the same state that you left it (expanded or collapsed). The topics above describe the different types of CDS alerts and provide an example of each. Many of the alert types can also include a View Source link (also described above), which when clicked, displays additional reference information related to the alert.

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Message Alerts

CDS message alerts are simple informational alerts, as in this example: [Insert Screen shot of CDS message alert here] These alerts display on the Order Details screen and remain visible each time you access the Order Details screen for the order, up until you sign and submit the order. Some dose range checking alerts also display as message alerts. However, these alerts behave somewhat differently than described above. For more information, see Dose Range Checking Alerts.

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Alerts with Clinical Data

Some CDS alerts contain clinical data about the patient. The clinical data might be incorporated into the text of a message, as in this example where the patient’s INR value is part of the message: [ Insert Screenshot of CDS alerts contain clinical data here] Or in other cases, the patient’s clinical data (for example, lab results, test results, or active medications) might be displayed as a list of clinical data items, without any message. Depending on configuration settings for your facility, you might see several instances of clinical data for a specific time period. These alerts display on the Order Details screen and remain visible each time you access the Order Details screen for the order, up until you sign and submit the order.

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Alerts with Suggestions for Additional Orders

CDS alerts might sometimes suggest that you enter additional orders for the patient. These alerts include buttons so that you can easily add those orders.

• In some cases, there are the button(s) to enter an individual order, or an order set. After reading the message, you can click the button to add the order or order set to the New Orders list [Insert Screenshot of message]
• In other cases, there are button(s) that launch an Order Search window. The button in the message displays keywords that are used to generate a list of search results in the Order Search window, from which you can select a new order. [Insert Screenshot of message]

These alerts display on the Orders Summary and disappear if you enter the recommended item. Otherwise they remain visible for the entire order session. You may proceed with placing other orders even if you do not enter the suggested order(s).

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Alerts Requiring an Override Reason

These CDS alerts display a warning message and also contain a field for an override reason, which may be presented as either a single checkbox or a drop-down list. Some dose range checking alerts also display as alerts requiring an override reason. However, these alerts behave somewhat differently than described above. For more information, see Dose Range Checking Alerts.

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Alerts Requiring Mandatory Discard

These CDS alerts display a warning message indicating that you cannot continue and that you must discard the new order. Your only option is to tap the Discard Order button. [INSERT SCREENSHOT] This alert displays on the Order Details screen. However, if you discard the order, the alert is no longer displayed.

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Dose Range Checking Alerts

Dose range checking alerts display information pertaining to the dosing of the medication, such as information about the maximum single or daily dosage, or whether renal function should be considered. Factors such as the patient’s age or weight are taken into consideration when appropriate. Dose range checking alerts might be presented as either a message, or as a message requiring an override reason.

• Message Alerts for Dose Range Checking: These alerts display a warning message pertaining to the dosing of the medication and/or might indicate that renal function should be considered [Insert Dose warning Screenshot] These alerts display on the Order Details screen. You can take one of the following actions:
  • Leave the order unchanged: If you simply close the Order Details screen without making any changes, you can then sign and submit the order. The alert remains visible each time you access the Order Details screen for that order, up until the point that you sign and submit the order.
  • Choose a different dose, frequency, or route: If you enter a different dose, frequency, or route, the alert is either immediately removed, or updated based on your changes. If an updated alert appears, review the new alert and then either modify the order again or close the Order Details and submit the order it’s current state.
• Message Alerts Requiring an Override Reason for Dose Range Checking: These alerts display a warning message pertaining to the dosing of the medication or renal function, and include a field to select an Override Reason. [Insert Dose Warning Screenshout] These alerts display on the Order Details screen. You must take one of the following actions to proceed with the order:
  • Select an override reason to submit the order as is: If you want to leave the order unchanged and submit it despite the warning message, then you must first select an Override Reason. After selecting a reason you can then close the Order Details and sign and submit the order. Note that the alert will remain visible each time you access the Order Details screen for that order, up until the point that you sign and submit it.
  • Choose a different dose, frequency, or route: If you enter a different dose, frequency, or route, the alert is either immediately removed, or updated based on your changes. Your changes must satisfy all alert requirements before you can submit the order.

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Viewing Source Information from a CDS Alert

Your organization may include a View Source link in some CDS alerts to provide additional information about the alerts. The link contains reference information and can also include links to additional resources. To view source information:

1. Review the CDS alert. Then, click the View Source link. The View Source screen opens and displays reference text and can also include links to web pages.
   • If the screen includes reference text, review the text.
   • If the screen includes web page links, click each link to review its content.

When you are done reviewing the information on the View Source screen, close the View Source screen and return to the order or Orders Summary.

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Reviewing Medication Interaction and Duplicate Order Alerts

CPOE checks for the following types of issues as you complete an order:

• Drug-drug interactions: Whether a new medication order interacts with another new or existing medication order for the patient.
• Drug-allergy interactions: Whether a new medication order interacts with an allergy that the patient has on record in the Allergies module.
• Drug-disease interactions: Whether a new medication order interacts with an active disease on the patient’s Problem List.
• Duplicate orders: Whether a new order is a duplicate of another new or existing order.

If an order would cause an interaction or would represent a duplicate order, a warning or alert is displayed as soon as you select the order. Typically, the warning or alert describes the problem and indicates whether further action is necessary. Your administrator determines the level of alert (critical or non-critical) that should be displayed, depending on the severity or type of the interaction or duplication. You must resolve any critical alerts when they occur, while non-critical alerts should be reviewed for possible further action. The types of orders that are considered to be duplicates, as well as the options are available to you when a duplicate or interaction is found, depend upon your system configuration. For more information, see the topics Resolving Medication Interaction Pop-up Warnings and Resolving Medication Interaction Inline Alerts.

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Resolving Medication Interaction Pop-up Warnings

Clinical Decision Support (CDS) warnings typically appear when the medication order triggers a severe interaction such as drug-allergy interaction or drug-drug interaction but could also appear for moderate interactions depending on how your Commure Pro system is configured. You must resolve any pop-up warnings as follows:

1. Review the CDS warning(s).
   When a warning displays to alert providers of one or more interactions (drug-allergy, drug-disease, or drug-drug) on the right-hand side of the screen, the order list on the left automatically scrolls to display the first of the medication orders identified in the interaction.
2. Determine how you want to proceed with the order. Then, take one of the following actions:
   • Click Don’t Order at the bottom of the window if you want to cancel the new order.
   The warning window closes and you are returned to the Order Entry window.
   • If you want to continue with the order, you must resolve all the issues listed in the left column using one of the following actions:
   • For any type of interaction, you might be able to enter an override reason that explains why the order should be processed, despite the alert. Click Provide Override Reason. Then, select a reason.
   The option to provide an override reason is available only when configured by your organization.
   • For drug-drug interactions, you can also:

• Click the DC icon to discontinue the interacting existing medication.
  You can restore a discontinued order by clicking Undo .
• Click Delete New Order to delete the interacting new order, and then click OK.
  • For drug-disease interactions, you can also:
• Resolve the patient’s disease/problem that is causing the interaction. Marking a problem as resolved indicates that the patient had the problem in the past, but it is no longer an active problem today. Click Resolve Problem under the disease’s name.
• Delete the patient’s disease/problem that is causing the interaction. You should only delete a problem if the patient never had the problem, either now or in the past. Click Delete Problem. The problem is immediately deleted from the patient’s Problem List.
  • Complete the Order Details window if there are missing required fields, and then click Done.
  If an Info pop-up displays, click OK to continue. Any discontinued interacting existing medication displays below it and is crossed-out while any interacting new order is removed from the New Orders list.

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Resolving Medication Interaction Inline Alerts

Medication interaction inline alerts generally indicate moderate interactions and duplications, however, your Commure Pro system may be configured to show all interactions - moderate and severe as an inline alert. Therefore, you should review all alerts to determine if further action is required as follows:

1. Hover over the inline alert (for example, a Moderate Interaction alert) to display the issue.
2. After reviewing the alerts, decide if you need to make any changes or if you want to proceed with no changes.
   • If no changes are required, no further action is required to resolve the alerts.
   • If changes are required, proceed to next the step.
3. If the order needs to change, determine if you need to modify or delete the order.
   • To modify the order: Select the order, make the changes to the Order Details window, and then click Done. See Modifying the Details of a New Order for more information.
   • To delete the order: Click Delete .
   After you resolve all inline alerts, you are ready to sign and submit your orders.

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Managing New and Existing Orders

From within the Order Entry window, you can manage your patient’s new and existing orders to reflect any changes you may need to make. This chapter describes the following the actions that are allowed for a given order based on its status (new or active) and the actions that your administrator has enabled for each type of order:

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Changing the Visit for a New Order

All orders are automatically associated with a patient visit. The Order for Visit: drop-down automatically selects the most current visit. In rare instances, you may need to change the visit for an order. For example, an emergency room physician may need to place orders for an emergency room (ER) visit and for an inpatient stay for admission. Depending on the order, the physician will need to change the visit to reflect either the ER visit or the inpatient visit. To change the visit for an order:

1. Select the Order for Visit: drop-down to display the available list of visits for the patient.
2. Select the appropriate visit for your patient order(s).

The Order for Visit: field should reflect the appropriate visit where you wish to submit the orders.

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Modifying the Details of a New Order

You can modify any of the details on a newly entered order, as long you have not yet signed and submitted it. To change any of the details of an order you created, you can do this through the Order Details window as follows:

1. Select the order from the New Orders list.

The Order Details window displays.

2. Review any CDS alerts that display. Then, make your changes to any of the editable fields.
   • For a free text order, you might want to enter a more descriptive name in the Description field.
   • Required fields have a red asterisk and must contain information. They cannot be changed to a blank field.
   • For medication orders, note the following:
   • Your administrator might have configured admin criteria fields or field sets. Admin criteria is data derived from an additional field set contained in an order string that defines the specific requirements for that particular string. For example, admin criteria might display default values and other data required for successful titration of a medication on an order string. These fields might also have default values that you can edit as you complete the order entry process.
   • Numerical dosage values: Any zeros that trail a decimal point are removed. Zeros are added at the beginning of a number if there is a decimal point with no numbers before it.
   • If you change the priority (selections of Now, Routine, and STAT), Frequency field, or Start First Dose field such that the number of hours to the patient’s first scheduled dose is more than half the total number of hours between doses (based on the Frequency that you selected), you may see the following message displayed next to the priority selections: “Next scheduled dose in nn hours nn mins (mm/dd hh:mm AM/PM).” If you want the first dose to be given now, select the Now radio button under the Start First Dose field. See Specifying “Now” as the First Dose Time for a Medication Order.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   • For lab and test orders, if you wish to be notified when the results are ready, select the checkbox next to the Notify when order resulted field at the top left of the Order Details screen. See Viewing and Responding to Unread Messages or Notifications Messages.
   For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
3. Click Done to save your changes (or the Cancel button to close the Order Details without saving your changes). The modified order displays in the New Orders list.

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Modifying the Order Details of a Weight Based Dosing Medication Order

You can modify any of the details on a newly entered or active weight based dosing medication order. To change any of the details of an order you created, you can do this through the Order Details window as follows:

1. Select the weight based dosing medication order from the following:
   • New Orders list or
   • Existing orders for this visit list, and then click Modify
   The Order Details windows displays.
2. Make a change to any one of the weight based dosing fields as follows:
   • Weight Based Dose: select a different weight based dose from the drop-down or choose Other to manually enter a dose, and then click OK.
   • Weight: select a different weight from the drop-down or choose Other to manually enter a weight, and then click OK.
   • Calculated Dose: enter a new dose for the patient.
   As a new value is entered into any of the weight based dosing fields, the weight based dosing calculator will automatically calculate the other fields.
   All weight based dosing fields are required and cannot be left blank.
3. Make changes to other editable fields as needed.
4. Click Done to save your changes (or the Cancel button to close the Order Details without saving your changes). The modified order displays in the New Orders list.

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Deleting New Orders

You can delete an order that you have entered in error, as long as you have not yet signed and submitted it.

• To delete a new order, click Delete located to the right of the order.

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Saving Orders as a Draft

If while adding orders for a patient you get interrupted and need to temporarily stop the ordering process, you can save the unsubmitted orders as a draft and return later to complete them.

1. To save unsubmitted orders as a draft, click the Save as Draft button at the bottom of the Order Entry screen. You will exit the Order Entry window and be returned to the Patient List. To return to your saved work, select the patient and then select Enter Orders from the Actions menu in the Patient Data Display or click on the unfinished orders link and click the Continue button for the patient. If you log out while orders are still in draft status, the Unsubmitted Orders dialog displays. Proceed to the next step.
2. Upon logging out with draft orders saved, you can choose any of the following actions:
   • Click Continue Ordering to return to the Order Entry window to either complete (Sign/Submit) the draft orders or remove (Cancel) the draft orders. To resume order entry, select the patient from the patient list and then click Add next to the Orders option. The Order Entry window displays with the saved unsubmitted orders.
   • Click Keep Orders and Exit Commure Pro to keep the orders saved as drafts for a later order session. Log back in to resume order entry for this patient, select the patient from the patient list and then click Add next to the Orders option. The Order Entry window displays with the saved unsubmitted orders.
   • Click Discard Orders and Exit Commure Pro if you do not wish to keep the orders for a future order entry session.
   If you should need to save the orders again as a draft while in order entry, you must click the Save as Draft button again. Clicking the Cancel button will delete any unsubmitted orders and then exit you out of the Order Entry window.

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Saving an Order Set as a Draft

If you need to temporarily stop the ordering process when filling out an order set, you can save the unsubmitted order set as a draft and return later to complete it.

• To save the unsubmitted order set, click the Save as Draft button at the bottom of the Order Set window. You will exit the Order Set window and be returned to the Patient List. If you log out while orders are still in draft status, the Unsubmitted Orders dialog displays. Proceed to the next step.

3. Upon logging out with draft orders saved, you can choose any of the following actions:
   • Click Continue Ordering to return to the Order Entry window to either complete (Sign/Submit) the draft orders or remove (Cancel) the draft orders. To resume order entry, select the patient from the patient list and then click Add next to the Orders option. The Order Entry window displays with the saved unsubmitted orders.
   • Click Keep Orders and Exit Commure Pro to keep the orders saved as drafts for a later order session. Log back in to resume order entry for this patient, select the patient from the patient list and then click Add next to the Orders option. The Order Entry window displays with the saved unsubmitted orders.
   • Click Discard Orders and Exit Commure Pro if you do not wish to keep the orders for a future order entry session.

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Adding or Modifying a PRN Reason to a New or Active Medication Order

During the process of adding orders, you can add a PRN reason as you create a new medication order. You can also add or modify a PRN reason to a new medication order in the New Orders list or an active medication order in the Existing orders for this visit list. To add or modify a PRN reason to a new or active medication order, you need to make your changes to the Order Details window.

1. Open the Order Details window of new or active medication order as follows:
   • New medications orders: Select the medication order from the New Orders list to open the Order Details window of your medication order. If you are in the process of creating a new medication order, the Order Details window will open as you select the new medication order from the Order Search window.
   • Active medication orders: Select an active medication order in the Existing orders for this visit list to get the Order Status window open, and then click Modify.
   If you are adding a PRN reason, proceed to the next step. If you are modifying an existing PRN reason, proceed to Step 3.
2. Select the PRN checkbox in the Order Details window A list of reasons displays.
3. Enter a reason in the PRN Reason text box to select a reason from the existing list (list will change to display any matching existing reasons as you type) or create a new reason. You can also scroll through the list of reasons and select one. MedHost only: The PRN Reason text box can display multiple reasons pulled from MedHost. In Commure Pro, you can also enter multiple reasons using free text. Separate each entry with a comma.
4. Click the Done button. For a new medication order, the order is added to the New Orders list with the added or modified PRN reason. For an active medication order, two new orders are displayed in the New Orders list: a new order with the modifications and a new order discontinuing the original order (displays as crossed-out with an Undo icon ). The original order also displays as discontinued (crossed-out) in the Existing orders for this visit list.
5. Click Sign/Submit to process the order.

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Modifying Active Medication Orders

Once an order has been signed and submitted, and has moved to the Existing orders for this visit list, you cannot make modifications to it. The only possible exception to this rule is medication orders. You can modify a medication order if:

• Your system administrator has enabled the modify workflow for medication orders. The Modify function is not available for any other type of order (such as Labs or Radiology). If modifications are allowed for medication orders, then it also includes orders with additives/diluents.
• The medication order is still Active (you cannot modify a medication order that is complete, or no longer active).
• The medication order is not currently in a “Held for Routing” status with the label New Upon Transfer. This is a new medication order placed in Transfer Order Reconciliation that is waiting to be executed once the patient has transferred to a new location.
  In contrast, if an existing medication order is discontinued in Transfer Order Reconciliation, and the discontinue is to be executed upon transfer to the new location, the order will continue to have an “Active” status, but also a “Stop upon Transfer” label, to indicate that it will not be discontinued until the patient actually transfers. In this case, a provider can modify the original existing order immediately (prior to the patient being transferred), if necessary.

To modify an active medication order in the Existing orders for this visit list:

1. From the Order Entry window, select Medication from the Show drop-down to display only the existing medication orders for the patient.
2. Select the Active Only checkbox located in the header above the Existing orders for this visit heading to display only the active existing orders for the patient.
3. Select an active medication order in the Existing orders for this visit list. The Order Status window displays.
   If there is a Related Order icon next to the medication order, your will see the related order in the Order Status window.
4. Click Modify. The Order Details window displays.
5. Make your changes to any of the editable fields.
   For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
   • Required fields have a red asterisk and must contain information. They cannot be changed to a blank field.
   • For medication orders, if you change the priority (selections of Now, Routine, and STAT), Frequency field, or Start First Dose field such that the number of hours to the patient’s first or next scheduled dose is more than half the total number of hours between doses (based on the Frequency that you selected), you may see the following message displayed next to the priority selections: “Next scheduled dose in nn hours nn mins (mm/dd hh:mm AM/PM).” If you want the first or next dose to be given now, select the Now radio button under the Start First Dose field. See Specifying “Now” as the First Dose Time for a Medication Order.
   If a patient receives a dose of the medication between the time you choose “Now” and actually submit the order, you are warned of this fact and given an opportunity to modify the order so that you can change the Priority.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   • Your administrator might have configured fields or field sets in the order to specify additional requirements (titration details for dosage, as an example) for ordering a medication in an order set, or an individual order. These fields might also have default values that you can edit as you complete the order entry process.
6. Click Done to save your changes (or the Cancel button to close the Order Details without saving your changes). Two new orders are displayed in the New Orders list with the modifications: a new order with the modifications and a new order discontinuing the original order (displays as crossed-out with an Undo icon ). The original order also displays as discontinued (crossed-out) in the Existing orders for this visit list.
7. Click Sign/Submit to process the order.

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Changing Active Diet Orders

You cannot modify the details of an existing diet order, but you can add additional diet orders or replace the active diet order with another order. To change an active diet order in the Existing orders for this visit list:

1. Select an active diet order in the Existing orders for this visit list. The Order Details window displays.
2. (Optional) If you are replacing the active existing diet order, click the column next to the order in the Patient Diet Orders list to discontinue it. A new order discontinuing the original order (shows as crossed-out with an Undo icon ) displayed in the New Orders list, and the original active order is discontinued (crossed-out) in the Existing orders for this visit list.
3. Find and select a diet order from the Select Diet Orders(s) list using either of the following:
   • Enter the name of the diet order in the Filter: field to find a matching order, and then select the appropriate order.
   • Scroll through the list of alphabetically sorted diet orders, and then select the appropriate order.
   The selected order is added as a new order to the Patient Diet Orders list.
4. Complete the details of the new diet order such as, Start Day and Start Meal, and then click OK.
   You can use In to set the Start Day for a future date. For example, In 8 days. The diet order will start in 8 days from the day of submitting the order.
   All new orders are added to the New Orders list and any discontinued existing order in the Existing orders for this visit list is crossed out.

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Discontinuing Active Orders

After reviewing a patient’s list of the Existing orders for this visit list of the Order Summary, you may decide that you want to discontinue one or more of them. You can discontinue an order if:

• Your system administrator has allowed discontinues for the type of order that you want to discontinue. In most cases, your administrator will allow discontinues for all types of existing orders. However, they can disable discontinues for certain types of existing orders, if your organization’s workflow requires it. If discontinues are allowed for medication orders, then it also includes orders with additives/diluents.
• The existing order that you want to discontinue is for the same visit that is currently selected for the order session.
• A medication order that is not currently in a “Held for Routing” status with the label New Upon Transfer. This is a new medication order placed in Transfer Order Reconciliation that is waiting to be executed once the patient has transferred to a new location.

Additionally, all active orders can be automatically discontinued for patients upon their discharge, if enabled by your organization. If the discharge is cancelled, all orders that were automatically discontinued upon discharge will be automatically re-activated. You can discontinue an active order in one of the following ways:

• Discontinuing Active Orders from the Order Entry Window
• Discontinuing Active Orders from the Order Status Window
• Discontinuing Active Diet Orders from the Order Details Window

There is no discontinue function for new orders. However, you can delete a new order that has not yet been signed and submitted. See Deleting New Orders. For example, if your organization has multiple hospitals and designates each hospital as a facility group with its own distinct set of order definitions and you have privileges to more than one hospital, you cannot use the Order Again, Hold, or Discontinue functions for an order that your patient had during a visit at a Hospital A (part of Facility Group A with its own set of order definitions) for your patient’s visit in Hospital B (part of Facility Group B with a different set of order definitions).

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Discontinuing Active Orders from the Order Entry Window

You can discontinue an order directly from the Order Entry window without opening the Order Status window for the order as follows:

1. Check the Active Only checkbox located in the header above the Existing orders for this visit column heading to only display the active existing orders for the visit.
2. Hover the mouse over the empty column directly to the right of the Status column for an active existing order. When the DC icon displays in the column, select it. The order displays crossed-out below the New Orders list and the Existing orders for this visit list.
3. Review any CDS alerts that display. Then, click Sign/Submit to process the order.

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Discontinuing Active Orders from the Order Status Window

For all existing orders except diet orders, you can discontinue the order from the Order Status window as follows:

1. Select the active order from the Existing orders for this visit list.
   Select the Active Only checkbox next to the Existing orders for this visit column heading to only display the active existing orders for the visit.
   The Order Status window displays with the details of the order and its current state.
2. Click Discontinue to exit the Order Status window and add the order to discontinue the selected active order. The order displays crossed-out below the New Orders list and the Existing orders for this visit list.
3. Review any CDS alerts that display. Then, click Sign/Submit to process the order.

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Discontinuing Active Diet Orders from the Order Details Window

You can discontinue active diet orders from the Order Details window as follows:

1. Select an active diet order in the Existing orders for this visit list. The Order Details window displays. The Order Details window for diet order also displays the order status of any existing diet order for the patient.
2. Click the column next to the diet order in the Patient Diet Orders list to discontinue it (DC icon displays), and then click OK to add the discontinued order to the New Orders list. A new order discontinuing the original order (shows as crossed-out with an Undo ) displays in the New Orders list, and the original active order is discontinued (crossed-out) in the Existing orders for this visit list.
3. Review any CDS alerts that display. Then, click Sign/Submit to process the order.

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Holding Active Medication Orders

You may be able to Hold (and Resume) active medication orders, if your system administrator has enabled this feature. The Hold and Resume functions are not available for any other type of order (such as Labs or Radiology).

1. Select an active medication order in the Existing orders for this visit list.
   Select the Active Only checkbox next to the Existing orders for this visit column heading to only display the active existing orders for the visit.
   The Order Status window displays.
2. Click Hold. The Hold Reason window displays.
3. Complete the following fields:
   • Enter the reason for holding the medication in the Hold Reason field.
   • If the hold should happen immediately, leave the Hold Date/Time fields empty. If the hold is for a future date, enter the future date and time that the hold should begin.
   • Enter the resume date and time, if known.
   The Orders Summary is re-displayed and the held order is listed in the New Orders section. The word “HOLD:” or “FUTURE HOLD:” precedes the order description, depending on whether the hold is to begin immediately or in the future. This is followed by the Hold Reason and Resume Date/Time (if any).
   Depending on configuration settings for your facility, Hold Reason and Resume Date/Time might be required fields.
4. Click Sign/Submit to process the order.
   The Order Again, Hold, Resume, and Discontinue functions may only be used with existing orders having the same set of order definitions from the same facility group. A facility group, which can consist of one or more facilities such as a hospital, has its own distinct set of order definitions that are only shared by its facilities. An order from one facility group (Facility Group A) will not match an order in a different facility group (Facility Group B). However, facilities within a Facility Group can share a set of order definitions.
   For example, if your organization has multiple hospitals and designates each hospital as a facility group with its own distinct set of order definitions and you have privileges to more than one hospital, you cannot use the Order Again, Hold, Resume, or Discontinue functions for an order that your patient had during a visit at a Hospital A (part of Facility Group A with its own set of order definitions) for your patient’s visit in Hospital B (part of Facility Group B with a different set of order definitions).

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Changing or Canceling a Future Hold on a Medication

If a future hold for an order has not begun, you can change the future hold date and time or cancel the future hold entirely. To change or cancel a future hold on a medication order from the Orders module:

1. In the Orders module, under the Existing Orders section of the Orders Summary, identify the medication order that is on future hold.
2. Select the existing medication order. The Order Details screen is displayed.
3. Click Hold.
4. Take one of the following steps:
   • To change the date/time that the future hold should begin, modify the Hold Date/Time fields as needed.
   • To cancel the future hold entirely, enter the same date and time in the Hold Date/Time fields and the Resume Date/Time fields.
5. Your changes are saved. The Orders Summary screen is displayed with two items listed under the New Orders section: a discontinue for the original order (shown with a line struck through the order description), and a new order containing your modifications.
6. Click Sign/Submit.
   The Order Again, Hold, Resume, and Discontinue functions may only be used with existing orders having the same set of order definitions from the same facility group. A facility group, which can consist of one or more facilities such as a hospital, has its own distinct set of order definitions that are only shared by its facilities. An order from one facility group (Facility Group A) will not match an order in a different facility group (Facility Group B). However, facilities within a Facility Group can share a set of order definitions.
   For example, if your organization has multiple hospitals and designates each hospital as a facility group with its own distinct set of order definitions and you have privileges to more than one hospital, you cannot use the Order Again, Hold, Resume, or Discontinue functions for an order that your patient had during a visit at a Hospital A (part of Facility Group A with its own set of order definitions) for your patient’s visit in Hospital B (part of Facility Group B with a different set of order definitions).

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Resuming a Held Medication Order

You may be able to Resume active medication orders, if your system administrator has enabled this feature. The Resume function is not available for any other type of order (such as Labs or Radiology).You can choose to resume a held medication order within the Order Entry window as follows:

1. Select a held medication order in the Existing orders for this visit list. The Order Status window displays.
2. Click Resume. The Resume Reason window displays.
3. Enter the reason for resuming the medication and the Resume Date/Time, and then click OK. The order displays with RESUME: along with any Reason and Resume Date/Time information in the New Orders list. It also displays with RESUME: in the Existing orders for this visit list.
   You can add a Reason or Resume Date/Time to the order after adding it to the New Orders list. Select the order in the New Orders list and complete the Resume Reason: and/or Resume/Date/Time: sections in the Order Details window, and then click Done.
4. Click Sign/Submit to process the order.
   The Order Again, Hold, Resume, and Discontinue functions may only be used with existing orders having the same set of order definitions from the same facility group. A facility group, which can consist of one or more facilities such as a hospital, has its own distinct set of order definitions that are only shared by its facilities. An order from one facility group (Facility Group A) will not match an order in a different facility group (Facility Group B). However, facilities within a Facility Group can share a set of order definitions.
   For example, if your organization has multiple hospitals and designates each hospital as a facility group with its own distinct set of order definitions and you have privileges to more than one hospital, you cannot use the Order Again, Hold, Resume, or Discontinue functions for an order that your patient had during a visit at a Hospital A (part of Facility Group A with its own set of order definitions) for your patient’s visit in Hospital B (part of Facility Group B with a different set of order definitions).

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Undoing Changes to Active Orders

You can undo any hold, modify, or discontinue action that you applied on an active order if you have not submitted the order as follows:

• Click Undo to the right of the order in the New Orders list. The order is removed from the New Orders list and the corresponding order in the Existing orders for this visit list returns to its previous state.
  The undo capability does not exist for submitted orders. You must discontinue an existing order to remove it

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Reordering Active Orders

You can repeat an active order from within the order entry window using the Order Again functionality. For instructions, see Repeating an Order.

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Renewing Expiring Medication Orders

You can renew expiring medication orders from the Order Entry window if your system has been configured to do this. Check with your system administrator to see if this functionality is enabled. Expiring medication orders that can be renewed will display in red in your list of Existing orders for this visit in either the Orders display option of the Patient Data Display, or the Order Entry window for a patient. To renew a medication order from the Order Entry window:

1. Find the expiring medication(s) in the Existing orders for this visit list. All expiring medication orders will display at the top of the list. You can also choose Expiring Meds from the Show drop-down filter in the Order Entry window to display only expiring medication orders. Expiring medication orders display in the Existing orders for this visit list with the date and time of expiration in red and a Renew button.
2. Click the Renew button next to the medication order(s). If the Order Details window displays, complete any missing information and then select Done. The renewed order(s) displays under the New Orders list and in the Existing orders for this visit list and will be renewed using the expiring medication order’s details.
   If you need to make changes to the order (except for changing the number of days for renewal), you should not click the Renew button but instead select the order to bring up the Order Details window to make any changes.
3. (Optional) Select the renewed order under the New Orders list to get the Order Details window to enter the number of days for renewal, and then click Done.
4. Submit your order(s). See Managing New and Existing Orders for more information.

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Managing Personal Favorites

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Adding Orders to your Favorites List

As you add new orders or order sets, you can also add them to your Favorites list, or you can select a new order from the New Orders list to add to your Favorites list. Additionally, you can add existing orders to your Favorites list from the Order Status window. You can also add orders and order sets using the Manage Favorites link (see Managing Orders in Your Favorites List for more information).

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Adding New Orders to Your Favorites List Using the Add to Favorites link

As you are adding a new order for a patient, you can also add it to your Favorites list at the same time. You can do this from the Order Details window of a new order as follows:

1. Either select a new order using the Add Order search or select a new order from the New Orders list. The Order Details window displays.
   For diet orders, the Order Details window also contains the order status information and will display all new and existing orders. Select the order you want in Patient Diet Orders list.
2. Complete the information within the Order Details window to create the desired order, including any required information (highlighted in red).
   If you edit any Admin Criteria (data that defines additional requirements such as titration details for dosage, for example) the edits are not saved when you favorite an order. Any values you edit revert back to the defaults configured by your administrator.
   If the order is a weight based dosing medication order, you do not need to make any changes to the weight based dosing fields as they will auto-calculate for the specific patient when used.
3. Click Favorite in the upper right corner of the Order Details window. The Add to Favorites window displays.
   If you entered a Stop Date/Time on the order that you are favoriting, the following message is displayed: “Warning: Stop date will not be saved when creating this favorite. Select and edit the Favorite within Manage Favorites to add a relative stop date such as “Stop In 2 Days.” Click OK to acknowledge the message. After you finish adding the order to your Favorites list (by completing the steps below), see Editing a Favorite Order if you want to add a relative stop date to the new favorite order.
4. Select the Favorites category where you want the order to be listed, and then click OK. The order is added to your Favorites list under the specified category.
   If you do not want to add it to a specific category, you can select Favorites at the top of the list of categories. This will add your order to your Favorites list above your categories.
5. Click Done to close the Order Details window.

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Adding Order Sets to Your Favorites List Using the Add to Favorites link

As you are adding a new order set for a patient, you can also add it to your Favorites list at the same time. You can do this from the Order Set Details window as follows:

1. Select a new order using the Add Order search. The Order Set Details window displays.
2. Click the Add to Favorites link in the upper right corner of the Order Set Details window. The Add to Favorites window displays.
3. Select the Favorites category where you want the order to be listed, and then click OK. The order set is added to your Favorites list under the specified category without anything you selected in the order set.
   If you do not want to add it to a specific category, you can select Favorites at the top of the list of categories. This will add your order set to your Favorites list above your categories.
4. Click Done with Order Set to close the Order Set Details window.

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Adding Existing Orders to Your Favorites List

You can add an existing order from the patient’s Existing orders for this visit list or the Existing orders for other visits list to your Favorites list. You cannot make any changes to an existing order while you are adding it to your Favorites list. Once the order is added to your Favorites list, you can modify it using the Manage Favorites link. See Editing a Favorite Order for more information. You add an existing order to your Favorites list using the Order Status window as follows:

1. Select an order from the Existing orders for this visit list located on the right side of the Order Entry window or the Existing orders for other visits list (click Expand icon in upper right corner of pane to display). The Order Status window displays.
   For diet orders, the Order Details window also contains the order status information and will display all new and existing orders. Select the order you want in Patient Diet Orders list.
2. Click the Add to Favorites link in the upper right corner of the Order Status window. The Add to Favorites window displays.
   If you entered a Stop Date/Time on the order that you are favoriting, the following message is displayed: “Warning: Stop date will not be saved when creating this favorite. Select and edit the Favorite within Manage Favorites to add a relative stop date such as “Stop In 2 Days.” Click OK to acknowledge the message. After you finish adding the order to your Favorites list (by completing the steps below), see Editing a Favorite Order if you want to add a relative stop date to the new favorite order.
3. Select the favorites category where you want to the order to be listed, and then click OK. The order is added to your Favorites list under the specified category.
   If you do not want to add it to a specific category, you can select Favorites at the top of the list of categories. This will add your order to your Favorites list above your categories.

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Managing Orders in Your Favorites List

You can manage your Favorites list using the Manage Favorites link at the bottom of the Favorites pane in either the directory tree view or the expanded view. Within the Manage Favorites window, you can do the following:

• Editing a Favorite Order
• Deleting a Favorite Order or Order Set
• Creating a Favorite Order
• Adding an Order Set to the Favorites List
• Creating a Category in the Favorites List
• Creating a Subcategory in the Favorites List
• Renaming a Category or Subcategory in the Favorites List
• Moving Orders, Order Sets, and Categories in the Favorites List

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Editing a Favorite Order

You can change an existing favorite order from the Order Entry window using the Manage Favorites link. However, you cannot change an order set. See your system administrator for any changes to order sets. To edit an existing favorite order:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select the order you wish to edit, and then click Edit. You may need to select a category to display the list of individual orders. For example, select the Medications category to get the drop-down of medication orders, and then select the desired medication order. The Edit Favorite window displays.
3. Make your changes to the order, and then click OK. For example, you can change when the order is administered, change its frequency, or add special instructions.

   Show Instructions for adding a relative Stop Date

   You can specify a relative stop date and time in a favorited order. When you create an order using that favorited order, the relative date will be converted to an actual date based on the current date.For example, if an order in your Favorites list has a relative Stop Date/Time of 2 days from today at 5:30 PM, and on August 10, 2022 you add an order using that favorited order, the Stop Date/Time is updated to August 12, 2022 at 5:30 PM.

   1. In the Stop Date field, select “In.”
   2. In the Number of Days from Today field, enter the number of days after which the order should stop, relative to the date on which the order is placed. For example, if you enter 5, the order will stop 5 days after the date it is placed.
   3. You might see any of these fields:

   • When Time of Day: Enter the time of day at which the order should stop, in addition to the number of days (for example, in 5 days at 3:00 PM).
   • Number of Minutes: Enter the number of minutes after which the order should stop, in addition to the number of days (for example, in 5 days and 30 minutes).
   • Number of Hours: Enter the number of hours after which the order should stop, in addition to the number of days (for example, in 5 days and 3 hours).
   If the order is a weight based dosing medication order, you do not need to make any changes to the weight based dosing fields as they will auto-calculate for the specific patient when used.
   The Edit Favorite window closes and the Manage Favorites window becomes active. The modified order displays the new information.
4. Click Save in the Manage Favorites window. The changes in the order are saved to your Favorites list.
   If you decide you do not wish to make the changes to your Favorites order, click Cancel in the Manage Favorites window instead of Save.

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Deleting a Favorite Order or Order Set

You can delete an order or order set in your Favorites list as follows:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select the order you wish to delete, and then click Delete. The order is removed from the Manage Favorites window.
   You may need to select a category to display the list of individual orders or order sets. For example, select the Medications category to get the drop-down of medication orders and then select the desired medication order.
3. Click Save in the Manage Favorites window. The order is removed from your Favorites list.
   If you decide you do not wish to remove the order from your Favorites list, click Cancel in the Manage Favorites window instead of Save.

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Creating a Favorite Order

You can create your own personalized favorites orders as follows:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select the category where you want to add the new favorite order, and then click New Favorite. The Add Favorite to Favorites window displays.
3. Enter your order in the search field, and then select the desired order. The Add Favorite window displays.
4. Set the information within the Add Favorite window to create the desired order.

   Show Instructions for adding a relative Stop Date

   1. In the Stop Date field, select “In.”
   2. In the Number of Days from Today field, enter the number of days after which the order should stop, relative to the date on which the order is placed. For example, if you enter 5, the order will stop 5 days after the date it is placed.
   3. You might see any of these fields:

   • When Time of Day: Enter the time of day at which the order should stop, in addition to the number of days (for example, in 5 days at 3:00 PM).
   • Number of Minutes: Enter the number of minutes after which the order should stop, in addition to the number of days (for example, in 5 days and 30 minutes).
   • Number of Hours: Enter the number of hours after which the order should stop, in addition to the number of days (for example, in 5 days and 3 hours).
5. Click OK. The Add Favorites window closes and the Manage Favorites window becomes active.
6. Click Save in the Manage Favorites window. The new order is saved to your Favorites list.
   If you decide you do not wish to add a new order to your Favorites list, click Cancel in the Manage Favorites window instead of Save.

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Adding an Order Set to the Favorites List

You can add order sets to your Favorites list; however you cannot create your own personalized order set. To add an order set to your Favorites list:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select the category where you want to add the new favorite order set, and then click New Favorite. The Add Favorite to Favorites window displays.
3. Enter your order set in the search field and select the desired order. (Optional) You can select the Order Sets tab if available to narrow the list of search results. The order set is added to the Manage Favorites window in the desired location.
4. Click Save in the Manage Favorites window. Your order set is saved to your Favorites list.
   If you decide you do not wish to add the order set to your Favorites list, click Cancel in the Manage Favorites window instead of Save.

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Creating a Category in the Favorites List

You can create categories to help you organize your favorite orders and order sets. This will make it easier and faster for you to find and use them. To add a new category to your Favorites list:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Click New Category. The Add Category to Favorites window displays.
3. Enter the name of the new category, and then click OK. The new category is added at the end of Favorites in the Manage Favorites window.
   You can move the category to a different place within the Favorites list. See Moving Orders, Order Sets, and Categories in the Favorites List for more information.
4. Click Save to add the category to your Favorites list for your use.

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Creating a Subcategory in the Favorites List

You can also create subcategories to help you organize your favorite orders and order sets within a category. To add a new subcategory to your Favorites list:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select an order in the category where you want the subcategory to exist.
3. Click New Category. The Add Category to Favorites window displays.
4. Enter the name of the new subcategory, and then click OK. The new subcategory is added at the end of the list of orders for the category.
   You can move the subcategory to a different place within the category. See Moving Orders, Order Sets, and Categories in the Favorites List for more information.
5. Click Save to add the subcategory to your Favorites list for your use.

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Renaming a Category or Subcategory in the Favorites List

If you decide that a category or subcategory is incorrectly named, you can rename it using the Manage Favorites link as follows:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select the category or subcategory that you want to rename, and then click Edit. The Rename window displays.
3. Enter the new name, and then click OK. The new name replaces the old name in the list of Manage Favorites.
4. Click Save to add the renamed category or subcategory to your Favorites list for your use.

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Moving Orders, Order Sets, and Categories in the Favorites List

You can move orders and order sets between categories or move categories within the Favorites list using “drag and drop” as follows:

1. Click the Manage Favorites link at the bottom of the Favorites pane. The Manage Favorites window displays.
2. Select and hold the order, order set, or category that you wish to move and then drag it the desired location. As you drag the order, a pop-up displays the name with an arrow above highlighted as either green to indicate you can move it to the location or red to indicate you cannot move it. The blue line indicates where the it will move.
3. Drop (release) the selected order, order set, or category to move it to the desired location. The order, order set, or category displays in its new location.
   You cannot move a category within another category to make it a subcategory. See Creating a Subcategory in the Favorites List for instructions on creating a subcategory. You can only move a subcategory within its category. You cannot move a subcategory so it reports to another category. For example, if your subcategory “Daily” reports to the “Lab” category, you cannot move it into the “Radiology” category.
4. Click Save. The order, order set, or category displays in its new location in your Favorites list.