Reconciling Orders For Transfer

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Starting Transfer Order Reconciliation

To start the transfer order reconciliation process for a patient:

1. Select the patient from your Patient List tab.
2. Start Transfer Order Rec by either:
   • Selecting the Actions drop-down at the top right corner of the Patient Data Display screen, and then selecting Transfer Order Rec under the Medication Reconciliation header;
   • Clicking the Orders link in the center column, and then clicking the Transfer Order Rec button in the middle of the Orders screen;
   • Clicking the Home Meds link in the center column and then clicking the Transfer Order Rec button located above the list of Pre-Admission Medication in the Home Medications screen; or
   • Selecting the Actions drop-down in the Patient Search tab after selecting a patient visit from the search results, and then selecting Transfer Order Rec under the Medication Reconciliation header.
   The Transfer Order Reconciliation window opens and displays any current active orders. The most recent visit is selected in the Transfer order reconciliation for Visit field.

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Reconciling Patient Orders for Transfer

You must reconcile all active orders as part of the transfer reconciliation process for a patient. You may also add other orders such as physician consults or restart inactive orders or stopped home medications. You need to complete the following procedure to reconcile all the orders:

1. Begin the transfer order process for a patient. See Starting Transfer Order Reconciliation.
2. Select the appropriate transfer destination from the To: drop-down menu. The transfer order associated with that transfer destination is added.
   You cannot access any active orders or stopped home medications until you choose a destination transfer location. If you decide that you only want to reconcile the orders (no transfer required), you can uncheck Transfer From: to remove the requirement for a transfer location. See Reconciling Patient Orders without a Transfer Order for more information.
3. (Optional) If you need to see past orders (completed or discontinued), uncheck the Active Order Only checkbox. The Show Orders From: drop-down menu displays. Choose one of the following timeframes to display the inactive orders:
   • Today
   • Last 2 Days
   • Last 5 Days
   The following selections are not available when transferring orders and appear grayed-out:
   • Last Discharge (mm/dd/yy)
   • Last Admission (mm/dd/yy)
   Inactive orders will display with their status of Complete, Discontinued, Canceled, etc. Discontinued and Canceled inactive orders have a strikethrough.
4. Review all active orders (medications, labs, radiology, etc), and choose a course of action of either Stop, Continue, or Change for each active order. See Choosing a Course of Action for Active Orders in Transfer Order Reconciliation.
   Medication orders will sort medications without a PRN before medications with a PRN. Held medications will display in their own section.
   While you decide the course of action for each active order, you can also choose to do the following:
   • (Optional) click the Show Clinical Data button to review any lab results, test results, or other patient data without exiting the Transfer Order Reconciliation process. See _Displaying Patient Information_in the Physician Portal User’s Guide for more information on all the available display options except for Home Meds and Discharge Orders. For information on the Home Medications link, see Viewing Home Medications in the Patient Data Display. For information on the Discharge Orders link, see Viewing Discharge Orders.
   Click the Return to Transfer Order Rec button to return to the Transfer Order Reconciliation screen.
   • (Optional) Review the Order Details of a particular order by clicking on the order in the left hand side of the Transfer Order Reconciliation screen.
   • (Optional) Restart a stopped home medication or a hospital order. See Restarting a Stopped or Completed Order in Transfer Order Reconciliation.
   • (Optional) Resume a held home medication or hospital order. See Resuming a Held Medication Order in Transfer Order Reconciliation.
   • (Optional) Add additional orders. See Adding Additional Orders in Transfer Order Reconciliation.
   • (Optional) Delete a new or continued order. See Deleting New or Continued Orders in Transfer Order Reconciliation.
   • (Optional) Modify a new or continued order. See Modifying New or Continued Orders in Transfer Order Reconciliation.
5. Reconcile and submit all orders. See Reconciling and Submitting Orders in Transfer Order Reconciliation.

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Choosing a Course of Action for Active Orders in Transfer Order Reconciliation

If you are reconciling orders for transfer (the Transfer From: checkbox is selected), you must decide to either stop, continue, or change each active order. You cannot complete the transfer reconciliation process until every active order has a course of action. The Action for Order column displays a red highlighted background to indicate an action is required unless partial reconciliation is enabled, then the background is highlighted gray. Any order that you choose to continue or change will become an order associated with the transfer when you complete the reconciliation. If you are reconciling active orders for the current visit without a transfer order, you can choose a course of action for only the orders you wish to stop or change.

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Stopping an Order in Transfer Order Reconciliation

If you determine that an order is not required for reconciliation, you can choose to stop it as follows:

• Click Stop under the Action for Order column to stop only that order.
• Click the Stop link in the Stop/Continue Remaining header which stops any active order for a group of orders such as Medication Orders.
• Click the Stop Remaining Orders button at the bottom of the Transfer Order Reconciliation window to stop all orders that were not changed or continued.

The red highlight in the Action for Orders section is removed and the word Stop displays in the Action for Orders column. If the order reconciliation does not require a discharge/readmit, the order displays as Discontinued: under the Transfer Orders column if transferring the patient (or the New Orders column if the Transfer From: checkbox is deselected at the top of the screen). This stopped order will be submitted as a discontinued order for the current visit. If the order reconciliation is for a transfer that requires a discharge and re-admission, the word Stopped displays under the Transfer Orders column. If you stopped an order in error, you can undo the Stop order action as long as you do so prior to submission for reconciliation. You can undo the Stop order action in one of the following ways:

• Hover over the Action For Order until radio buttons for Stop and Continue/Change appear, and then select either select the radio button for Continue (see Continuing an Active Order in Transfer Order Reconciliation) or click the Change link (see Changing an Order in Transfer Order Reconciliation).
• Click Edit next to the order to display the menu of options, and then select Undo Stop to return the medication order to its original state.

If you need to add a reason for discontinuing an order, you can modify the discontinued order as follows:

1. Click the discontinued order or click Edit next to the discontinued order, and then select Modify. The Order Details window displays.
2. Enter the reason in the text box and then click OK. You are returned to the Transfer Order Reconciliation screen.

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Continuing an Active Order in Transfer Order Reconciliation

You can continue active orders if there are no changes required as follows:

• Click the radio button next to Continue/Change under the Action for Order column to continue only that order, or
• Click the Continue link in the Stop/Continue Remaining header which continues any active order for a group of orders such as Medication Orders.

The red highlight in the Action for Orders section is removed and Continue/Change displays in the Action for Orders column. If the order reconciliation does not require a discharge/re-admission, the order displays as Continued: under the Transfer Orders column (or the New Orders column if the Transfer From: checkbox is deselected at the top of the screen). If the order reconciliation is for a transfer that requires a discharge and re-admission, the word New: displays under the Transfer Orders column.

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Changing an Order in Transfer Order Reconciliation

You can change an active order as follows:

1. Click the Change link in Continue/Change under the Action for Order column next to the order. Depending on the type of order, either the Order Details window will display allowing you to change the specifics of the order or the Order Search will display allowing you to find and select a different order. All medications orders will trigger an Order Search.
2. Make the desired changes to the order by either:
   • Selecting a new order if the Order Search executes. 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.
   If the Order Details window displays, complete any missing required fields, and then click Done.
   • Modifying the order with the desired changes in the Order Details window, and then clicking Done.
   For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.

The red highlight in the Action for Orders section is removed and Continue/Change displays in the Action for Orders column. If the order reconciliation does not require a discharge/re-admission, the old order displays as Discontinued: while the modified order displays as New: under the Transfer Orders column (or the New Orders column if the Transfer From: checkbox is deselected at the top of the screen). If the order reconciliation is for a transfer that requires a discharge and re-admission, the word New: displays under the Transfer Orders column.

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Restarting a Stopped or Completed Order in Transfer Order Reconciliation

All stopped or completed hospital or home medications orders can be restarted as follows:

1. Hover over Stop under the Action for Order column for a specific order until the Continue/Change selection appears.
2. Choose to either Continue (select radio button, see Continuing an Active Order in Transfer Order Reconciliation) or Change (click Change link, see Changing an Order in Transfer Order Reconciliation) the order. Continue/Change displays in the Action for Orders column, and the word New: displays under the Transfer Orders column.
   If you decide that you do not want to continue/change the order, you can click Edit next to the continued/changed order in the Transfer Orders or New Orders Column and select Delete. The order will return to its original state.

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Resuming a Held Medication Order in Transfer Order Reconciliation

If a patient has held a held medication order, it will display in a separate section labeled Medication Orders on Hold. You can choose to resume the medication order as part of the transfer orders.

• Select the radio button next to Resume/Change for a held medication order to resume the order. The medication order displays under the Transfer Orders with the prefix Resume: if you are transferring the patient to a location within the facility or with a prefix New: if you are transferring the patient to an external location.
  You can also choose to stop or change the held medication order. See Stopping an Order in Transfer Order Reconciliation or Changing an Order in Transfer Order Reconciliation for more information.

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Adding Additional Orders in Transfer Order Reconciliation

You can choose to add new orders to start upon transfer or as part of an order reconciliation for the current visit as follows:

1. Click the Add button next to the Transfer Orders (or New Orders if the Transfer From: checkbox is deselected at the top of the screen) header in the right side of the Transfer Order Reconciliation screen. If your patient does not have any existing active or inactive orders, click the here link in “The patient does not have any active orders to reconcile. Please deselect the ‘active’ checkbox or click here to enter new orders.” The Search Order window displays. You can choose an order one of the following ways:
   • Using the Favorites list, continue to Step 2.
   • Using the Search field, continue to Step 3
   • Creating a free text order if you cannot find the order you want on the Favorites list or by searching, see Using Free Text to Add a Discharge Order.
   All new orders that you add will be listed in a new section called Additional Transfer Orders (or Additional New Orders if the Transfer From: checkbox is deselected at the top of the screen), designated by a gray bar and displayed at the bottom right-hand side of the screen. Each order will have a New: prefix.
2. If you are adding an order or order set from the list of Favorites, select the appropriate category under Favorites and then the desired order. One of the following actions occurs:
   • The order is added to the Additional Transfer Orders or Additional New Orders section. The order is to be submitted.
   • The Order Details window displays. Complete any required information, and then click Done to add the order to the Additional Transfer Orders or Additional New Orders section.
   • The order set form displays. Check the desired orders (may need to scroll to see complete form), including any highlighted required orders to create the desired set of orders, and then click Done with Order Set.
   The orders are added to the Additional Transfer Orders or Additional New Orders section. The orders are ready to be submitted.
   You may also see either the Order search triggered or additional orders added when you check an order in the order set form, depending on the requirements set up within the form. You can also modify an order on the form by selecting the order and making changes to the Order Details window.
3. If you are using the Search field to add an order, enter the name of the desired order or order set. As you enter the order into the Add Order search field, a list of possible matches displays.
   If no matches are found, then you may create a custom order using the Add as free text button if it is available. See Using Free Text to Add a Discharge Order; otherwise see your system administrator.
   1. (Optional) Select a tab for the desired category to narrow the search results if desired.
   2. (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.
   3. Select the order or order set from the search results. If the Order Details window displays with required information highlighted go to Step d, or if the order set form displays go to Step e.
   4. If the Order Details window displays, complete the required information (highlighted in red) and any other requirements, and then click Done.
   Your administrator might have configured fields or field sets that define 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. For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order. The order is added to the Additional Transfer Orders or Additional New Orders section. The order is ready to be submitted.
   5. If the order set form displays, check the desired orders, including any highlighted required orders to create the desired set of orders, and then click Done with Order Set.
   You may also see the Order search triggered or additional orders added when you check an order in the order set form, depending on the requirements set up within the form. You can also modify an order on the form by selecting the order and making changes to the Order Details window.
   The orders are added to the Additional Transfer Orders or Additional New Orders section. The order is ready for reconciliation unless a warning or an alert needs resolution.

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Repeating an Existing Order for Transfer

You can repeat an existing lab or test for transfer when you check their results:

1. Click the Show Clinical Data button in the upper right corner of the Transfer Order Reconciliation window to view the results of a completed lab or test order.
   Click the Return to Transfer Order Rec button if you want to return to the Transfer Order Reconciliation window or click the Transfer Order Rec button found in the Orders or Home Meds screen.
2. Click either Lab Results or Test Results in the center column, and then select the desired order.
3. Click Order Again and choose one of the following actions, depending on your choice of order:
   • If you choose to repeat a test, you have the following choices:
   • Order Details window displays. Complete any required information and click Done.
   • Test is added, no further action is required.
   Search For Order window displays if the order cannot be found. Choose the desired order, and complete any required information for the Order Details window, and then click Done if prompted.
   You are returned to the Transfer Order Reconciliation window. The order is added to the Additional Transfer Orders or Additional New Orders section. The order will have a New: prefix and is ready for reconciliation unless a warning or an alert needs resolution.
   • If you choose to repeat a lab the Order Again window displays. Choose to repeat the entire panel or specific components, and then click OK.
   The order is added to the Additional Transfer Orders or Additional New Orders section. The order will have a New: prefix and is ready for reconciliation unless a warning or an alert needs resolution.

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Using Free Text to Add a Discharge Order

If you do not find any matches for your order using the Search function, you can create a free text order.

1. Click Add as free text in the search window. A dialog box appears with the possible order types available for custom orders.
2. Select the correct order type, such as Medications. A blank Order Details window displays.
3. Enter the name of the order in the Description field, complete the rest of the order details including any required information, and then click Done. The order is added to the Additional Transfer Orders or Additional New Orders section. The order will have a New: prefix.

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Deleting New or Continued Orders in Transfer Order Reconciliation

If you decide you no longer need a new or continued order (prior to submitting it), you can delete the order as follows:

• Click Edit next to the order under the Transfer Orders, New Orders, Additional Transfer Orders, or Additional New Orders section, and then select Delete from the pop-up. The order is removed. If the new order has a discontinued order associated with it, the discontinued order is also removed.

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Modifying New or Continued Orders in Transfer Order Reconciliation

If you need to change any of the unsubmitted new or continued orders, you can modify the order as follows:

1. Select the order listed under the Transfer Orders, New Orders, Additional Transfer Orders , or Additional New Orders section in one of the following ways:
   • Click on the order that you wish to modify, or
   • Click Edit next to the order, and then select Modify from the pop-up.
   The Order Details window displays.
2. Make any desired changes, and then click Done. The modified new order continues to display with the label New:. A modified continued order displays as New: and the original order displays as Discontinued:. The order is ready to be submitted.

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Reconciling and Submitting Orders in Transfer Order Reconciliation

After you have decided upon an action for each active order, added any new orders, and resolved any interaction alerts, you are ready to complete the reconciliation process.

• Click Reconcile and Submit at the bottom of the Transfer Order Reconciliation window to reconcile the orders and submit them for routing. One of the following actions will happen:
  • The Transfer Order Reconciliation window closes and you are returned to the Patient Data Display window. All orders including continued or changed home medications and the transfer order 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 (click on the Orders link display) except if transfer orders are configured to be held for routing (see Transfer Orders Held for Routing for more information).
  • A Warning dialog displays asking if you want to submit a partial reconciliation. This dialog only appears if your organization allows partial reconciliation of transfer orders and you are choosing to do a partial submission. Click the Submit Partial Transfer Order Rec button. The Transfer Order Reconciliation window closes and you are returned to the Patient Data Display window.
  • A Signature dialog displays. 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.
  • A CDS warning displays. Review and resolve any medication interaction warnings and alerts if the Clinical. See Reviewing Medication Interaction Pop-up Warnings and Inline Alerts. Once all the warnings and alerts are resolved, you need to reconcile and submit your orders again.
  • You are returned to the Transfer Order Reconciliation screen to review any Inline alerts. Make any needed changes, and then reconcile and submit your orders again.
  If you click Cancel at the bottom of the Transfer Order Reconciliation window, the window closes, and none of your changes are saved.

Enter one of the following depending on what Signature dialog displays:

• Enter your password or PIN, and then click OK.

The Transfer Order Reconciliation window closes and you are returned to the Patient Data Display window. All orders including continued or changed home medications 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 (click on the Orders link display).

• 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.

The Transfer Order Reconciliation window closes and you are returned to the Patient Data Display window. All orders including continued or changed home medications and the transfer order 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 (click on the Orders link display).

• 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.

Upon submitting the transfer orders, the Transfer Order Reconciliation window closes and you are returned to the Patient Data Display window. All orders including continued or changed home medications are then routed to appropriate destination (for example, a printer for future action) with the electronic signature of the ordering physician and they also added to the patient’s Existing orders for the current visit list (click on the Orders link) except if transfer orders are configured to be held for routing (see Transfer Orders Held for Routing for more information). All medication orders submitted in Commure Pro will display in italics when viewing a printout or existing orders in the Commure Pro system.

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Transfer Orders Held for Routing

Transfer orders may be configured to be held for routing. When you sign and submit these transfer orders, they will be held and not sent until the patient actually transfers. These held transfer orders will display in CPOE on the Existing Order for this visit list and in the Orders display option on the Existing Orders list as follows:

• For a new medication order placed in Transfer Order Reconciliation, the order has a “Held for Routing” status with the label New Upon Transfer, to indicate that the new order is waiting to be sent to the back end system until the patient actually transfers. In order entry, the provider cannot modify or discontinue the order.
• For an order that was discontinued in Transfer Order Reconciliation, the order has an “Active” status with the label Stop upon Transfer, to indicate that it will be discontinued in the back end system once the patient actually transfers. In order entry, a provider can modify or discontinue the original active order (prior to the patient being transferred), if necessary.
• For an order that was continued in Transfer Order Reconciliation, the order has an “Active” status with no additional label. The order will be continued in the back end system once the patient actually transfers. In order entry, provider can modify or discontinue the original active order (prior to the patient being transferred), if necessary.

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Transferring a Patient without Active Orders

Patients with an active current visit but who do not have any active orders can be transferred with only a transfer order or with new orders as follows:

1. Begin the transfer order process for a patient. See Starting Transfer Order Reconciliation.
2. Select the appropriate transfer destination from the To: drop-down menu. The transfer order associated with that transfer destination is added.
3. (Optional) If you need to see past orders (completed or discontinued), uncheck the Active Order Only checkbox. The Show Orders From: drop-down menu displays. Choose one of the following timeframes to display the inactive orders:
   • Today
   • Last 2 Days
   • Last 5 Days
   The following selections are not available when transferring orders and appear grayed-out:
   • Last Discharge (mm/dd/yy)
   • Last Admission (mm/dd/yy)
   Inactive orders will display with their status of Complete, Discontinued, Canceled, etc. Discontinued and Canceled inactive orders have a strikethrough.
4. (Optional) Add new orders or restart stopped orders. See Adding Additional Orders in Transfer Order Reconciliation or see Restarting a Stopped or Completed Order in Transfer Order Reconciliation for more information on the different ways to add a new order or restart an inactive order.
5. Reconcile and submit all orders. See Reconciling and Submitting Orders in Transfer Order Reconciliation.

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Reconciling Patient Orders without a Transfer Order

You can use Transfer Order Reconciliation to quickly stop orders for a current visit without creating a transfer order. You can also change or add order if needed too. You do not have to reconcile all the active orders, only the ones that you wish to stop, change, or add.

1. Begin the transfer order process for a patient. See Starting Transfer Order Reconciliation.
2. Deselect (uncheck) the checkbox next to Transfer From: location to remove the transfer requirement.
3. (Optional) If you need to see past orders (completed or discontinued), uncheck the Active Order Only checkbox. The Show Orders From: drop-down menu displays. Choose one of the following timeframes to display the inactive orders:
   • Today
   • Last 2 Days
   • Last 5 Days
   • Last Discharge (mm/dd/yy) if available
   • Last Admission (mm/dd/yy) if available
   Inactive orders will display with their status of Complete, Discontinued, Canceled, etc. Discontinued and Canceled inactive orders have a strikethrough.
4. Review all the orders (medications, labs, radiology, etc), and decide which orders you want to Stop or Change. See Choosing a Course of Action for Active Orders in Transfer Order Reconciliation.
   All medication orders will sort all medications without a PRN before all medication with a PRN.
   You can also choose to do the following:
   • (Optional) click the Show Clinical Data button to review any lab results, test results, or other patient data without exiting the Transfer Order Reconciliation process. See _Displaying Patient Information_in the Physician Portal User’s Guide for more information on all the available display options except for Home Meds and Discharge Orders. For information on the Home Medications link, see Viewing Home Medications in the Patient Data Display. For information on the Discharge Orders link, see Viewing Discharge Orders.
   Click the Return to Transfer Order Rec button to return to the Transfer Order Reconciliation screen.
   • (Optional) Review the Order Details of a particular order by clicking on the order in the left hand side of the Transfer Order Reconciliation screen.
   • (Optional) Restart a stopped home medication or a hospital order. See Restarting a Stopped or Completed Order in Transfer Order Reconciliation.
   • (Optional) Add additional orders. See Adding Additional Orders in Transfer Order Reconciliation.
   • (Optional) Delete a new order. See Deleting New or Continued Orders in Transfer Order Reconciliation.
   • (Optional) Modify a new order. See Modifying New or Continued Orders in Transfer Order Reconciliation.
5. Reconcile and submit your orders. See Reconciling and Submitting Orders in Transfer Order Reconciliation.

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Saving as Draft in Transfer Order Reconciliation

If you should need to stop and save any work done in Transfer Order Reconciliation, you can click the Save as Draft button. Once you click the Save as Draft button, you will exit the Transfer Order Reconciliation window and return to the Patient Data Display. To return to your saved work, select the patient and then select Transfer Order Rec 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 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 Transfer Order Reconciliation, select the patient from the patient list and then select Transfer Order Rec from the Actions menu in the Patient Data Display to enter the Transfer Order Reconciliation window 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 Transfer Order Reconciliation for this patient, select the patient from the patient list and then select Transfer Order Rec from the Actions menu in the Patient Data Display to enter the Transfer Order Reconciliation window with the saved unsubmitted orders.
• Click Discard Orders and Exit Commure Pro if you do not wish to keep the orders for a future session.