Signing Documents And Orders Electronically

• Documents from non-Commure Pro source systems: Instead of logging into the organization’s source system or visiting the medical records department, a provider can access and sign these clinical documents from the Commure Pro eSignature application. The eSignature application locates clinical documents originating in a source system or transcription system. eSignature assigns these documents to the appropriate provider, who can then view, edit, and sign them. Next, the signed documents are sent to your organization’s system of record that validates the signature and accepts edits. And finally, the system of record stores and manages the signed documents. The documents that are available for eSignature are based on the types of documents in your source system, as well as the document types that your organization has chosen to enable for eSignature. Some examples of the types of documents that a provider might be able to sign in eSignature include:
  • Reports: textual documents such as Discharge Summaries, Physician Consultation Reports, Patient Progress Notes, Radiology Reports, etc. For some documents, such as Radiology Reports, either the original report, or addendums to the report, may be electronically signed.
  • Scanned Documents: any document that has been electronically scanned as an image file into your system of record. These may include some of the Reports or Orders listed above.
  MEDITECH® Magic users will also have access to these additional two document types:
  • Orders: orders for items such as laboratory tests, radiological tests, consultations, etc.
  • Attestations: documents used to confirm that the coding performed when a medical record was abstracted is correct.
• Documents from Commure Pro systems: In organizations where teaching physicians (such as attending MDs) are supervising mid-level practitioners (such as residents or physician assistants), a mid-level practitioner might be responsible for initially creating a clinical note or an order, which would then in turn require review, potential edits, and a co-signature from their supervising provider.
  • Documents from Commure Pro NoteWriter: In this workflow, the mid-level provider creates a note in the Commure Pro NoteWriter application, signs the document within that same application, and also specifies the supervising provider who should co-sign it. The Commure Pro system then sends the document to the eSignature application for the supervising provider, who can view, edit/attest, and co-sign it. The document is sent to your organization’s system of record, which stores and manages the signed documents, when it is initially signed by the mid-level provider, and then again when it is co-signed by the supervising provider.
  • Orders from Commure Pro CPOE: This workflow is available to organizations with a MEDITECH back-end and requires work by Commure Pro’s Integration team in order to implement it. In this workflow, the mid-level provider enters an order in the Commure Pro CPOE application, signs and submits it within that same application, and also specifies the supervising provider who should co-sign it. The order is routed to the appropriate destination, such as the pharmacy, the lab, and so on for processing. The order is also sent to your organization’s back end order deficiency system, which then forwards it to the Commure Pro eSignature application for the supervising provider, so that they can co-sign the order. Once signed, a record of the co-signature is then sent back to the order deficiency system. This same workflow is also followed when a mid-level provider modifies, discontinues, holds, or resumes an order.

The eSignature application is a web application that is accessed via a desktop or laptop computer. The eSignature application is typically used in conjunction with the Physician Portal^TM application. This chapter discusses the daily usage of the eSignature desktop application within the Physician Portal application. Clinical documents can be viewed, edited, and signed via the eSignature application. All edited and signed documents are then sent to your institution’s system of record that validates the signature, accepts the changes made to the documents (if any), and signs the document. The eSignature application is supported via HL7 for better processing.

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Signing Permissions

When signing notes or documents via eSignature, the Commure Pro system works with Meditech privileges to compare the visit location to the provider’s facility privileges, and if valid, allows the provider to write a note. The facilities for which the provider has signing privileges displays in the provider file (user preferences) - with the sign setting for each facility. If not valid, a message displays:
“You do not have permission to sign documents in this facility. Please contact your administrator if you believe you have received this message in error.” You may save the note as a draft until permissions have been updated.

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Accessing eSignature on the Physician Portal

Access to eSignature is through the Inbox tab on the Physician Portal. The Inbox tab is Commure Pro’s internal e-mail application that tracks and manages e-mail messages from other users within the Commure Pro system. When the eSignature application is enabled, the Inbox tab also tracks clinical documents that require signatures. If there are any unsigned documents, the Inbox tab displays a red exclamation point next to the number of e-mails. In addition, if there are any NoteWriter documents requiring your co-signature as a supervisory physician, you will see a notice at the top of the Physician Portal screen stating You have unfinished item(s): ndraft note where n is the number of draft notes to complete and nto Co-sign where n is the number of NoteWriter documents that require your co-signature. You can click the link to go directly to the eSig and Commure Pro Mail tab where you can see the list of draft items, or view and sign the notes that require your co-signature. To access eSignature:

1. Click the Inbox tab.
2. Click the eSig and Commure Pro Mail tab to view all the clinical documents and e-mails that require your review and action. The Inbox tab consists of the following secondary tabs:
   • eSig and Commure Pro Mail tab: If you have both eSignature and Commure Pro Mail access, this tab appears. You can view, edit, and sign clinical documents, as well as respond to all e-mails. It contains the following items:
   • All your text-based e-mails received from other users that require your action.
   • Clinical documents from your source system (reports, attestations, orders, and scanned documents) requiring your review and action. If your organization has implemented the Commure Pro CPOE or NoteWriter co-signature feature, this can also include clinical documents (entered via the Commure Pro NoteWriter application) or orders (entered via the Commure Pro CPOE application) that require your co-signature. In the case of draft notes, you are given the option to delete notes in draft status (both as original note author and as clinician authorized for note co-signature).
   For more information about using the eSig and Commure Pro Mail tab, see Viewing Documents in the eSig and Commure Pro Mail Screen.
   If you do not have eSignature access, the tab is simply called Commure Pro Mail, and it lists only the text-based e-mails that you have received from other users. See your administrator about giving you eSignature access.
   • Outbox tab: This tab lists all e-mails and clinical documents that you have signed or sent to another user or department (Medical Records) for action.
   For more information about using the Outbox tab, see Viewing Sent Messages in the Outbox.
   • Send Commure Pro Mail tab: This tab allows you to send general e-mails to other users.
   For more information about sending Commure Pro Mail, see eSignature and Commure Pro Mail.
   • Summary, Inbox Search, and Processed Search tabs: HIM users may be able to see some or all of these three additional tabs, depending upon their user access settings.
   For more information, see Defining User Access to eSignature and Tracking and Monitoring Electronically Signed Documents.

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Viewing Documents in the eSig and Commure Pro Mail Screen

The eSig and Commure Pro Mail screen is available under the Inbox tab. This is where your deficiency items are listed, such as orders you need to sign, notes you need to sign or co-sign, and e-mails for you to review. The sections below describe the screen and how it works, and provide steps for viewing items.

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Understanding the eSig and Commure Pro Mail Screen

The eSig and Commure Pro Mail sub-tab under the Inbox main tab includes two panes: List Filter Pane (left) and List Display Area (right). Below is a description of the screen so you can understand exactly what you are seeing.

• List Filter Pane- On the left side of the window is the List Filter pane. This pane displays options for controlling which list you see in the List display area. You can view All of your deficiency items, or filter by type to show only Notes, only Orders, or only Mail items. The screen is responsive so this pane may collapse if the window size decreases. The List filter pane is sticky, so your last selection is remembered the next time you the access the eSig and Commure Pro Mail screen. List Display Area- The main area of the window displays the list of e-mails and/or clinical documents that require your review or action. The items that are visible in the List display area are controlled by what is selected in the List filter pane. By default, clinical documents and e-mails are listed by date with the most recent item appearing first.
  You can sort the items in the List Display Area. For more information about sorting options, see Sorting Commure Pro Mail and Documents in the List Display Area.
  The List Display Area shows the following information near the top of the window for all lists:
  • List Name: The name of selected list displays at the top of the window with the number of unread items in parenthesis.
  • Refresh button: Click this button to refresh the List display area with updated data, if available.
  • Search field : You can search the selected list using any of the available data in the Date, Patient, or Description columns (excluding status). Search only applies to the currently selected list. As you type, only rows with matching text are displayed in the list.
  When there is no data in eSig and Commure Pro Mail, the application does not show the Refresh and Search options.
  The actual list of documents and/or e-mails is located just below the heading area in the window. Each item is listed in its own row. Items that are displayed in bold typeface indicate that some type of action is required, while items in regular typeface indicate that you have already taken some type of action:
  • Bold Typeface: E-mails that are unread, or documents with an Unsigned, Re-sign or Edited status.
  • Regular Typeface: E-mails that are read, or documents with a Signed or Declined status.
  The List display area shows the following columns of information for each clinical document and/or e-mail:
  • Exclamation Mark : This icon indicates a critically overdue clinical document or e-mail that requires your immediate attention. This icon appears in the left-most column in the List display area.
  • Select All/Multi-Select: If enabled for your site and for your user, you can select all items in a list or select multiple items individually, when viewing items of the same type. For example, if the Orders list is selected so only orders are shown in the List display area, you can select all of the orders in the list by clicking the Select All checkbox at the top of the column.
  If a Shared draft is selected as part of multi-selecting drafts, the Delete button on screen is disabled to prevent removal of the Shared draft, as Shared Drafts cannot be deleted.
  • Date: This column displays the date and time associated with the selected e-mail or clinical document. For orders, this is the date the order was placed, not the service date of the order.
  • Patient: This column identifies the patient name associated with this clinical document or e-mail.
  • Description: The description varies, based on whether the item is a clinical document or an e-mail:
  • For e-mails, the description shows from whom the e-mail was received.
  • For clinical documents, the description indicates the name of the document. Some documents, such as radiology reports, are associated with one or more orders or exams. In this case, the document description is the name of the first exam associated with the report, such as “ELBOW AP & LATERAL LEFT.” Furthermore, some documents might be addendum to previous reports. If a document is an addendum, the description is preceded by the word “ADDENDUM:” For example, an addendum to the previous report would be listed as: “ADDENDUM: ELBOW AP & LATERAL LEFT.”
  • Status: This column displays the status of clinical documents.

• Subject: The subject applies to e-mails. If a subject line was entered by the sender, it appears in this column. The subject appears blank if one was not entered. E-mail messages related to declined clinical documents include a subject of “eSignature Document Declined.”
• Details window- This pop-up window displays the clinical document or e-mail that you’ve selected in the List display area so that you can review its details. The actions available depend on the type of document you are viewing.
  The Patient icon appears next to the patient name in the header of the Details window. Click on this icon to open the detail screen for the patient selected.
  For e-mails, you can reply, forward, or delete the e-mail. For clinical documents, you may be able to sign or edit the document. You can also skip to the next clinical document in the list, reassign it to a different provider, or decline to sign the document.

You can adjust the size of the eSig signing window popup, to improve screen resolution. When you select a note from the list in Inbox > eSig and Commure Pro Mail, the popup signing window displays. The angled arrows icon in the upper-right corner of the popup controls the size of the popup window. This sizing is sticky from the point changed onward.

• When the angled arrows are pointed outward, the popup window is minimized, and selecting the icon expands the popup window to cover more of your display.
• When the angled arrows are pointed inward, the popup window is maximized, and selecting the icon makes the popup window smaller.

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Sorting Commure Pro Mail and Documents in the List Display Area

You can change the sort order in which e-mails or clinical documents appear in the List display area:

• Click a column heading to sort the list based on that item. Click the heading a second time to toggle between ascending and descending order. For example, clicking the Date heading would sort the items in chronological order by date. Clicking the Date heading a second time would sort the list in reverse chronological order.
• Click the far left column so that all overdue documents (those with an exclamation mark and the date marked in red) appear at the top of the list.

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Viewing the Details of Commure Pro Mail and Documents

The Details pop-up window displays the e-mail or clinical document that you have selected in the List display area. To view the details of an e-mail or clinical document:

1. Select the list you want to view in the List filter pane on the left side of the window. All shows all of your deficiency items in the List display area. Notes shows notes or scanned/transcribed documents that require your signature. You can filter even more by selecting the type of notes, including Draft notes or unsigned notes that require your signature or co-signature. Orders shows only unsigned orders that require your signature. Mail shows all e-mails that have been sent to you. The deficiency items in the selected list are shown in the List display area. 2. In the List display area, identify the e-mail or clinical document that you wish to review, and then click anywhere in that item’s row. The details of that item are displayed in the Details pop-up window.
   If you are looking for a specific item, you can sort using the column headings, or you can search the text that the is visible in the current List display area. For more information, see Sorting Commure Pro Mail and Documents in the List Display Area.
   The Patient icon appears next to the patient name in the header of the Details window. Click on this button to open the detail screen for the patient selected.
2. The next action you take is based on whether you selected an e-mail or a clinical document:
   • Commure Pro Mail: You can reply to, forward, or delete the e-mail. Details are described in Responding to Commure Pro Mail.
   • Clinical Documents: You may be able to sign, decline, reassign, or edit the document. You can also skip to the next clinical document in the list. Finally, you can auto-scroll through the clinical document in order to see the complete contents at a faster pace or to find a section quickly. All of these topics are covered in the following sections:
     • Auto-scrolling through Clinical Documents
     • Skipping Documents in the List
     • Signing Clinical Documents
     • Declining Clinical Documents
     • Reassigning Clinical Documents
     • Viewing Sent Messages in the Outbox

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Auto-scrolling through Clinical Documents

When viewing clinical documents in the Details window of the eSig and Commure Pro Mail tab, you can review multi-page clinical documents at an automated pace using the auto-scroll feature To auto-scroll through a clinical document:

• At the bottom right of the Details window, click the Auto-Scroll button to Scroll or Pause .

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Skipping Documents in the List

While viewing clinical documents in the Details window of the eSig and Commure Pro Mail tab, you can quickly work through the clinical documents in your list by skipping from one clinical document to the next.

• Click the Skip button to jump to the next clinical document in your list. The next clinical document in the list is highlighted in the List display area and displayed in the Details window. When you reach the last document in the list, the Skip button becomes unavailable.

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Working with Scanned Documents

Scanned documents are a subset of clinical documents, which are image files (such as tiff or jpeg files) that originate in your institution’s source system. Some clinical documents are scanned into and managed by your source system. When these scanned documents require a signature, the source system sends the document to eSignature. The following sections describe viewing, signing, and other functions you can perform when working with scanned documents. Like all clinical documents in eSignature, you can also skip, unsign, decline, and send e-mails about scanned documents.

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Viewing a Scanned Document

You can view scanned documents in the Details pane using a special viewer that enables you to rotate, resize, and page through a document.

1. In the List filter pane, select the Scanned/Transcribed list under Notes. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, click on the document you want to see. The document opens in the Details window.
3. From the document viewer’s task bar, you can adjust the document view:
   • Click the Resize icons to reduce the document, fit the document to the width of the window, or enlarge the document.
   • Click the Rotate icons to rotate a scanned document:
   
   • Click the Paging controls to page through a document, moving from the beginning to the end of a document:

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About Signature Blocks

A signature block is a highlighted area that corresponds to a section of the scanned document where a provider is required to review before signing. A scanned document can contain one or more signature blocks that are embedded in the image. The signature block counter, located at the bottom of the document viewer, indicates the number of signature areas requiring review before signing. Each instance of a signature block may require a provider’s attention before the scanned document can be signed. In some cases, a site may enforce that providers scroll to all of their signature blocks before they are able to sign a scanned document. In other cases, Sign All/Multi-Sign functionality may be enabled for the site and for a provider, in which case, scrolling to signature blocks is not required in order for a provider to sign a scanned or transcribed document.

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Signing Clinical Documents

In most cases, clinical documents require a signature from only one provider. In some cases however, a document requires signatures from two or more providers. The method in which this is handled depends on the source of the document:

• Commure Pro NoteWriter: When a document is created in the Commure Pro NoteWriter application, the author signs the document within that same application and is not required to sign it in the eSignature application. However, if the document requires a co-signature by a supervising provider, it is sent to the eSignature application for the co-signing provider.
• Commure Pro CPOE: When an order is created in the Commure Pro CPOE application, the ordering provider signs the document within that same application and is not required to sign it in the eSignature application. However, if the order requires a co-signature by a supervising provider, it can eventually end up in the eSignature application for the co-signing provider.
• Non-Commure Pro source system: When a document is created in a non-Commure Pro source system, and it requires more than one signature, it is sent to the eSignature application for all of the providers at the same time. Usually, all of the providers sign the document and the signatures are processed in the system of record with no delay. However, there are a couple of scenarios that may require a provider to wait before signing a document, or to sign a document twice:
  • Some source systems have restrictions in place that prevent a provider from editing or signing a document after it has already been edited or signed by another provider (this is often the case in teaching hospitals where reports that are dictated by residents or nurse practitioners must be co-signed by attending providers). For example, let’s say a provider signs and/or edits a document, and the signature and/or edit has not yet been processed in the system of record. When the second provider attempts to sign the original document, they will receive an error message stating that “This document is pending signature by another provider.” In this case, the second provider must wait until the first provider’s signature and/or edit is processed before they can sign and/or make their own edits to the report. If the first provider made changes to the document, the second provider will receive an updated version of the document for their signature.
  • In another scenario, if one provider signs a document, and then the document is edited by a second provider, the first provider may be required to re-sign the document. An updated version of the document is presented to the first provider, so that they can review the changes and then re-sign it. Whether or not a provider must re-sign a document after edits by another provider is based on the following setting: Require all providers to re-sign document after each user’s edits.

It does not matter whether a provider is signing, co-signing, or re-signing a document; the steps involved are identical, and are described in the topics referenced below. Every user who is authorized to electronically sign clinical documents, is able to sign documents on an individual, one-by-one basis. Some users may also be authorized to sign multiple documents at once (either multiple orders, or multiple documents of any type). The ability to sign multiple documents is based on the Enable Sign All/Multi-Sign setting in their user profile.

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Signing an Individual Document

Individual clinical documents can be signed from the Inbox > eSig and Commure Pro Mail tab by following these steps:

1. Select the list you want to view in the List filter pane on the left side of the window. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, click on the document that you want to sign. The item opens in the Details window.
   If you are looking for a specific item, you can sort using the column headings, or you can search the text that the is visible in the current List display area.
3. The button that is available to sign depends on the type of document you have selected:
   • For Drafts, click the Edit/Sign button to open the NoteWriter Wizard, and then click the Sign/Submit button.
   • For Co-Sign notes, click the Sign button to sign the selected note.
   • For Scanned/Transcribed notes, click the Edit/Sign button to open the document for signing, and then click the Save & Sign button. In some cases, multiple signature blocks exist in a document. Steps for signing scanned documents are described in Signing an Individual Scanned Document.
   • For Orders, click the Sign button to sign the selected order.
4. You may now be prompted to enter either your PIN or your password from your source system. Your user permissions determine whether:
   • You enter your PIN or password every time you sign a clinical document; or
   • You enter your PIN or password only the first time you sign a clinical document (per web session). Even in this instance, your administrator may set a limit as to the number of minutes of inactivity that are allowed before your PIN or password times out, and you must re-enter it to sign additional documents.
   • You click the Sign button only to automatically sign documents. No PIN or password is required to sign documents. When you sign a document in the Details window, eSignature automatically scrolls to the next document in the List display area.

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Signing an Individual Scanned Document

Scanned documents can be signed from the Inbox > eSig and Commure Pro Mail tab. Since these documents originate from a system outside of Commure Pro, they may require signatures from multiple providers in different sections of the document. These locations are identified in each document using signature blocks. To sign a scanned document:

1. In the List filter pane, select the Scanned/Transcribed list under Notes. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select the document you want to see. The document opens in the Details window. Signature blocks appear as highlighted boxes on the scanned document. Each block is located on or near a section of the scanned document that requires your review.
3. To acknowledge that you have reviewed each signature block, do one of the following:
   • For documents with only one signature block, click the Sign button.
   • For documents with multiple signature blocks, click the Next Tag button to advance from one signature block to the next.
   Each block is numbered relative to all the blocks in the document. As you advance block by block, each reviewed block is grayed out and the next immediate block is highlighted in yellow. When the Institution-level setting Must Scroll Through All Signature Blocks to Sign Scanned Documents is set to Yes, the Sign button is disabled (grayed out) whenever one or more signature blocks have not been reviewed. If you attempt to sign, an alert message (n Require Attention) appears in red to the left of the signature block counter, where “n” is the number of blocks that are unsigned and require your attention. When you have advanced through all the signature blocks in the scanned document, the Sign button is enabled and you can click it.
4. After clicking the Sign button, you may be prompted to enter either your PIN or your password from your source system. Your user permissions determine whether:
   • You enter your PIN or password only the first time you sign a clinical document (per web session). Even in this instance, your administrator may set a limit as to the number of minutes of inactivity that are allowed before your PIN or password times out, and you must re-enter it to sign additional documents; or
   • You enter your PIN or password every time you sign a clinical document; or
   • You only click the Sign button; you do not need to enter your PIN or Password.

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Signing Multiple Documents

Multiple items can be signed at once using eSignature’s Multi-Sign functionality. When Multi-Sign is enabled, a checkbox is available next to each item in the list display area so providers can select multiple items to sign. A checkbox is also available in the header at the top of the list to select all of the items in the list with a single click. This feature is available only if Multi-Sign is enabled at the Institution-level and in a user’s profile. Depending on your site’s configuration, Multi-Sign may apply to orders only, or to clinical documents of all types. To configure your system for this workflow, administrators should refer to the Defining eSignature (to configure system-wide settings) and Defining User Access to eSignature (to configure individual user preferences). To sign multiple documents:

1. Select the list you want to view in the List filter pane on the left side of the window. The deficiency items in the selected list are shown in the List display area.
2. Select the documents that you want to sign from the List display area. There are several ways you can do this:
   • To select several non-contiguous documents (for example, a document at the top of the list and one at the bottom): click the Select checkbox at the beginning of the row for the items you want.
   • To select all types of clinical documents in the List display area, click the Select All checkbox column heading at the top of the list.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the multi-sign action.
3. Click the Sign button to sign the selected items. The button that displays depends on which types of documents you have selected.
   • For Drafts, click the Edit/Sign button to open the NoteWriter Wizard, and then click the Sign/Submit button.
   • For Co-Sign notes, click the Sign button to sign the selected notes.
   • For Scanned/Transcribed notes, click the Edit/Sign button to open the documents for signing, and then click the Sign button. Multi-Sign for Scanned/Transcribed notes requires an additional step, which is described in Signing Multiple Scanned/Transcribed Documents.
   • For Orders, click the Sign button to sign the selected orders.
4. You may now be required to enter either your PIN or your password from your source system. Your user permissions determine whether:
   • You enter your PIN or password every time you sign a clinical document; or
   • You enter your PIN or password only the first time you sign a clinical document (per web session). Even in this instance, your administrator may set a limit as to the number of minutes of inactivity that are allowed before your PIN or password times out, and you must re-enter it to sign additional documents; or
   • You click the Sign button only to automatically sign all the selected clinical documents. No PIN or password is required to sign documents.

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Signing Multiple Scanned/Transcribed Documents

Scanned or transcribed documents can be signed from the Inbox > eSig and Commure Pro Mail tab. Since these documents originate from a system outside of Commure Pro, they may require signatures from multiple providers in different sections of the document. These locations are identified in each document using signature blocks. To sign multiple scanned/transcribed documents:

1. In the List filter pane, select the Scanned/Transcribed list under Notes. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select the documents that you want to sign. There are several ways you can do this:
   • To select several non-contiguous documents (for example, a document at the top of the list and one at the bottom): click the Select checkbox at the beginning of the row for the items you want.
   • To select all of the documents in the List display area, click the Select All checkbox column heading at the top of the list.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the multi-sign action.
3. Click the Edit/Sign button to open the selected documents for signing. If more than one signature block exists in the document, you can click the Next Tag button to jump to the next section that you need to review.
4. When you are ready to sign the document, click the Sign button. The next document in the list displays automatically for your review and signature. You may be prompted to enter either your PIN or your password from your source system. Your user permissions determine whether:
   • You enter your PIN or password only the first time you sign a clinical document (per web session). Even in this instance, your administrator may set a limit as to the number of minutes of inactivity that are allowed before your PIN or password times out, and you must re-enter it to sign additional documents; or
   • You enter your PIN or password every time you sign a clinical document; or
   • You only click the Sign button; you do not need to enter your PIN or Password.

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Editing Clinical Documents

You can edit text-based clinical documents in eSignature from the Inbox > eSig and Commure Pro Mail tab. The method by which the document is edited depends on the type of document:

• Documents from Commure Pro NoteWriter: When you edit document that was created in the NoteWriter application, the document opens for editing in the NoteWriter application, rather than in the eSignature application.
  • If you are editing a draft document that you authored, you can edit the document at will. When you click Sign/Submit in the NoteWriter application, you have signed the document.
  • If you are editing a document that a mid-level provider authored and sent to you for your co-signature, you may be able to add comments to each section of the note, or only add a single comment in the Co-Signature section, depending on your system’s configuration. When you click Sign/Submit in the NoteWriter application, you have co-signed the document (with your additions and the attestation statement defined for your note).
• Documents from your source system: The documents are edited directly in the eSignature application. Editable sections of a document are indicated by a frame and scroll bar. There can be multiple editable portions of a document in the eSig Edit screen. If the document is an addendum (as indicated by a document description that begins with the word “ADDENDUM”) then only the addendum may be edited. Sections of the report that were included in the original document cannot be changed in an addendum document.
  You cannot edit the following items: orders (whether derived from your source system or from the Commure Pro CPOE system), attestations, or scanned documents.
  To edit a clinical document that was derived from Commure Pro NoteWriter:

1. In the List Filter pane, select Notes or one of the sub-lists under Notes. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select a document using one of the following methods:
   • To edit one item, click on the document that you want to edit. The document opens in the Details window.
   • To select multiple items to edit, click the checkbox next to each document you want to edit or click the Select All checkbox column heading at the top of the list to select all items.
   The order that you select documents is the order in which they are edited.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the edit action.
3. The button that is available to edit depends on the type of document(s) you have selected.
   • For Drafts, click the Edit/Sign button.
   • For notes requiring co-signature, click the Attest button.
   The document opens in the NoteWriter application.
4. Make your edits or additional comments as necessary. You can view the NoteWriter Wizard window and a Patient Detail window side-by-side using Pop Out mode.
5. Once you have finished your edits to the clinical document, click the Sign/Submit button. The document is signed (if you are the author) or co-signed (if you are the co-signing provider). The eSignature application is redisplayed and the document is removed from the eSig and Commure Pro Mail tab.

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To edit a clinical document, or an addendum to a document, that was derived from your source system

1. In the List filter pane, select Orders or Notes (or one of the sub-lists under Notes). The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select a document using one of the following methods:
   • To edit one item, click on the document that you want to edit. The document opens in the Details window.
   • To select multiple items to edit, click the checkbox next to each document you want to edit or click the Select All checkbox column heading at the top of the list to select all items.
   The order that you select documents is the order they are edited.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the multi-sign action.
3. Click the Edit/Sign button. The text in the Details window becomes editable.
4. Scroll through the window, revising content and adding text where necessary.
5. Once you have finished your edits to the clinical document or addendum, take any of the following actions:
   • Click Save to save your edits to the document. The document is maintained in eSignature and is not submitted to the system of record. If you selected more than one item to edit, the next item displays for editing.
   • Click Save & Sign to save your edits and sign the document. When signing a document, you may be required to enter your PIN or password at least once per session. If you selected more than one item to edit, the next item displays for editing.
   • Click Cancel to remove any edits and return the document to its previous state.
   • Click Back to Inbox to stop editing the selected items and return to the List display area. Changes you saved are retained; the rest of the items remain unedited.
   • Click Skip to jump to the next item in the list without saving any changes.

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Declining Clinical Documents

Occasionally, you might receive a document in error or one that has an issue that only Medical Records or another provider can resolve. In such cases, you have the option of declining a clinical document. Clinical documents can be declined from the Inbox > eSig and Commure Pro Mail tab. Occasionally, you might receive a document in error or one that has an issue that only Medical Records or another provider can resolve. In such cases, you have the option of declining a clinical document. What happens to the document after you decline it depends on the type of document:

• Documents from Commure Pro NoteWriter that require your co-signature: When you decline to co-sign a document that was assigned to you, the document is removed from the eSig and Commure Pro Mail tab and it is sent back to the author (the mid-level provider). The document appears on that user’s eSig and Commure Pro Mail tab with a “Declined” status. You also have the option of including a message to the author when you decline the document. The author is alerted to the fact that their document was declined with a message at the top of the Physician Portal screen stating You have unfinished item(s): nNotes to Review where n is the number of documents that were declined.
• Orders from your source system, or orders from Commure Pro CPOE that require your co-signature: When you decline to sign or co-sign an order, it is removed from the eSig and Commure Pro Mail tab. In addition, depending on how your system is configured (based on the Interface declined orders to MEDITECH setting; see Defining eSignature) an e-mail may be sent automatically to Medical Records to alert them of the declined order, or the order may instead be sent directly back to your organization’s order deficiency system.
• Documents from your source system: When you decline to sign a document assigned to you, the document is removed from the eSig and Commure Pro Mail tab and an e-mail is sent automatically to Medical Records, alerting them to a declined clinical document. You also have the option of sending an e-mail to Medical Records or other users from the Send Commure Pro Mail tab.
  Declined documents remain in this state between 1 and 30 days as specified by your Administrator. However, these documents can re-appear as “Unsigned” documents in your list if no other action has been taken to change the declined status.

To decline signing a clinical document in eSignature:

1. In the List filter pane, select Orders or Notes (or one of the sub-lists under Notes). The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select a document using one of the following methods:
   • To decline one item, click on the document that you want to decline. The document opens in the Details window.
   • To select multiple items to decline, click the checkbox next to each document you want to decline or click the Select All checkbox column heading at the top of the list to select all items.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the decline action.
3. Click the Decline button. The Decline screen appears, allowing you to select a reason for declining from the drop-down list and to add any additional comments.
4. Select a reason for declining from the drop-down list, such as:
   • Not my patient
   • Re-dictated
   • Signature not required
5. (Optional) Enter any additional remarks in the Additional Comments text field. This field may or may not be available, depending on your system’s configuration.
6. You may be required to enter either your PIN or your password from your source system. If the field is visible, enter your source system PIN or password.
7. Click the OK button. The clinical document is removed from the List pane of the eSig and Commure Pro Mail tab, and:
   • If it was a NoteWriter document requiring your co-signature, it is sent back to the author.
   • If it was an order, either an e-mail is sent to Medical Records or the order is sent back to your organization’s order deficiency system.
8. If it was a document from your source system, an e-mail is automatically sent to Medical Records for further action. The e-mail and declined document appear on the Outbox tab.
   The Outbox tab contains all e-mails that you have sent to other users or departments (such as Medical Records) within your institution.

Show Settings that control this feature:

• Admin - Institution - eSignature - Allow Decline
• Admin - Institution - eSignature - Show Free Text Comment on Decline

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Reassigning Clinical Documents

The Reassign function is available only for documents that were created in Commure Pro NoteWriter, and that require a co-signature by a supervising provider. Occasionally, a mid-level provider might send a document to the wrong supervisor for a co-signature. If you receive a document for co-signature, but you feel that a different supervising provider should co-sign it, you can reassign it to that provider. When you reassign a document to a different provider, the document is removed from your eSig and Commure Pro Mail tab it is sent to the other provider’s eSig and Commure Pro Mail tab for their co-signature. Clinical documents can be reassigned from the Inbox > eSig and Commure Pro Mail tab. To reassign signing a clinical document in eSignature:

1. In the List filter pane, select the Co-Sign list under Notes. The deficiency items in the selected list are shown in the List display area.
2. In the List display area, select a document using one of the following methods:
   • To reassign one item, click on the document that you want to reassign. The document opens in the Details window.
   • To select multiple items to reassign, click the checkbox next to each document you want to reassign or click the Select All the checkbox column heading at the top of the list to select all items.
   If a document in the list is currently being edited by another user, a Lock icon appears at the beginning of the row and the item will be excluded from the reassign action.
3. Click the Reassign button. The Reassign Note screen appears, allowing you to select a provider from the search field.
4. Search for supervising provider by entering a few characters of their name, or by clicking the Search icon. You may only select providers that are allowed to co-sign documents of this type.
5. Click the OK button. The clinical document is removed from the List pane of the eSig and Commure Pro Mail tab, and is sent to the other provider for their co-signature.

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Entering Data in a Split Screen View using Pop-Out Mode

When editing or signing a note in NoteWriter Wizard, you may find it helpful to review a patient’s clinical data. The NoteWriter Wizard screen has a Pop-Out mode that allows you see both the patient’s clinical data and the note you are reviewing side-by-side on the same screen (or even extend the NoteWriter Wizard screen to an external monitor). To open NoteWriter Wizard in Pop-Out mode:

1. Open a note you want to edit (Editing Clinical Documents) or sign (Signing Clinical Documents).
2. In the top-right corner of the NoteWriter Wizard screen, click the Pop-Out button. NoteWriter Wizard and a Patient Detail window open side-by-side. You can resize and reposition these windows.
3. To return to the NoteWriter Wizard screen, click the Pop-In button

Show Settings that control this feature

• Admin - User - NoteWriter - Set Clinical Data Percent Width in Pop-Out Mode

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Viewing Sent Messages in the Outbox

The Outbox screen is available under the Inbox tab. This is where items are sent after you’ve taken an action, such as clinical documents you’ve signed or declined, and e-mails you’ve sent. The sections below describe the screen and how it works, and provide steps for viewing items.

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Understanding the Outbox Screen

Both the eSig and Commure Pro Mail tab and the Outbox sub-tabs under the Inbox main tab are divided into two panes: the List pane and the Details pane.

• The List Pane (left): This pane displays the list of all the e-mails and/or clinical documents you’ve reviewed and taken action against. By default, e-mails and clinical documents are listed by date with the most recent item appearing first.
  You can sort or filter the documents in the List pane.
  You can resize the Inbox’s List pane by clicking on the Minimize/Maximize button in the top right corner of the List pane. When you minimize the List pane, the Details pane expands to show the document or e-mail, and all the items in the List pane are hidden. To select a new document or e-mail, you must first click the Minimize/Maximize button again to maximize the List pane.
• The Details Pane (right): This pane displays the e-mail or clinical document that you selected from the List pane so that you can review its details. You can reply, forward, or delete the selected item.

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Viewing Items in the Outbox Screen

The List pane (the left pane) shows the following information near the top of the pane.

• Options button: Click this button to view the Options Display dialog. From the drop-down list, select the maximum number of documents that you want shown on your List pane.
• nn of nn: You can limit the number of eSignature documents currently displayed in your list via the Options button. This counter appears to the left of the Options button and indicates the number that corresponds to the document you currently have selected in relation to the number of documents or e-mails currently displayed on your list.
• Showing nn of nn: This counter appears above the Select All/Select None buttons only when the number of actual documents exceeds the Maximum Number of Documents to Show that you selected on the Options dialog. The numbers indicate the number of documents or e-mails currently displayed on your List pane in relation to the total number of documents and e-mails available.
• Refresh : Click this button to refresh the List pane with updated data if available.
• Delete all messages button: This button is available at the bottom of the list of the List Pane. Click this button to delete all of the messages in your Outbox.

The actual list of documents and/or e-mails is located just below the heading area of the list pane. Each document or e-mail is listed in its own row. The List pane displays the following columns of information for each e-mail or clinical document:

• Date: This column displays the date and time associated with the selected e-mail or clinical document. For orders, this is the date the order was placed, not the service date of the order.
• Patient Name: This column identifies the patient associated with this e-mail or clinical document.
  The Patient icon appears next to the patient name in the header of the Details window. Click on this icon to open the detail screen for the patient selected.
• Description and Document Status: The description varies, based on whether the item is an e-mail or a clinical document:
  • For e-mails, the description includes either to whom the e-mail was sent or from whom it was received, as well as the subject line of the e-mail.
  • For clinical documents, the description indicates the name of the document on the first line, and its status on the second line. Some documents, such as radiology reports, are associated with one or more orders or exams. In this case, the document description is the name of the first exam associated with the report, such as “ELBOW AP & LATERAL LEFT.” Furthermore, some documents might be addendum to previous reports. If a document is an addendum, the description is preceded by the word “ADDENDUM:” For example, an addendum to the previous report would be listed as: “ADDENDUM: ELBOW AP & LATERAL LEFT.” The second line of the description contains the status of the document.

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Sorting and Filtering Commure Pro Mail and Documents in the List Pane

You can change the sort order in which e-mails or clinical documents appear in the List pane:

• Click a column heading to sort the list based on that item. Click the heading a second time to toggle between ascending and descending order. For example, clicking the Date heading would sort the items in chronological order by date. Clicking the Date heading a second time would sort the list in reverse chronological order.

You can also filter the list to limit (or filter) the number of clinical documents shown in the List pane of the eSig and Commure Pro Mail and Outbox tabs:

1. Click the Options button (located in the upper right of the List pane).
2. Click the Maximum Number of Documents to Show drop-down list and select the maximum number of eSignature documents that you want displayed at one time on the Outbox tab.

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Viewing the Details of Outbox Items

The Details pane (the right pane) displays the e-mail or clinical document that you have selected in the List pane (the left pane). To view the details of an e-mail or clinical document:

1. Identify the e-mail or clinical document in the List (left) pane that you wish to review, and then click anywhere in that item’s row. The details of that item are displayed in the Details (right) pane.
2. Determine if you want to reply to, forward, or delete items in your outbox.
   • Click Print to print a copy of the e-mail.
   • Click Delete to delete the e-mail from your Inbox.
   • Click Reply to send a response back to the sender. The Send Commure Pro Mail dialog opens with the sender’s name already selected in the Recipients area, and the text of the original e-mail listed in the Message field. Select any additional recipients, if desired, and enter the text of your response in the Message field. Then click the Send button.
   • Click Reply to All to send an e-mail to the sender, as well as all other persons included on the original e-mail. The Send Commure Pro Mail dialog opens with the sender’s name and all other persons already selected in the Recipients area, and the text of the original e-mail listed in the Message field. Add or remove persons from the list of recipients, if desired, and enter the text of your response in the Message field. Then click the Send button.
   • Click Forward to send a copy of the e-mail to a new recipient. The Send Commure Pro Mail dialog opens with text of the original e-mail listed in the Message field. Select one or more recipients and enter any additional e-mail you want to include in the Message field. Then click the Send button.

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eSignature and Commure Pro Mail

The Commure Pro Mail application, combined with eSignature, enables you to send or receive e-mail messages to/from other users. Using Commure Pro Mail, you can send e-mails to another user or department within your institution from the Inbox tab (via the eSig and Commure Pro Mail, Outbox, or Send Commure Pro Mail sub-tabs). In the Commure Pro system, you can send the two types of e-mails listed below. These are reviewed in Using Commure Pro Mail to Communicate.

1. General E-mails: Click the Inbox tab and then the Send Commure Pro Mail sub-tab (highlights in orange when selected), to send general e-mails to other users within the Commure Pro system. These e-mails do not include links to patient data or clinical documents.
2. Patient-Specific E-mails: Click the Send Commure Pro Mail about Patient icon , located in the top right corner of the patient data display for any patient on the Patient List tab. This e-mail includes a link to the patient’s information via the Details icon. The recipient can click the Patient button to view the standard patient data display.

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Responding to Commure Pro Mail

E-mails that are sent to you from other users or departments within the Commure Pro system are visible on the eSig and Commure Pro Mail tab. They can include general e-mails, patient-specific e-mails, and document-specific e-mails. You can respond to any type of e-mail from the eSig and Commure Pro Mail tab. To respond to an e-mail:

1. In the List filter pane, select the Mail list. The items in the selected list are shown in the List display area.
2. In the List display area, click on the item you want to see. The e-mail opens in the Details window. The e-mail header field (located at the top of the Details window) indicates sender, date, and recipient(s).
3. Review the e-mail displayed in the Details pane and determine whether you want to print, delete, reply, reply to all, or forward the e-mail:
   • Click Print to print a copy of the e-mail.
   • Click Delete to delete the e-mail from your Inbox.
   • Click Reply to send a response back to the sender. The Send Commure Pro Mail dialog opens with the sender’s name already selected in the Recipients area, and the text of the original e-mail listed in the Message field. Select any additional recipients, if desired, and enter the text of your response in the Message field. Then click the Send button.
   • Click Reply to All to send an e-mail to the sender, as well as all other persons included on the original e-mail. The Send Commure Pro Mail dialog opens with the sender’s name and all other persons already selected in the Recipients area, and the text of the original e-mail listed in the Message field. Add or remove persons from the list of recipients, if desired, and enter the text of your response in the Message field. Then click the Send button.
   • Click Forward to send a copy of the e-mail to a new recipient. The Send Commure Pro Mail dialog opens with text of the original e-mail listed in the Message field. Select one or more recipients and enter any additional e-mail you want to include in the Message field. Then click the Send button.

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Tracking and Monitoring Electronically Signed Documents

There are several administrative functions available to HIM (Health Information Management) and administrators, which allow both tracking and monitoring of eSignature documents from the eSignature application.

• Tracking function that tracks the status of eSignature documents in real-time.
  • Summary tab that allows HIM to view queued, successful and failed signatures.
• Search functions that provide the ability to search for eSignature documents by the following search criteria: provider, patient, visit number, MRN, as well as a document’s type, description, start and/or end dates and Inbox status. HIM can perform two different types of search:
  • Inbox Search tab that allows users to search and review the location and status of documents within a specific provider’s Inbox.
  • Processed Search tab that allows user to search and review documents that already have been processed.
• Monitoring function that enables administrators to receive eSignature script and alerts in the following cases:
  • When the script stops running; or
  • When the script generates unknown failures—that do not make their way back to the user—as a way to capture an increased backlog of documents that have not been processed or re-processed successfully.
  Typically, these alerts go to Commure Pro Support, however, alerts also can be configured to go to your organization’s HIM or System Administrator.
  When using any of the above functions, a Level 1 Administrator can identify and re-process any document.

Each user’s access to the tracking and monitoring functions described above is controlled by the following settings in their user profile:

• Show Summary Tab
• Show Inbox Search Tab
• Show Processed Search Tab

Please refer to Defining User Access to eSignature for detailed information on each of these settings.

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Using the Summary Tab

The Summary tab enables you to review the status of signed documents interfacing from Commure Pro to your system of record. The Summary tab screen shows a number of options for tracking and monitoring the process of:

• Last Ran On: indicates the last time a signed document was sent to the system of record.
• Oldest in Queue: indicates the date and time of the oldest document that needs to be processed.
• Queued link: indicates the number of signed documents waiting to interface with the system of record. Click either the Queued link or its corresponding number to view all the documents with this status.
• Summary Date Range: filters the interface activity by date range.
• Processed successfully: indicates the number of documents that have been successfully signed in the system of record. Click either the Processed Successfully link or its corresponding number to view all the documents with this status.
• Failures sent back to Inbox: indicates the number of failed documents that have been sent back to the provider’s Commure Pro Inbox for re-signature. Click either the Failures sent back to Inbox link or its corresponding number to view all documents with this status.
  Whether or not a failure is sent back to a provider’s Inbox is based upon a configuration. Certain types of failures, such as “incorrect PIN” or “a more recent version of this document is available” may require re-signature by the provider. These documents appear with a status of Re-sign and require re-signing.
• Failures not sent back to Inbox: indicates the number of failed documents that have not been sent to the provider’s Inbox. Click the Failures not sent back to Inbox link or its corresponding number to view all documents with this status.
  Whether or not a failure is sent back to a provider’s Inbox for re-signature is based upon a configuration. Certain types of failures, such as “system not available” may require re-processing by an administrator rather than by a provider.
• Failures no longer requiring signature: indicates the number of documents that have failed, but that no longer require a signature in Commure Pro. For example, if a document is signed in Commure Pro eSignature, and is then also signed manually in the system of record before the Commure Pro signature is processed, it is returned in the Failures no longer requiring signature category. Since the document no longer requires a signature in the system of record, it does not need to be re-signed in Commure Pro.
• Results Display drop-down: select the number of results from this drop-down list, which you want displayed in the Results Display pane.
• Reprocess button: the Reprocess button is available to only Level 1 users. To re-process failed documents that appear in the Results Display pane, select the document(s) in question, and then click the Reprocess button. Please note that documents that are currently queued for processing cannot be reprocessed.
• Hide Criteria button: click this button to expand the Results Display pane to gain more screen real estate and thus view more results.
  Documents with a status of “Failed” appear as “Re-sign” in the provider’s Inbox.

To track the status of all eSignature documents:

1. In the Summary Options section, click on the link that corresponds to the documents you want to view. For example, if you want to see all the Inbox documents that are queued for signature, click Queued. For all documents that have been processed successfully, click the Processed successfully link, and so on through the Summary Options that are listed. All documents associated with a specific status that correspond to that link appear in the Results display pane.
2. To expand the Results Display pane so as to view more documents on the Summary screen, click the Hide Criteria button.
3. You can also select or deselect all the documents in the list by clicking the either the Select All or Select None buttons.
4. (Optional) Click the Reprocess button to re-queue the selected document(s) to be signed in the system of record. Please note that documents that are currently queued for processing cannot be re-processed. This step is available to Level 1 users only.

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Using the Inbox Search Tab

You can track and monitor eSignature documents that are located in the Inbox of various providers. To search for eSignature documents located in the Inbox:

1. Click the Inbox Search tab. The eSig Inbox Search screen appears.
2. In the criteria section of the search screen, you can enter the following search criteria:
   • Department: choose a department from the available drop-down list. Returns all eSignature documents associated with all providers in that department.
   • Provider: the name of the provider if known. Returns all eSignature documents associated with that provider.
   You must choose either a Department (of providers) or an individual Provider as your minimum search criteria. If you attempt to generate a search without any specified search criteria, you will receive a “minimum search criteria not met” message.
   • Patient Last/First Name: Enter a specific patient’s last and/or first name to search for all documents related to that patient.
   • Visit Number: If known, enter the visit number of a patient.
   • MRN: Enter a Medical Record Number to find all eSignature documents associated with this MRN.
   • Document Date Range: Enter the start/end dates of all Inbox documents that you want to view.
   • Document Type: Select an item from this drop-down list. You can filter your search by orders, reports, attestations, scanned documents, and so on.
   • Inbox Status: Select a status item from this drop-down filter to return documents with the status of either signed, unsigned, declined, edited, or re-sign.
   If you do not select a specific document status, then all documents in the Inbox will display, regardless of their status.
3. Click the Display Results drop-down, and then choose the number of results that you want displayed in the Results pane.
4. Click Search to return all the documents in the Inbox as defined by the search criteria used.
5. (Optional) Select one or more documents and click the Reprocess button to re-queue the document(s) to be signed in the system of record. This button is available to Level 1 users only. Click Clear Criteria to remove your currently selected search criteria. You can also click Hide Criteria to hide the criteria section.

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Using the Processed Search Tab

You can also track and monitor eSignature documents that have already been processed by either a provider (such as those documents that have been edited or signed) or the eSignature interface. Use the Processed Search tab to locate these documents. To search for processed eSignature documents:

1. Click the Processed Search tab. The eSig Processed Search screen appears.
2. Enter the search criteria that you want to define for your search. The search criteria at the top of the screen (above the horizontal line) is the same for both the Inbox Search and Processed Search tabs. Please refer to Using the Inbox Search Tab for descriptions of those criteria fields. The Processed Info section of the search screen has these additional search criteria:
   • Processed Date Range: Enter the start/end dates of when the documents were processed.
   • Signed Status drop-down filter: Choose a status item to return processed documents with that specific status.
   • Document Description: A text field that allows you to enter key words, such as “History and Physical,” to specify which type of eSignature document you want to locate.
   You must define one of the minimum search criteria combinations listed below. If you do not, a message appears instructing you to choose one of the required minimum search criteria combinations.
   • Department or Provider and Processed Date Range
   • Department or Provider and Document Date Range
   • Department or Provider and Signed Status
   • Department or Provider and Patient Name/Account Number/MRN
   • Patient or MRN and Document Type (Scanned, Medical Records, Orders, etc.), Processed Date Range.
3. Click Search to return all the documents as defined by the search criteria used.
4. (Optional) Select one or more documents, and then click the Reprocess button to re-queue the document(s) to be signed in the system of record. Please note that documents that are currently queued for processing cannot be re-batched. This function is available to Level 1 users only.
5. Click Clear Criteria to remove your currently selected search criteria. You can also click Hide Criteria to hide the criteria section.

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Viewing Search Results

You can monitor the status of documents for all types of alerts from all three tabs (Summary, Inbox Search and Processed Search tabs). To view the status of documents, click one of the links in the Summary Options area of the Summary tab, or run a search from the Inbox Search or Processed Search tabs. Documents are returned in the Search Results pane. Each search result can contain the following information:

• Status: Indicates the status of the error condition. In this example, the document failed and was sent back.
• Document Date: The date associated with the document.
• Processed Date: The date the document was signed and processed by the interface.
• Provider: The name of the provider required to sign the document.
• Patient: The name of patient associated with the document.
• MRN: The medical record number for this patient.
• Visit Number: The patient’s visit number.
• Category: Identifies the type of document, such as a scanned document, medical records report, order, or attestation.
• Document Name link: Describes the document as it is displayed in the Inbox. Click this link to view the document itself.
• Document ID: The internal document identifier.
• Inbox Status: The status of the document as it appears in the provider’s Inbox, which can be unsigned, signed, failed, declined, and so on.
• Details link: The identifier that Commure Pro generates when queuing the document for signature. Click this link to view the details for the selected document.
• Signature Status: Shows the status of a document in the Commure Pro database:
  • Unsigned - Still in the provider’s Inbox.
  • Pending - Signed by the provider, but not yet queued to the interface.
  • Submitted - Queued to be sent to the system of record.
  • Success - Successfully processed.
  • Failed - Unsuccessfully processed.
  • Failed Retry - Queued to be reprocessed after a failed attempt.
  • Fatal Error - Unsuccessfully processed for an unknown reason.
• System Details link: Explains why the document failed. Click this link to display the complete application error log for the processed file.