Configuring eSignature

• Level 1 Administrator has institution-wide privileges with access across all departments and users and is responsible for the information technology systems within a health care facility. Level 1 administrators configure the institutional settings of the eSignature application. Level 1 administrators can enable the eSignature application for an institution’s facilities, departments and users; specify which users can receive and send e-mails from within the eSignature application; and define whether or not a user PIN is cached in the system.
• Level 2 Administrator has department-wide access. This administrator can configure eSignature access, how frequently a user is alerted to critically overdue unsigned documents, and whether or not to validate PINs each time a document is signed.

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Basic Steps for Configuring eSignature

1. Establish institution-wide settings for eSignature such as (Level 1):
   • Whether or not a user’s password or PIN is cached, and for how long it is cached.
   • Whether or not a user should enter passwords or PINs when signing documents.
   • Whether or not a user must review an entire document before signing it.
   • Whether or not a user can select and sign all orders only, or all clinical documents of any type.
   • The number of days before unsigned reports are considered critically overdue.
   • The duration in which a clinical document remains in the “Declined” status.
2. Define each user’s access and preferences for eSignature and Commure Pro Mail. (Level 1 & 2), such as:
   • What the user access will be.
   • Whether or not the pin is validated within the source system.
   • Whether or not all providers are required to re-sign a document that a user has edited.
   • Whether or not an individual user can sign either orders only, or all eSignature documents of any type at once.
   • Whether or not a user has access to eSignature’s tracking and monitoring functions.

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Defining eSignature

1. Click the Admin tab, and then the Institution tab.
2. Select eSignature from the Edit Settings drop-down list. Define the following settings: Enable Sign All/Multi-SignThis setting determines whether or not a provider can select and sign multiple documents/orders or all documents/orders at once. Options let you apply this to either orders only, or all types of clinical documents, including documents with Unsigned, Edited, and Re-Sign status.

• Yes (default): Allows the provider to select either all items in a list by means of the Select All checkbox, or any combination of multiple documents (both orders and other document types), and then click the Sign button to sign all of them at once (or another available action).
• Orders Only: Allows the provider to select all orders only by clicking the Select All checkbox when viewing Orders, and click the Sign button to sign all the selected orders. The Orders Only setting is available if your system of record is MEDITECH Magic.
• No: The provider cannot sign all documents with one click.

• Yes (default): The provider enters their PIN or password only once per session after which the PIN or password is cached for the remainder of that session (unless it is timed out per the Minutes before saved PIN is timed out setting below).
• No: Indicates that the PIN or password is not cached. The provider must re-enter a PIN or password each time they sign a clinical document. Minutes before saved PIN is timed out Enter the number of minutes of inactivity (between 0 and 99) that is allowed before the saved PIN or password is timed out, thereby requiring that the user re-enter it to sign additional documents.

• Yes (default): forces the user to scroll through a scanned document and review every signature block before they are able to sign it.

• No: allows the user to sign a scanned document without scrolling through each signature block.

• 0 to 99: Indicates the allowed range in days before the date of the unsigned report turns red. Enter the number of days in this text box. The user is alerted to all documents that are critically overdue, which need to be signed. If you indicate a value of zero (0), users will not receive any alerts.

• PIN: The user should be required to enter their PIN from their source system in order to sign documents in eSignature.
• Password: The user should be required to enter their password from their source system in order to sign documents in eSignature.
• None: The user is not required to enter a PIN or Password in order to sign documents. The user only has to click the Sign button.

• Declined orders trigger the generation of Inbox e-mails that are sent to medical records users to inform them of the decline action.
• Declined orders trigger a Decline window so that clinicians can enter a reason for declining the order, and also enter any additional comments (if enabled via Show Free Text Comment on Decline).

• Inbox e-mails are no longer sent to medical records users when clinicians decline orders. Instead, declined orders are directed to the eSig scripter, to be declined in MEDITECH.
• Declined orders continue to trigger a Decline window so that clinicians can enter a reason for declining the document, and also enter any additional comments (if enabled via Show Free Text Comment on Decline). This Decline window displays the same reasons for declining the document that are available when orders are declined in the Commure Pro CPOE application.
• Input from this window is directed to the eSig scripter along with its associated (declined) order.

3. Click the Save button to save all your eSignature Institution settings.

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Defining User Access to eSignature

1. Click the Admin tab, and then the User tab.
2. Select a user and then click on Edit button in the Quick Details box. The user’s General Settings are displayed.
3. Select User Permissions from the Edit Settings drop-down list and configure the following settings: Medical Records UserUser permission that specifies which users within the Medical Records department can receive the e-mails generated from eSignature. For example, if a document is declined, an e-mail can be sent to all users designated as Medical Records recipients. - o Yes: The user can receive e-mails that have Medical Records as the designated recipient.
   • No: The user cannot receive e-mails that have Medical Records as the designated recipient. Can Send Commure Pro Mail ToUser permission that specifies to whom this user can send e-mails related to eSignature documents. - o None: The user cannot send e-mails to anyone. The Send Commure Pro Mail sub-tab is disabled.
   • Medical Records Only: The user can send e-mails to only the medical records department. The Medical Records User permissions setting must be set to Yes for at least one other user.
   • Within the User’s Department: The user can send e-mails to the medical records department, as well as to any users within the same department to which the user belongs.
   • Within the User’s Facilities: The user can send e-mails to the medical records department, as well as to any users that work within the same facilities as the user.
   • All Users: The user can send e-mails to any user.
4. Click the Save button to save any changes to the user’s permissions.
5. Select eSignature from the Edit Settings drop-down list and configure the following settings: eSignature AccessDetermine the appropriate viewing, signing, and editing privileges for this user. Your choices include: - o None: No eSignature documents are available in this user’s Inbox and no eSig sub-tab appears.
   • Sign Only: The user can only sign, but not edit all the clinical documents available in their inbox.
   • Edit and Sign (default): The user can edit and electronically sign all the clinical documents available in their Inbox.

• No: Click this radio button to disable validation of the password or PIN. Require all providers to re-sign document after user’s editsIndicates whether or not all providers must re-sign a document in which an edit or addendum has been made after this provider has already signed. Choose one of the following options: - o Yes: Click this radio button to force all providers to re-sign a previously signed, but subsequently amended document.
• No (default): This radio button indicates that providers will not be required to re-sign a changed document. Enable Sign All/Multi-SignThis user preference controls whether or not a provider can sign multiple documents/orders (either all orders only or all types of documents) at once. Note that the Institution-level setting Enable Sign All/Multi-Sign determines whether or not this user preference becomes available. - o Yes (default): Allows the provider to sign multiple items from the List display area. When enabled, a checkbox is available next to each item in the list and a checkbox is available in the header to select all items in the list. If the Institution-level setting Enable Sign All/Multi-Sign is set to Orders Only, then only orders are signed during a Sign All/Multi-Sign action.

• No: The provider cannot sign all items in a list with one click.

6. The following settings are related to the tracking and monitoring functions in eSignature. These are typically enabled for HIM users and administrators. For more detailed information on these functions, see Tracking and Monitoring Electronically Signed Documents. Show Summary tabEnables the user to view a summary of eSignature document activity by date range. - o Yes: Shows the Summary tab.
   • No: Hides the Summary tab. Show Inbox Search tabEnables the user to perform Inbox searches and review the location and status of documents that are currently in a specific provider’s Inbox. - o Yes: Shows the Inbox Search tab.
   • No: Hides the Inbox Search tab. Show Processed Search tabEnables the user to search and review documents that have been processed in the system. - o Yes: Shows the Processed Search tab.
   • No: Hides the Processed Search tab. Inbox Navigation Access LinksThis setting is for a future release and should not be configured.
7. Click Save to save your changes to the user’s eSignature settings. For signing privileges with Meditech (the following setting is in Administration > Institution > Site Administration):

• If set to No, Commure Pro preferences are respected (default value).
  • If set to Yes, the system checks the facility preferences as follows:
• R for Reports – eSignature for documents (scanned/transcribed/“notes” in eSignature) and write sign note in NoteWriter. Controls signing of any document not classified as an order in the Inbox (such as scanned/transcribed, “notes” grouping) and signing of notes in the NoteWriter module.
• O for Orders – eSignature is permitted for the orders “grouping”. Controls any order incoming to the Inbox, but not writing orders in the CPOE module, which is controlled by a different CPOE privilege.
• B for Both – eSignature (Orders) and write note (NoteWriter)/eSignature (Notes – eSignature is permitted for the orders “grouping”, scanned/transcribed documents, and Notes. NoteWriter permits signing of notes.) Allows orders, documents, and notes to be signed in Inbox and notes to be signed in the NoteWriter module.