Configuring NoteWriter

In general, NoteWriter configuration occurs within a hierarchy, in which the highest level is institution, the next level is department, and the lowest level is user. Some configurations can occur at multiple levels, with a higher-level administrator configuring basic settings and delegating any further configuration of these settings to a department administrator. In the case of some settings, users can make additional changes, configuring NoteWriter to suit their own personal preferences. For example, a Level 1 (institution) administrator might start by configuring basic (default) settings for all users within the institution, including all department administrators and health care providers. This administrator could then enable all Level 2 (department) administrators to edit the NoteWriter settings of all users belonging to their own departments. In this scenario, some configuration is left to the discretion of Level 2 administrators, who can determine how best to configure NoteWriter for the users belonging to their department. Some of these department-level settings can be further modified by individual users. At a high level, the process for configuring the NoteWriter system involves the following steps, which are grouped according to access level:

1. Work with Commure Pro implementation team to determine what note templates are needed and have them enabled to your institution.
2. Determine institution-level settings. (Level 1 users only)
   • Configure NoteWriter settings for all users, including other institution administrators (Level 1 users), department administrators (Level 2 users), and health care providers (Level 3 users).
   • Review any default note templates that have been provided and plan how you will assign these to each of your departments. More information about assigning these templates is provided in the steps that follow.
   • If you plan to use NoteWriter with Commure Pro’s Desktop Charge Capture application, review your organization’s Desktop Charge Capture settings to ensure that they are configured properly for NoteWriter. For more information, see Configuring Charge Capture Settings for Your Institution.
3. Define your departments. (Level 1 and 2 administrators)
   • Assign one or more note templates to each department that will record its notes using the NoteWriter application. How you assign these templates depends on how each department plans to use its template(s). In some institutions, many departments might share a single template, while in other institutions, different departments might require their own custom templates for a particular work flow.
   • Set up Note Pickers for each department. By defining Note Pickers, you are specifying the list of available note templates that users belonging to each department can select. This step includes associating each template with a note type and a visit type.
4. Establish each user’s NoteWriter permissions (Level 1 and 2 administrators), and assign each user to one or more departments.

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Configuring Institutional Settings

There are several institution-level configuration settings that affect how the NoteWriter application works in conjunction with the Commure Pro Physician Portal or Desktop Charge Capture application. System administrators can perform the following activities, based on their user level:

• Level 1 Administrators have access across all departments and users. These administrators can define access policies that regulate each user’s ability to access and modify data in NoteWriter. They can also define the templates used by each department within their organization.
• Level 2 Administrators can manage one or more departments and administer the users that belong to these departments.

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NoteWriter Institution Settings

All NoteWriter configuration settings that are defined at the institution level are global, taking effect as system-wide defaults. Only Level 1 administrators have access to configure these settings, which affect users at all levels, including institution-level administrators, department administrators, and providers. Although these settings are global across an organization, some settings can also be set at the department or user level. To access the institution-level NoteWriter settings:

1. Click the Admin tab and then the Institution tab.
2. Select NoteWriter from the Edit Settings drop-down list. The NoteWriter Settings are displayed.

The settings provided on this page can include: Note Templates Level 1 administrators can access the list of available templates from this setting if their NoteWriter user configuration allows them access to the setting. For more information, see NoteWriter User Settings. The action button Template Editor opens the NoteWriter Template Editor, which allows you to configure the display of notes. For more information, click the Help icon (question mark) in the NoteWriter Template Editor to access Help for that functionality. From the list of available templates, administrators can select a template to modify some of its settings. Clicking Edit displays the Note Template Maintenance screen, which lists all available note templates. From this list, you can select an existing template and edit it in any of the following ways:

• Activate the template or make it inactive
• Modify some template properties, such as note type and template name
• Determine whether the template should prompt users to print a note each time that they sign it

For more information, see Configuring NoteWriter Templates for Your Institution. Enable Notes by Facility Authorized administrators can use this setting to restrict note access to one or more facilities within an institution. When note access is restricted to selected facilities, clinicians can only create and edit notes for patient visits that take place within these selected facilities. When working with patient visits from other facilities, clinicians are unable to access notes from either the Actions drop-down menu or from the Clinical Notes link on the Patient List. For more information, see Restricting Note Entry to One or More Facilities. Allow Edits to Note Date on Template Selection Page Determines whether clinicians have the flexibility to choose a date other than the current date when creating a note. When this preference is set to No, the date and time fields display as read-only fields on the Select Note Template window, enforcing clinicians to use the current date and time whenever they create notes. Note Auto Save Frequency This setting lets authorized (level 0 and 1) administrators define a frequency (in minutes) for automatically saving draft notes. Auto-save functionality applies to notes that are in progress only. A note is considered in progress between the time that it is opened and the time that it is either signed or saved in draft form. When you save a note as draft and continue making edits, the auto-save feature continues to save your note at the configured interval. The minimum value allowed for this setting is 1 (the default) and the maximum is 30. Auto-save frequency settings always apply globally to all users; these settings cannot be overridden at the user or department level. For more information about how auto-save works in conjunction with manual save operations, see Auto-Saved Notes. Validation Method This setting specifies the type of authentication used to validate users when they sign a note. The available validation options are:

• PIN: Specify this value if you plan to validate providers using a MEDITECH ® back end when they sign a note.
• Password: Specify this value if you plan to validate providers using a Commure Pro password when they sign a note.
• None: Specify this value if you do not plan to validate providers when they sign a note. Enable Saved PIN or Password This setting determines if a user’s PIN or password is cached.
  • 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 or Password is timed out Enter the cache threshold (between 0 and 99 minutes) after which the saved PIN or password is no longer saved. When this limit is exceeded, the clinician must re-enter credentials to sign and submit additional notes.

Clinical Notes and Test Results Layout This setting determines the orientation of the Summary and Detail panes for the Clinical Notes and Test Results display options.

• Side-by-Side (the default): The Summary and Detail panes are displayed side be side, with the Text Selection pane below the Summary pane.
• Top-Down: The Summary and Detail panes are displayed vertically, with the Summary pane at the top, and the Detail pane below. The Text Selected for Note pane is to the right of the Summary pane. Default Dashboard for Pop-Out Mode Determines which Dashboard is opened by default when NoteWriter goes into Pop-Out mode. If the Dashboard configured for this setting is deleted, the setting is set to blank, and not automatically set to any other Dashboard. If the user does not have view permission for the Dashboard configured here, or if the setting is blank, the default Dashboard selected in Pop-Out mode is instead the first Dashboard on the patient’s list of Patient Dashboards.

Allow Trended Values Determines whether to enable or disable support for displaying data trends among lab and vitals data. When this preference is enabled, clinicians can add multiple instances of lab components or vitals signs to their note, and then view tables in their note to see how this data trends over time. When this preference is enabled, a column of check boxes is added to the left of both lab results and vital signs when viewed in the portal, so that clinicians can select specific results to copy a progress note. This functionality supports the selection of multiple instances of a single lab component, providing clinicians with the option to view data trends from a single lab component or a specific vital sign reading. Text Area Font Determines the font size of all text displayed within free-text fields. You can choose to display all text with an arial (11pt) or courier (9pt or bold 9pt) font style. Enable Commure Pro Spellcheck Determines whether to enable or disable the spell checking feature. When this preference is enabled (for templates configured to support this feature at the field level), a spell-checking dictionary is automatically run as providers enter content into free-text fields of any standard template. This dictionary is specifically designed to recognize and correct medical terminology. When words are detected that are spelled incorrectly, the user interface identifies these words by underlining the words using a red line. By highlighting any mis-spelled words that have been identified and right-clicking their mouse, clinicians can utilize the spell checker for recommended alternatives. The spell checker lets providers choose from the following options:

• Ignore the correction
• Use a term from the list of suggested alternatives to substitute for one instance or all instances of the mis-spelled term This feature is typically available to all fields into which providers enter text into a note template, including both text fields and Quick Text entry fields. If for some reason this feature has been disabled for one or more of your templates, contact your Commure Pro representative.

Addendum Timeframe in Days Specifies the duration (in days) that clinicians have to enter a note addendum after signing and submitting notes. Clinicians can use note addenda to amend content of notes after the notes are submitted. Use of note addenda requires templates that support this functionality. For more information, contact your Commure Pro representative. The range is 0-999. Select Specialty when creating a note Enables the display of specialties in note template headers. When this setting is enabled for a particular user, the user can assign a particular specialty during note creation. Using specialties to categorize notes can help clinicians to organize and locate notes using subject matter in addition to simply note template type. For more information about assigning specialties during note creation, see Assigning a Specialty to Your Note. Administrators can create a list of available specialties using the Specialty reference list. Administrators can then configure the general user preference Specialties to assign one or more of these specialties to a specific user. Require Specialty Selection Use of this setting determines whether to require clinicians to select a specialty from the available list of specialties that displays in note template headers. This assignment list only displays when you enable specialty assignment using the user preference Select specialty when creating a note. Specialty Display with Note Type Use of this setting determines whether the Specialty displays Before or After the Note Type in the clinical notes module. Select from the drop-down field. Default is After Note Type. Allow Alphabetic Sort in Quick Text Determines whether clinicians can sort their Quick Text entries in the Add Quick Text window. When you enable this preference, a Sort icon displays in the header above the list of Quick Text that lets clinicians apply an alphabetic sort order to their list of entries. Allow Notes to be Cancelled Determines whether to allow clinicians within your institution to cancel notes that they have signed and submitted. Canceled notes are retained on the clinical notes list, but are identified as canceled using strike-through markup. Though this setting enables this functionality institution-wide, you can configure the user preferences Restrict Cancel to Providers and Restrict Cancel to Department to limit which clinicians can access this feature. Allow Cancel “n” Days Past Note Date Specifies the window period in days within which authorized clinicians can cancel their notes. When configured in conjunction with the setting Allow Notes to be Cancelled, this setting defines the duration within which clinicians can cancel notes after they sign and submit them. You can configure this preference to specify any number of days in the range of 1 - 30. Require Reason to Cancel Note Determines whether clinicians are required to provide a reason whenever they cancel a note. When you enable your institution to allow for note cancellation and (optionally) limit this functionality to specific clinicians through the user preferences Restrict Cancel to Providers and Restrict Cancel to Department, these clinicians are prompted to specify a cancellation reason in free text. This reason then displays above the note content of those that display on the Clinical Notes list. Set Findings/Impression Labels Allows you to set beginning and ending terms the system looks for as Start and Stop labels in a report for text to add to a note. For each label, enter a comma-delimited list of search term labels for Findings and for Impressions, and click OK when done. For more information, see Including Text from a Clinical Note or Test Result. Enable Co-Signature Determines whether to enable clinician co-signature within your institution or facility. Enabling the co-signature feature is part of a large process that involves defining co-signature rules for one or more clinicians or departments that apply to one or more specific templates. For more information, see Configuring Templates to Require Clinician Co-Signature. Co-signature Attestation Message Specifies a custom message (4000 character limit) to inform clinicians who are delegated with co-signature responsibilities. When clinicians sign and submit a note needing co-signature from an authorized co-signer (either department or provider), the note is sent to the delegated co-signer’s Inbox and this custom message displays to the clinician(s) to inform them of their co-signature assignment. To edit, enter a message and click OK. For more information, see Configuring Templates to Require Clinician Co-Signature. Allow Note Creator to Edit a Note in Signed Status In the co-signature workflow, this setting authorizes clinicians requiring co-signature to make further edits to notes that they have signed. For more information about configuring co-signature, see Enabling and Configuring Co-Signature for Your Institution. Allow co-signing physician to edit resident shared drafts Allows the attending physician to edit the shared draft note of a resident. (Default is No) For more information about allowing this, see Shared Draft Notes. Allow shared drafts for residents/mid-levels to be viewed by all users Controls whether resident shared draft notes are visible to all users. (Default is No) For more information about allowing this, see Shared Draft Notes. Allow Users to Reassign Notes in Inbox In the co-signature workflow, this setting authorizes clinicians to re-assign notes for which they are designated co-signer. For more information about configuring co-signature, see Enabling and Configuring Co-Signature for Your Institution. Show Free Text Comment on Decline When clinicians at your institution are granted permission to decline signing documents (per the eSignature institution setting Allow Decline), this preference configures whether to display or hide a Comments box enabling them to add a free-text description to provide an elaboration when they decline co-signature on a note. For more information about the eSignature setting, see Allow Decline. Auto-delete Draft Notes When set to Yes, allows drafts greater than a certain number of days old (based on create date) for automatic deletion, and activates the following preference for selection. Number of Days after Create Date to Delete Draft Notes When Auto-delete Draft Notes is set to Yes, this activates and allows you to slide to select the number of days before automatic deletion. Allowed values are 0-90, and the default value is 90. NWTE Server URL This field displays the location of the NoteWriter Template Editor URL. Check number of days for nearby visits Does a check for visits within close proximity to the current visit. Allows you to select a range of days from 0-5, with zero as the default. If zero is selected, no check is done. In most cases, the range will likely be set to one or two days. If the day of the “close by” visit is within the selected range, an alert displays to notify the provider when writing a note on either visit. Once the date is set to a value greater than 0, an alert type preference is available at the user level. When this setting is enabled, the User preference Close Visit Alert Type can be configured to define a user’s alert type.

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Configuring NoteWriter Templates for Your Institution

Because health care providers create and maintain many different types of documentation, NoteWriter is a template-driven application. Its flexibility enables organizations to document many types of patient data using templates that can be customized to accommodate a variety of clinical situations and visit types. To enable organizations to start using NoteWriter immediately, some note templates are provided that enable health care providers to create and maintain a number of different notes such as:

• Progress note template - this template uses the SOAP (Subjective, Objective, Assessment, and Plan) format to address common scenarios that providers in an organization are likely to encounter while documenting patient visits.
• History and Physical template
• Operative Note template
• Chart Notation template
• Consult Note template
• Attending Addendum These templates can be customized to create notes for a particular work flow. See your Commure Pro representative to customize any of the Note templates for your particular work flow.

Configuring a template can include any combination of the following tasks:

• Activating an existing note template
• Adding a new note template
• Changing the note title, note type, template name, or template version
• Enabling or disabling the print prompt that displays when users sign a note or save the note in draft form

To Configure a Note Template:

1. From the NoteWriter Settings screen, click the Edit link associated with the Note Templates setting. For more information about accessing the NoteWriter Settings screen, see NoteWriter Institution Settings

The Note Template Maintenance screen displays a list of all available note templates.

2. Click on the name of the template that you want to configure. The Add/Edit Note Template screen displays.
   • (Optional) You can activate a template by clicking on the Make Active button and then clicking the OK button from the pop-up Question window. Once you activate a template, the Active check box setting is enabled. A template must be activated before providers can select it from their Note Pickers.

To de-activate a template, un-check the Active box and then click Save.

• To create an updated version of a template, click the Create New Version button. This option copies all of the settings from the original template except the Version, which is a value you define for the new version. When you create a new version of a template, the original Template Link ID is retained so that existing notes using the template are preserved and previously created notes are unaffected by note template updates. Creating a new template version is particularly useful when fields have been added or removed in a template and you do not want to disrupt notes using an earlier version of the template. The new template version is inactive by default. If you want the new version to become the active template, open the new version, click the Make Active button, and then click Yes to make it active and deactivate the previous version.
• To create a copy of a template click the Copy button. This option uses the current template as a starting point and lets you customize the Template Name and External ID. When you copy a template, the new template has its own, unique Template Link ID so that the template is not associated with the template it was copied from.
  • (Optional) You can assign and change note types by selecting the type you want from the NoteType drop-down menu.

• (Optional) You can edit the following note and template data:
  • Note name: Edit the note name in the Note Title field and click the Save button.
  • Template name: Edit the template name in the Template Name field and click the Save button.
  • Version: Edit the template version in the Version field and click the Save button.
• (Optional) You can configure how printing operates in relation to the activity of signing a note. To display a print dialog when the provider signs a note, select the Automatically Prompt for Local Printing check box setting that displays in the upper-right portion of the Add/Edit Note Template screen. Conversely, de-select this setting to disable prompting of the print option upon signing of notes.

In the upper-right of the display are additional options: Active Templates can be loaded into Commure Pro at any time by Commure Pro representatives or via the NoteWriter Template Editor process. After loading a new template into your Commure Pro environment, select the “Make Active” button to activate the template for use in picklists by providers. The Active flag is set on the top right of screen, and the date and time that it was made active is displayed. You can uncheck the “Active” checkbox at any time if a note is no longer needed for use. Automatically Prompt for Local Printing If needed, you can configure a note to prompt to print when it is signed as final. This allows certain providers to opt to print and save in a paper chart, or fax to a local physician if needed. This is configured by an administrative user at the template level, and by default is disabled. When this is activated, after signing a note as final, the provider gets the Print Preview display, and can opt to print to a local printer. Interfaced Templates may be configured to be printed or interfaced, although in most cases they are interfaced. Check this flag after configuration of Note routing to ensure that your notes are sent to the appropriate EMR. Please contact your Commure Pro representative for assistance in this process. Populate Diagnoses to Discharge Summary The discharge summary has an admitting and discharge diagnoses section by default on the Commure Pro standard template layout. On templates such as the History and Physical or the Progress Note, you can set those templates to add their problems on the Assessment and Plan tabs to the admitting and discharge diagnoses section of the Discharge Summary template. This speeds writing of the Discharge Summary for physicians and allows them to get a comprehensive list of admitting and discharge diagnoses without manually reviewing each note. You may wish to enable this for the History and Physical templates, but disable it for the Consult note templates. It is configurable, to ensure that the write template types propagate problems to the Discharge Summary type templates. Add AI Modifier from Charge validation If you are using templates that have the Charge Validation pop-up enabled on the Billing or Attestation tab, when you select the button, a list of valid Charges based on your documentation displays. For History and Physical type templates, the charge typically also needs a Charge Modifier of type “AI” to indicate that the physician adding the charge is the principal physician of record. You may configure this by template (History and Physical, but not Consult note) to ensure that the modifier also gets added automatically, as well as the charge code. Allow Template on Phone This controls whether a template is allowed to be displayed on the iPhone and Android devices (it displays on the iPad and Android tablet regardless). Setting this to checked enables physicians to write notes of that type on the phone, even if the template might not be fully responsive to a small screen. After you finish configuration of your note template by clicking Save, you are returned to the Note Template Maintenance screen.

3. Click Close to return to the NoteWriter Settings screen.
4. Click Save. Your template configuration changes are saved.

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Configuring Note Templates to Prompt for Printing Upon Completion

When providers in your institution sign and submit a note, they might want to print this note at a specific location within your facility or institution. As shown below, you can individually configure NoteWriter templates to automatically prompt providers with a print dialog once they click the Sign/Submit button. In addition to the local printer, this print dialog can include additional printers as determined by configuration of any NoteWriter Route Actions that have been defined from within the CPOE application. A NoteWriter Route Action is an activity that is performed for a specific note template meeting a specific set of criteria. To configure a template so that providers are prompted to print after signing and submitting a note:

1. Click the Admin tab and then the Institution tab.
2. Select NoteWriter from the Edit Settings drop-down list. The NoteWriter Settings are displayed.
3. Locate the Note Templates setting and click the associated Edit link.
4. From the Note Template Maintenance screen, click the name of the template you want to configure.
5. From the Add/Edit Note Template screen, locate and enable the setting Automatically Prompt for Local Printing.
6. Click Save.
7. Click Close from the Note Template Maintenance screen. The selected template is configured to prompt providers with a print dialog box upon clicking Sign / Submit to complete a note. In addition to the local printer, the printer options that are included in this dialog box are determined by additional NoteWriter Route Actions that you have defined.

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Restricting Note Entry to One or More Facilities

For sites with multiple facilities, the NoteWriter application supports the restriction of note entry to one or more of these specific Facilities. This functionality lets administrators enable the use of NoteWriter more selectively, such as during an incremental deployment of NoteWriter across several different facilities within a single institution. When you restrict NoteWriter usage to one or more specific facilities, clinicians can only add notes for patient visits taking place within one of these facilities. When clinicians select patient visits in facilities for which note entry is disabled, they are prevented from accessing notes, both from the Clinical Notes link (where the plus sign (‘+’) is removed) and also from the Actions drop-down menu (where the ‘Write Note’ option is removed). To restrict note entry to one or more Facilities within your institution:

1. Click the Admin tab and then the Institution link.
2. From the Edit Settings drop-down menu, select the NoteWriter option.
3. Locate the Enable Notes by Facility setting and click the associated Edit link.
   Before configuring one or more facilities for note entry, it is important to note that you cannot make changes to this configuration once facility-specific data has been read from your back-end system or added from the CPOE application.
4. Select only the facility (or facilities) to which you are restricting note entry.
5. Click Save. Note entry is restricted to the selected facility or facilities. Clinicians can only access note templates when they select patient visits that take place in these facilities.

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Configuring Notes to be Routed to Additional Printers

In addition to configuring NoteWriter to prompt users to print completed notes at the local printer, you can configure your system to route notes to additional printers within your facility or institution. These additional printers are configured by defining Route Actions in the CPOE application that specify a Route Type of NoteWriter. Defining Route Actions in NoteWriter is very similar to defining Route Actions in CPOE, except for a few configuration preferences that are required when you select the NoteWriter Route Type:

• NoteWriter Templates: Provides a list of the available NoteWriter templates that you can assign when you define a NoteWriter Route Action. Note that you can enable the All Templates option to apply your selected Route Action to all templates shown, or use Control + click to select multiple templates from the list.
• NoteWriter Status: Provides more granularity about the status of notes that can be routed to a specified Destination using NoteWriter Route Actions. Administrators can configure this setting to restrict the status of notes that can be printed at a selected Destination to one or more (using ctrl+click) of the following statuses:
  • Signed: Only notes that are signed but awaiting co-signature (and not yet finalized) can be printed at the selected Destination.
  • Final: Only notes that are signed, submitted, and considered finalized can be printed at the selected Destination. (This is the standard default behavior.)
  • All: Notes in any status (once saved as drafts) can be printed at the selected Destination.
• Layouts: Provides a list of the available Layout IDs that are associated with NoteWriter templates. Note that, for a layout ID to be available from this list, the layout must be available to every note template that is included in the list of templates available to the NoteWriter Templates setting (described above). For more information about defining and configuring Route Actions, see Configuring Order Routing,

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NoteWriter Reference Lists

In NoteWriter, reference lists are used solely for the purpose of specifying the note types that you want to create. The NoteWriter application uses note types in two ways:

• Note types are used in the assignment of Note Pickers, both at the department and user level
• Note types are assigned during the creation of templates. Assigning note types enables you to categorize them according to their function.

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Adding New Note Types

Level 1 administrators can add new note types by modifying the Note Type reference list. However, administrator should only add note types if their back-end system does not create them. If the back-end system (for example MEDITECH) does create note types, the Commure Pro system pulls in and creates the note type in the Reference List. To access this reference list, click on the Admin tab, then the System Management tab, and then select the Note Type list from the Reference List Maintenance screen. From the Note Type screen on the right-hand side of the screen, click on the New Entry button and enter the name of the note type you want to add into the new table row. You can also enter the following reference list data into this table:

• System identifier
• Context
• Sort order
• Alias For more information about reference lists, see Managing Reference Lists & System Settings.

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Monitoring NoteWriter Activity

Monitoring of the NoteWriter application has been integrated with all existing mechanisms for monitoring Commure Pro data. There are two basic types of NoteWriter activity that you can monitor from the Commure Pro Physician Portal:

• User activity: Using audit reports, you can monitor the activity of providers as they launch note instances, access different Commure Pro modules, and sign notes. An event log summarizes this activity, recording the date and time of each type of event. For more information, see Monitoring NoteWriter User Activity.
• HL-7 activity: Data is provided on the Submission Status tab to enable you to monitor information about all note instances that have been submitted to your back-end system. For more information, see Monitoring NoteWriter HL-7 Activity.
• Problem and Assessment and Plan activity: Using the Problem Detail Report, administrators can generate a report of Problems and associated Assessment and Plan information added to the A/P tab in a note. For more information, see Monitoring Problem and Assessment and Plan Entries.

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Monitoring NoteWriter User Activity

Administrators can use audit reports to monitor a user’s activity in the NoteWriter interface. This activity is identified using several event types, which are primarily used by the Physician Portal to describe how users navigate between the modules belonging to the portal. In the case of NoteWriter, a few other event types have been added to provide additional information about what providers are doing in relation to note activity. These events are:

• Web - InitializePKNote
• Web - NoteInstanceEdit
• Web - Note Signed on: [date] [time] - [note name]
• Web - Deleted Draft Note: [note name] The audit reporting interface enables you to filter this data over a specified range of dates, for one or more users. You can also filter by patient name, to further reduce the scope of the event activity included in the report. By default, these reports display to the screen. You can also export this data to a file for printing or archiving.

Audit reports are included on the Administrative Options screen. To access this screen, click on the Admin tab, then the System Management tab, and then click the Audit Report link in the list of options. For more information about audit reports, see Audit Report.

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Monitoring NoteWriter HL-7 Activity

You can monitor how communication takes place between the NoteWriter application and the back-end server. Data that is exchanged between NoteWriter and the back-end system includes statistical data to report on the status of message submissions and back-end processing operations. In addition to communication-related data, the Commure Pro monitoring tools also provide some additional detail about the notes exchanged over the HL-7 interface, such as information about the note author and patient associated with each note. Monitoring of all HL-7 activity is performed on the Submission Status tab. To access this tab, click the Admin tab, followed by the Tracking/Reporting tab. By configuring a few filters on the Search Criteria screen, you can filter the monitoring data so that only NoteWriter activity is included in the statistics reports. When monitoring NoteWriter activity, it is important to remember that the Note Submission record type can refer to both the original note submission, but also any note addenda that clinicians use to append data to their note at a later time. Note addenda are sent using their own distinct note submissions and use identifiers to reference their associated notes. This approach prevents the need for clinicians to re-open notes that were previously submitted and signed. The following statistics enable you to track all data exchanged over the HL-7 interface, between the NoteWriter application and the back-end server:

• The total number of notes submitted
• The total number of invalid note submissions
• The total number of note submission failures
• The total number of valid notes, prior to and after back-end processing
• The total number of notes queued for back-end processing
• The total number of back-end processing failures and successes
• The average back-end and server processing times
• The maximum back-end and server processing times For more information about submission criteria and results, see Submission Status Reports.

To monitor all NoteWriter-specific activity:

1. From the Submission Status tab, click the Select Patient button and choose a patient if you plan to restrict monitoring data to a specific patient.
2. From the Application drop-down menu, select NoteWriter.
3. From the Submission Record Type drop-down menu, select Note Submissions.
4. Enter one or more of the following search criteria:
   • Select Patient
   • Time frame
   • Start Date
   • Status
   • End Date
   • User
   • Submission Id
   • Department
   • Location
   • Correction Status
   • Server Processing Time (ms)
   • Back-end Processing Time (ms)
   • Maximum # of Results
   • Include Ignored Records
5. Click the Show Detailed Results button to view the status of all notes that were submitted over the HL-7 interface. The Search Results screen displays the following information:
   • Submitted column: The date and time when the note was submitted over the HL-7 interface.

• Device column: (Not applicable to NoteWriter.)
• Type column: The type of note submitted.
• Status column: The status of the note submission. The status of a submission can include: Completed, Submission Parsing Failure, or Submission Record Parsing Failure.
• Patient column: The name of the patient associated with the note.
• User column: The name of the user associated with the note.
• Correction Status column: The current status of the correction.
• Correction Reason column: The current reason for the correction.
• Failure Reason column: Provides information about the failure.

6. Click the Back to Criteria button to return to the Submission Status screen.

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Purging NoteWriter Logs

The NoteWriter logs maintain all note submission data over a configurable duration, as specified by the NoteSubmission Purge Type entry. You can configure this setting to specify the number of days that you want the system to retain these logs. You can configure purge criteria from the Administrative Options screen. To access this screen, click on the Admin tab, then the System Management tab, and then click the Purge Criteria link in the list of options. From the Device Session and Submission Record Purge Criteria screen, select the NoteSubmission purge type and click the Edit button on the right-hand side of the screen. For more information about purge criteria, see Purge Criteria.

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Monitoring Problem and Assessment and Plan Entries

Administrators can generate a report of the Diagnoses and their associated Assessment and Plan information that has been added on the A/P tab of a note. This Problem Detail Report is available via Admin > System Management > Problem Detail Report. For more information about this report, see Problem Detail Report.

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Configuring Charge Capture Settings for Your Institution

If you plan to integrate Charge Capture into your NoteWriter process, you must configure the Desktop Charge Capture application for your institution. For more information on the Institution-level Charge Capture settings, see Charge Capture Settings. In addition, in order for providers to enter charges in conjunction with entering notes, you must implement a note template that includes an Add Charge section. The Add Charge section gives the provider access to the Charge Transaction screen, where they can enter their charges. Contact your Commure Pro representative to discuss using or creating a note template that has an Add Charge section. You can also implement the optional E & M Charge Validation feature to help facilitate the entry of E & M charge codes for either:

• Subsequent hospital care (CPT codes 99231, 99232, and 99233). When E&M validation is done for subsequent care, data in the Progress Note is evaluated to determine whether the data qualifies for any of three charge codes specified above. The provider can then quickly select an appropriate subsequent hospital care charge code. Once providers make a selection, the Charge Transaction screen displays with the selected E & M charge code already populated. For information on how charge codes are validated for subsequent hospital care, see How Evaluation & Management Charge Validation Works in the Progress Note Template.
• Initial hospital care (CPT codes 99221, 99222, and 99223). When E&M validation is done for initial care, data in the History & Physical is evaluated to determine whether the data qualifies for entry of any of three charge codes specified above. The provider can select an appropriate initial hospital care charge code. Once providers make a selection, the Charge Transaction screen displays with the selected E & M charge code already populated. For information on how charge codes are validated for initial hospital care, see How Evaluation & Management (E & M) Charge Validation Works in the History & Physical Template.

In order to use the E & M Charge Validation feature, you must use the standard Progress Note (for subsequent hospital care) and History & Physical (for initial hospital care) templates included with the NoteWriter product. The E & M Charge Validation feature cannot be used with any other note templates, nor with any other charge codes. For more information, consult your Commure Pro representative. Whether you use a template that has an Add Charge section only, or a specific Progress Note template that also has the E & M Charge Validation feature, you must configure the template and make it active as described in Configuring NoteWriter Templates for Your Institution. See also Entering and Validating Charges for instructions on how a provider would actually enter charges from the NoteWriter application.

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How Evaluation & Management Charge Validation Works in the Progress Note Template

The Evaluation & Management (E & M) Charge Validation feature reviews the information that the provider has documented in the Progress Note, and compares it to the requirements for each of the three levels charge codes for subsequent hospital care. Specific fields in the Progress Note are checked to see if the provider completed them, and to what extent. The table below illustrates the three main components that are evaluated: HPI (History of Present Illness), Exam, and Decision Making. The criteria in two of these three components must be met in order for a specific level of E & M code to be considered valid. For example, in order for 99232 to be valid, the criteria in the 99232 column must be met for the HPI and Exam components, or for the HPI and Decision Making components, or for the Exam and Decision Making components. Below are three sample scenarios where 99232 is considered a valid code.

• Scenario #1 where 99232 is considered valid:
  • HPI criteria is met:
    • HPI Review: 2 elements checked
    • PFSH: checked or unchecked
    • ROS: 1 system
  • Exam criteria is met: 2 body areas
  • Decision Making criteria is not met.
• Scenario #2 where 99232 is considered valid:
  • HPI criteria is not met.
  • Exam criteria is met: 2 body areas
  • Decision Making criteria is met: Moderate
• Scenario #3 where 99232 is considered valid:
  • HPI criteria is met:
    • HPI Review: 2 elements checked
    • PFSH: checked or unchecked
    • ROS: 1 system
  • Exam criteria is not met.
  • Decision Making criteria is met: Moderate All though the Time Spent field is shown to the provider in the Charge Code Validation window, it is displayed for informational purposes only and is not evaluated when validating the charge code.

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How Evaluation & Management (E & M) Charge Validation Works in the History & Physical Template

The Evaluation & Management (E & M) Charge Validation feature reviews all current data that a clinician has entered into the H&P template and compares this data against the requirements for each of the three levels charge codes for initial hospital care. As part of the validation process, individual fields in the H&P template are evaluated for completeness and to assess the overall scope of services provided to the patient. The table below illustrates the three main components that are evaluated: HPI (History of Present Illness), Exam, and Decision Making. The criteria in two of these three components must be met in order for a specific level of E & M code to be considered valid. For example, in order for 99221 to be valid, the criteria in the 99221 column must be met for the HPI and Exam components, or for the HPI and Decision Making components, or for the Exam and Decision Making components. Below are three sample scenarios where 99221 is considered a valid code.

• Scenario #1 where 99221 is considered valid:
  • HPI criteria is met:
    • HPI Review: 4 or more elements are selected.
    • PFSH: 1 of 3 areas is selected.
    • ROS: Coverage for a minimum of 2 (and a maximum of 9) systems is complete.
  • Exam criteria is met: Coverage of 5-7 body areas or organ systems is complete.
  • Decision Making criteria is met.
• Scenario #2 where 99221 is considered valid:
  • HPI criteria is not met.
  • Exam criteria is met: Coverage of 5-7 body areas or organ systems is complete.
  • Decision Making criteria is met: Straightforward / low level of decision making is involved.
• Scenario #3 where 99221 is considered valid:
  • HPI criteria is met:
    • HPI Review: 4 or more elements are selected.
    • PFSH: 1 of 3 areas is selected.
    • ROS: Coverage for a minimum of 2 (and a maximum of 9) systems is complete.
  • Exam criteria is not met.
  • Decision Making criteria is met: Straightforward / low level of decision making is involved. All though the Time Spent field is included in the Charge Code Validation window, it displays for informational purposes only and is not evaluated when validating the charge code.

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Configuring Which Notes are Available to Users

Several system administration settings determine whether to include future scheduled visits among the visits made available to users when they first attempt to create a note for a patient. These settings are configured by Commure Pro Visit Type settings under System Management. Settings that control this feature: Admin - System Management - Commure Pro Visit Types - Visit Type - (Charge Capture, NoteWriter): Activate Date Admin - System Management - Commure Pro Visit Types - Visit Type - (Charge Capture, NoteWriter): Activate Days Admin - System Management - Commure Pro Visit Types - Visit Type - (Charge Capture, NoteWriter): Deactivate Date Admin - System Management - Commure Pro Visit Types - Visit Type - (Charge Capture, NoteWriter): Deactivate Days

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Configuring How Visits are Selected During Note Creation

When writing a note, available note types are configured by visit type. Administrators configure Commure Pro Visit types for department and user templates to determine how visit assignments are made when users create a new note. Basic visit type determination is done using the Commure Pro Visit Type setting. Within this setting is the option Current Visit: Auto-select visit (Add Charge, Add Note), so administrators can have the visit currently selected in the Patient List be auto-selected (either the ‘Always’ or ‘Only with Relationship’ setting) or disable auto-selection of visits (with the setting ‘Never’). Note that when users have only a single visit, the visit automatically displays in the Select a Visit field on the Select Note Template window, regardless of how this setting is configured. When a physician writes a note, only note types associated with the selected visit are displayed. If a visit type has not been configured for that visit, a warning error message displays. If the selected visit is changed before completion, the list of available note types changes to reflect the new visit type. You can filter by visit types in a user’s profile via the Note Pickers preferences. Settings that control this feature: Admin > System Management > Commure Pro Visit Types Admin > User > Note Pickers

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Configuring Department Settings

Configuration of NoteWriter at the department level involves:

• Organizing templates via Note Picker: You organize your templates for distribution to the various departments within your organization by means of Note Picker. You can configure Note Pickers so that only the relevant note templates are made available to users in each department.
• Creating Quick Text entries for your departments: You can create Quick Text entries in groups, which you can assign by department, so that only the relevant Quick Text selections are made available to users in each of your departments.

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NoteWriter Department Settings

You can configure both Note Pickers and Quick Text using settings on the Department tab in the Physician Portal interface. This guide assumes you are familiar with basic functionality of the Department tab, such as adding, editing, or deleting departments (detailed in Configuring Department Settings). To Edit Note Pickers or Quick Text for a specific department:

1. Select the Admin tab, followed by the Department tab. The Department tab consists of a toolbar, a Quick Details area for editing, and a workspace with context-sensitive forms that change as you select different departments.
2. Select a department by clicking on its name in the Choose Department form.
3. Click the Edit button in the Quick Details box to edit the department settings.
4. From the Edit Settings drop-down menu, select NoteWriter to view the NoteWriter-specific settings. The configuration settings screen displays with a list of all available settings. From the NoteWriter Settings screen, you can edit the following settings.

Note Pickers You can define Note Pickers for each of your departments. Note Pickers define the list that each department provides to its users to enable them to select a note template. For more information, see Defining Note Pickers for Your Departments. Include Department Notes in Insert Previous Determines whether to include or exclude a department’s notes among the list of notes available to clinicians when carrying forward data from their department’s notes using the Insert Previous feature. When this preference is set to:

• Yes: The notes of all users from the selected department are available to clinicians when carrying forward data from their department’s notes ([from note template] > Insert Previous link > Data to Insert from Previous Notes window > My Department’s Notes option).
• No: (Default) The notes of all users from the selected department are not available to clinicians when carrying forward data from their department’s notes on the Data to Insert from Previous Notes window.

Quick Text (Summary View) You can define Quick Text entries globally in all note templates for each of your departments. Providers can then use these entries to substitute for phrases and terms that they are likely to use frequently as they enter data into notes. For more information, see Using Quick Text (Summary View). Quick Text (Template View) You can define Quick Text entries in each note template for your departments. Providers can then use these entries to substitute for phrases and terms that they are likely to use frequently as they enter data into notes. For more information, see Using Quick Text (Template View).

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Defining Note Pickers for Your Departments

Pickers are categorized lists that enable users to make selections in the user interface. The NoteWriter application uses Note Pickers to define the template selection menus for each of your departments. Before you can edit department Note Picker settings, your Level 1 administrator must grant you permission to edit settings for each of your departments. To determine whether you have been granted access, click on the Admin tab and check to ensure that the Administrative Options screen includes a Department tab among the tabs displayed. If this tab is not included among the tabs that you can view, contact your institution-level administrator. To Define a Note Picker for Your Department:

1. Click the Admin tab, followed by the Department tab. The list of your available departments displays.
2. Select the department for which you want to create a note picker, and click the Edit button.
3. On the Department Settings screen, select NoteWriter from the Edit Settings drop-down menu.
4. Click the Edit button associated with the Note Pickers setting. The Department Note Pickers screen displays for the specified department.
5. On the right-hand side of the screen, click the Edit button associated with the category to which you want to add the Pickers. In this example, we will add two templates to a top-level Department Pickers category. The Edit Department Pickers screen displays.
6. Click the Search button to the right of the Add Note Template field. The list of available templates displays. Click on the name of the note template that you want to add to the picker list. Repeat this step for each template that you want to add. Alternatively, you can create one or more categories to organize your templates by function. You are likely to use categories once your list of available templates grows enough to require organization.
7. Click Save, and then Close. The templates are added to the Department Pickers category. When users belonging to this department click the Add Note icon to create a note, they are prompted to select from the Pickers you defined for their department. In the case of our example a provider launching a note would see the two templates in their departmental Note Picker as we defined it above.

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Creating Note Picker Categories for a Department

If each department has a large number of templates, you can create note picker categories to organize how Note Pickers display for the users in each of your departments. By logically grouping notes by type or function, you can enable users in your departments to easily locate and select the correct template, especially as your template list grows over time. Categories added to a Pickers list exist at the same directory level as the templates that are contained in its parent directory. If you create both templates and categories in a department’s top-level Pickers directory, your users see a list containing note templates that appear as “uncategorized”, along with a list of template categories. You create note picker categories as part of the process of defining Note Pickers. To create a Note Picker category:

1. From the Department Note Pickers screen, click the Edit button associated with the category to which you want to add this new category.
2. From the Edit Department Pickers screen, click the Add Category button. The Add Category dialog box prompts you to enter the category name.
3. Enter the category name and click OK. The category name is added to the Pickers list, and exists at the same directory level as any Pickers that have been created in this category.
4. Click Save. You are returned to the Department Note Pickers screen, where you can see the new category displayed under its parent directory.
5. To add templates to this new category, click the Edit button associated with the new category you just created. The process for adding templates to a new category is the same as it is for the default (top-level) category.

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Changing the Order of the Items within a Note Picker Category

You can change the order in which the subcategories and note templates are listed with a Note Picker list. To change the order of a Note Picker list:

1. Open the Note Pickers window for the department or user you want to edit.
   • Click Admin > Department > [Department Name] > NoteWriter and then click the Edit button associated with the Note Pickers setting.
   • Click Admin > User > [User Name] > NoteWriter and then click the Edit button associated with the Note Pickers setting.
   • Click Preferences > NoteWriter and then click the Edit button associated with the Note Pickers preference.
2. From the Note Pickers for [Department Name/User Name] dialog, locate the category whose items you want to re-order, and click the Edit link next to its name.
3. At the top of the list, click on the Sort icon to the right of the word Children.

The Reorder dialog opens.

4. Select the item you want to move and use the Top, Up, Down, and Bottom buttons to place the category where you want it in the list.
5. When they are in the order you prefer, click OK to save the order and dismiss the dialog.
6. Click Save and then click Close to close the Note Pickers window.

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Moving a Note Picker Category

You can move categories to different locations within the Note Picker structure, as follows:

• When modifying department-level Note Pickers, you can move a departmental category to a new location under a different departmental category.
• When modifying user-level Note Pickers, you can move a personal category a new location under a different personal category, but you cannot move it to a location under a departmental category. You cannot move a departmental subcategory. To move a category to a new location in the Note Picker structure:

1. Open the Note Pickers window for the department or user you want to edit.
   • Click Admin > Department > [Department Name] > NoteWriter and then click the Edit button associated with the Note Pickers setting.
   • Click Admin > User > [User Name] > NoteWriter and then click the Edit button associated with the Note Pickers setting.
   • Click Preferences > NoteWriter and then click the Edit button associated with the Note Pickers preference. The Note Pickers window displays.
2. From the Note Pickers for [Department Name/User Name] dialog, locate the category whose items you want to move, and click the Edit link next to its name.
3. Click the Move button at the bottom of the screen. The Move Item dialog appears.
4. Select the destination category to which you want to move it, and then click OK. The original category is now relocated to a subordinate position under the destination category.
5. Click Save and then click Close to close the Note Pickers window.

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Hiding Departmental Items or Categories in a User’s Note Picker

When editing User-level Note Pickers, you have the option to hide or unhide items or categories that are not useful to a specific user.

1. Open the Note Pickers window for the user you want to edit using one these methods:
   • Click Preferences > NoteWriter and then click the Edit button associated with the Note Pickers preference.
   • Click Admin > User > [User name] > NoteWriter and then click the Edit button associated with the Note Pickers preference. The Note Pickers window displays.
2. Follow the steps below to hide a specific note template or an entire category.
   • To hide a specific note template in the Note Pickers list:
   1. Click on a note template name to open a pop-up window listing just that one item.
   2. Select the Hidden checkbox to enable it. To show a hidden template, deselect the Hidden checkbox.- c. Click Save to return to the Note Pickers window.
   • To hide an entire category, or several items within a category, follow these steps:
   1. Click the Edit link located to the right of a category name. The system opens a window displaying that category, as well as all the subcategories and individual items within the category.- b. Select the Hidden checkbox near the top-right corner of the window to hide the entire category, or select the checkbox next to the items you want to hide. To show a hidden template, deselect the Hidden checkbox.- c. Click Save to return to the Note Pickers window.
3. When all of the changes are complete, click Close to close the Note Pickers window.

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Configuring Charge Capture Settings for a Department

If you plan to integrate Charge Capture into your NoteWriter process, you must configure the Desktop Charge Capture application for each of your departments. In addition, in order for providers to enter charges in conjunction with entering notes, you must implement one or more of these templates:

• A note template that includes an Add Charge section
• A standard Progress Note template enabling the Add Charge tab and (optional) E & M Charge Validation feature.
• A standard H&P template enabling the Add Charge tab and (optional) E & M Charge Validation feature. See Configuring Charge Capture Settings for Your Institution for more complete information about the templates above.

Whether you use one or both of the templates above, you must configure the template and make it active as described in Configuring NoteWriter Templates for Your Institution. Once you have done so, you must then add the template to the Note Pickers for the departments where you want to use it. See Defining Note Pickers for Your Departments for instructions.

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Configuring User Settings

On the User tab you can establish settings for individual NoteWriter users. Administrators with Level 1 access can change settings for all users in their organization. Administrators with Level 2 access can change settings and passwords for users in their department(s), but only if their Level 2: Can Edit Users in Assigned Departments setting is set to Yes (one of the User Permissions settings on the User tab). Note that users may be able to edit the settings below for themselves via either the User tab (Level 1 and 2 users) or the Preferences tab (all users). However, depending on their access level, they may not have access to all of these settings.

• Level 1 users can view and edit all of the settings below for themselves.
• Level 2 users can view and edit most of the settings below for themselves, with the exception of settings that affect their security access, or the amount of data they can view.
• Level 3 users can view and edit only those settings that are considered preferences, such as their Note Pickers. They cannot edit any settings that affect security access, or the amount of data they can view. The User tab consists of a toolbar, a Quick Details area for editing, and a workspace with context-sensitive forms that change based on the user information that you are editing. This guide assumes you are familiar with basic functionality of the User tab, as it relates to adding new users, editing, or deleting users (detailed in Configuring Individual User Settings).

There are a variety of settings that affect the amount and type of functionality that is granted to a user of the Commure Pro system. Nearly all of the settings that impact the NoteWriter application are found in the NoteWriter Settings option. However, some of the General settings, User Permissions, Problem List, and Patient List settings also affect NoteWriter users.

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NoteWriter User Settings

A user’s NoteWriter settings determine the level of access the user has to adding notes, copying data from other modules, and specifying the interval at which data is copied into a note. In addition, these settings determine how a user’s Note Pickers should work in relation to the Note Picker settings affecting the user’s department. Note Pickers If you should need to configure supplemental note templates at the individual user level, you can use the Note Pickers settings. Generally, note templates are configured at a department level and not a user level. User Note Pickers are configured exactly like Department Note Pickers except at the User level. For more information, see Defining Note Pickers for Your Departments. Quick Text (Summary View) You can configure supplemental Quick Text Pickers globally across all templates at the individual user level, which are added to the user’s list of department-level Quick Text entries. Providers can then use these entries to quickly enter phrases and terms that they are likely to use frequently as they enter data into notes. For more information on configuring Quick Text for a user, see Using Quick Text (Summary View). Quick Text (Template View) You can configure supplemental Quick Text Pickers in each note template at the individual user level, which are added to the user’s list of department-level Quick Text entries. Providers can then use these entries to quickly enter phrases and terms that they are likely to use frequently as they enter data into notes. For more information on configuring Quick Text for a user, see Using Quick Text (Template View). Can Add Notes on the Web This setting enables or disables the user’s ability to add notes from the Physician Portal. When this setting is disabled, the Add Note icon is removed from the Physician Portal interface, preventing users from accessing the NoteWriter module. Default = No. EMR eSign Privileges (Meditech) This setting is only displayed when the following Institution-level setting is enabled: Respect EMR eSign Privileges (Meditech). When enabled for a site, this setting displays the user’s the facility list and privilege value if pulling note signing privileges from the EMR. Scribe User When set to Yes, determines whether the user is designated as a scribe. Default = No For more information on scribe usage, see Scribe. Can Add Notes on the Handheld This setting enables or disables the user’s ability to add notes from the Mobile NoteWriter application (available on Apple® and Android devices). When this setting is disabled, the Add icon is removed from the Clinical Notes Summary screen, preventing users from accessing the NoteWriter module from the mobile device. Default = No. Allow Data Selection on the Portal/Handheld This setting determines whether the user has permission to copy data from other Commure Pro modules into a note. When this setting is enabled, the user can access one or more of these modules from within the NoteWriter interface. The modules that can be accessed from the NoteWriter interface are determined by template configuration, but can include any of the following:

• Allergies
• Clinical Notes
• CPOE Orders (web application only)
• Lab Results
• Medications
• Orders
• Test Results
• Vital Signs Granting access to the user enables them to copy data from any of these modules into a note, provided the note template references these modules. Note that this user preference also enables the Mobile NoteWriter application. Default = No.

Clinical Data Insertion Timeframe This setting specifies the duration (hours) that pre-selected clinical data remains available to add to a note. You can configure this setting so that all pre-selected data expires after a specified time limit. Setting an expiration time ensures that clinical data remains relevant when providers pre-select this data from one or more modules in the Physician Portal to include in a note at a later time. You can configure this setting to specify any number between 1 and 72 hours. The default setting is 24 hours. A setting of 24 enables providers to pre-select clinical data up to one full day before adding it to a note. Once this limit is reached, the data is no longer available to insert into a note. Max Trended Labs for Insertion This setting determines the amount of lab information to include for insertion into a note, with a range of 1-10. This pulls the data from the number of columns from the Panel Table of a Labs report, from left to right. For example, entering a 6 for this value pulls data from the first six columns of the table. The default value is 10. Max Trended Vitals for Insertion This setting determines the amount of vitals information to include for insertion into a note, with a range of 1-10. This pulls the data from the number of columns from the Vital Signs table of a Vitals report, from left to right. For example, entering a 6 for this value pulls data from the first six columns of the report. The default value is 10. User Can Search for Notes This setting determines the search scope of all searches that the user conducts from the Note Search tab. This setting can also be used to disable a user’s search activity entirely, by removing the Note Search tab from the user’s Physician Portal interface. A user’s search scope can specify:

• None: The Note Search tab is removed, preventing the user from conducting any note searches. Default.
• Within User’s Departments: The user can search for notes within any of the departments to which he/she belongs.
• Within User’s Facilities: The user can search for notes associated with visits in any of the facilities associated with the departments to which the user belongs.
• All: The user can search for notes without any restrictions. Allow User to Delete Other User’s Draft Notes Determines whether a user can see and delete draft notes created by other users. When set to Yes, Level 0-2 users are able to see and delete draft notes created by other users. If set to No (Default), users can only see and delete their own notes that are not in draft status.

Use Templated Addendum Choose this option to associate a specific addendum to a template. You can link a specific addendum to a template to ensure that mid-level clinicians use the correct addendum for their note(s), When mid-level clinicians subject to this restriction click the Add Addendum button, they are no longer prompted to select an addendum template, but instead are restricted to the addendum that has been linked to the template type in use. For more information, see Configuring Addenda to Require Clinician Co-Signature. Default = No Always Display Note Entry in Pop-Out Mode When this option is set to Yes, it automatically opens NoteWriter in Pop-Out mode when creating a note. Saving the note or saving as a draft causes the display to return to full view (100%). This preference does not affect the view in NoteWriter Wizard via Inbox. Set Clinical Data Percent Width in Pop-Out Mode Select an option to set the Pop-Out mode clinical view width to 50 (default), 60, or 70 percent of the available screen. This preference affects the view in both NoteWriter and NoteWriter Wizard via Inbox. Can Edit Note Templates Determines whether a user is granted permission to configure note templates. This setting is only available for users that are Level 1 and Level 0 administrators. When this option is set to No (Default), the configuration setting Note Templates is removed from the Institution Settings screen that provides all of the NoteWriter configuration options for institution-level administrators. Can Delete Templates from NWTE (Only available to Level 0 users) Determines whether a user can delete templates from NoteWriter Template Editor. When this option is set to No, the NoteWriter Template Editor does not display the Delete option to the logged-in user. Can Publish Templates from NWTE (Only available to Level 0 users) Determines whether a user can configure note templates in NoteWriter Template Editor. When this option is set to No, the NoteWriter Template Editor does not display the Publish option to the logged-in user. Prompt to Keep auto-saved Changes Determines whether a prompt offers providers the choice to keep changes that have been auto-saved when they edit a note. When this setting is enabled, the user is prompted each time that they open a note to select from either the most recent auto-saved version of the note, or resort to the last manually-saved version of the note. When this setting is disabled, users are not prompted to make a selection; the most recent auto-saved version of the note is automatically used. Default = No Remove confirmation pop-up on Save/Save as Draft Determines whether confirmation dialogs are displayed to the provider when they sign or co-sign a note, or save it as a draft, after the provider has entered their PIN/password in a cached session. This setting applies to all options where a note can be signed/co-signed/saved as draft, such as on the Patient List, Patient Search, and Inbox tabs. Default = No

• When this setting is disabled, the confirmation dialogs below are shown to the user every time they sign/co-sign/save as draft.
  • When signing or co-signing notes: “Once the note is signed, it cannot be edited. Click OK to save it or select Cancel to return to your note.”
  • Saving a note as a draft: “Save orders/notes as draft and finish later?”
• When this setting is enabled, the confirmation dialogs above are not shown to the user when they sign/co-sign/save as draft. Cancelling a note will always display a confirmation dialog (“Exit NoteWriter without saving your note?”), regardless of how this setting is configured.

Allow user to share draft notes Specifies whether a user can share draft notes. Default = No. See Shared Draft Notes. Include entire Clinical Note or Test Result when checkbox selected Specifies whether the provider can add the entire text of the note into their new note, due to the clinical relevance. Default = No.

• When set to Yes, the Select All option is disabled.
• When a user selects more than 5 Clinical Notes or 5 Test Results, an informational message displays:
  A maximum of 5 complete Clinical Notes or Test Results can be included in a note when the checkbox is used. Insert Previous Max Number Notes Specifies the number of previous notes a user can access when employing the “Insert Previous” feature. In addition to the user’s own notes (both draft and signed), this number includes the notes of other users within this user’s department, provided they have been signed. Default = 7

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of Days Beyond Visit End to Allow Add/Edit Note

Specifies the number of days that a provider can write or edit notes for a patient visit after the visit is deactivated. This user-level preference works in conjunction with the Institution-level setting (Charge Capture, NoteWriter): Deactivate Days. When the Deactivate Days timeframe is reached, a visit is no longer available for notes. This user-level preference allows Administrators to extend the timeframe that a visit is available for notes in case a provider did not complete their documentation before a visit was deactivated. The default value for this preference is 999. If your organization determines a different default value is more appropriate, you can use Bulk User Edit option to change the default for all providers (available on the Admin tab). For more information on configuring the Bulk User Edit option, see Editing User Settings in Bulk. Let’s look at an example where a provider needs to write a note for a patient who was discharged on January 28. If the Deactivate Days setting is 1, then a provider could create a note for the visit until January 29. If the provider needs to write a note or complete a draft note for that patent visit on January 30, their timeframe for creating a note for that visit could be extended by 1 day using this preference. In this example, if the visit was discharged on January 28, and the Deactivate Days setting is 1, but the provider’s preference # Days Beyond… is 1, then they can create a note for the visit until January 30. Typically, it is recommended that you configure this setting to equal the value specified by the (comparable) Charge Capture user preference ‘# of Days Beyond the Visit End to Allow Editing a Charge’. Configuring these two settings to use matching values ensures that clinicians always have access to enter and submit charges whenever they sign and submit a note. Restrict Addendum to Providers Clicking the Edit link associated with this preference lets you selectively grant authority to one or more specific users to enter addenda for notes that they already signed and submitted. An institution preference (Addendum Timeframe in Days) lets you configure the number of days that clinicians have to add an addendum to a note after submitting the note. Restrict Addendum to Department Clicking the Edit link associated with this preference lets you selectively grant authority for creating note addenda on a department-wide basis. An institution preference (Addendum Timeframe in Days) lets you configure the number of days that clinicians belonging to this department have to add an addendum to a note after submitting the note. If you want to authorize the use of note addenda to only selected users within a department, configure the Restrict Addendum to Providers user preference instead of this preference. Restrict Cancel to Providers Clicking the Edit link associated with this preference lets you selectively grant authority to one or more specific users to cancel notes that they already signed and submitted. Note that the cancel functionality must be enabled institution-wide for this user preference to take effect through configuration of the institution preference Allow Notes to be Canceled. Another institution preference (Allow Cancel “n” Days Past Note Date) lets you configure the number of days that clinicians have to cancel notes after submitting them. For more information, see Configuring Institutional Settings. Restrict Cancel to Department Clicking the Edit link associated with this preference lets you selectively grant authority for canceling signed notes on a department-wide basis, provided functionality for canceling notes is enabled at the institution level. The institution preference Allow Cancel “n” Days Past Note Date lets you configure the number of days that clinicians belonging to this department have to cancel notes that they signed and submitted. All Templates Require Co-Signature/Scribe Determines whether all templates require co-signature, or whether just certain templates require co-signature.

• When set to Yes, all templates require co-signature by the user, and the Select Templates Requiring Co-Signature/Scribe setting is disabled. If you later add new templates to your system, those new templates will also require co-signature, with no additional changes needed to the user’s settings.
• When set to No, only certain templates require co-signature, and those should be specified in the Select Templates Requiring Co-Signature/Scribe setting. If you later add new templates to your system, they will not require a co-signature by the user unless you specify them in the Select Templates Requiring Co-Signature/Scribe setting. Select Templates Requiring Co-Signature/Scribe Restricts enforcement of co-signature rules to one or more specific templates. When All Templates Require Co-Signature/Scribe is set to No, click the Edit link to select one or more of the available templates. Remember that your selection applies to the selected user only; for any template restrictions that apply more globally (for example, beyond the scope of a single department), you are advised to define rules through the Bulk User Edit (BUE) administrative interface (Admin > Bulk User Edit).

Restrict Co-Signature/Scribe to Department Limits co-signature authorization for the selected templates to one or specific departments. When the selected user attempts to sign and submit notes requiring co-signature (defined by Select Templates Requiring Co-Signature/Scribe), they are then required to select from the list of authorized departments defined by this user preference. Restrict Co-Signature/Scribe to Providers Limits co-signature authorization for the selected templates to one or more specific clinicians. When the selected user attempts to sign and submit notes requiring co-signature (defined by Select Templates Requiring Co-Signature/Scribe), they are then required to select from the list of authorized clinicians defined by this user preference. Note Entry Settings Allows ROS and Exam lists to be customized by provider per note type. Allows a user to select which ROS and Exam entries to hide, if they are not used. All of the settings specified above are also available via the Bulk User Edit option (available on the Admin tab). For more information on configuring the Bulk User Edit option, see Editing User Settings in Bulk. Close Visit Alert Type When the Institution-level setting Check number of days for nearby visits is enabled for a site, then this preference allows the type of alert for a “close by” visit to be selected from the following options:

• None (default): No alert displays.
• Message: Displays a message with an alert indicator in the message bar of the first Note tab (on the portal and handheld). No provider action is required. The close by visit is displayed with an alert (orange) and the option to select that visit. If the user does not select, then the current visit is used.
• Prompt: If two visits are in the “close by” timeframe when adding or editing a note, a prompt displays for the provider to confirm or select a visit (either the selected visit or the “close by” visit).

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Configuring Charge Capture Settings for a User

If you plan to integrate billing into your note templates, you must configure the Desktop Charge Capture application for your users. Much of the configuration of this module occurs independently from the NoteWriter application. The following setting(s) involve functionality that directly impacts the NoteWriter application. Copy Diagnoses when Creating a New Transaction This setting determines the default behavior of all new charge transactions that users initiate from within a note template, in relation to diagnosis code settings. You can configure this setting to specify:

• Always copy from charge: If you want each charge transaction initiated by the current user to inherit its diagnoses from its associated charge.
• Always copy from note: If you want each charge transaction initiated by the current user to inherit its diagnoses from the current note template.
• Always copy from note and charge: If you want each charge transaction initiated by the current user to inherit and combine the diagnoses from the note template and any associated charges.
• Prompt user: If you want the current user to be prompted each time he or she initiates a charge transaction. The prompt requests the user to select the source (note or charge transaction) of the diagnosis codes.
• Never: If you do not want to copy diagnosis codes from either the note or the previous charge transaction.

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Defining Quick Text Entries for Your Departments and Users

Defining Quick Text entries enables you to simplify how health care providers in your departments enter frequently-used phrases and terms into their notes. Use of Quick Text entries can save time for providers, by reducing their dependence on the keyboard for data entry when they enter duplicate data in commonly-encountered clinical situations. All Quick Text entries defined at the department level are accessible to all clinicians within the specified department when entering data into the particular field for which the Quick Text is defined. Users cannot make changes to Department Quick Text, but they can hide entries that they do not want to use. Typically, you should create Department Quick Text for entries expected to be shared among a team, and create Quick Text at the user level when usage is expected to be restricted to one or more individual users. This will allow users to get Quick Text tailored to their specific needs and allow them to change it if needed without involving an administrator. Administrators can define Quick Text entries using either the Quick Text (Summary View) or the Quick Text (Template View) NoteWriter settings. It is recommended that administrators use the Quick Text (Template View) to set up Quick Text specific to each template. If a global approach to Quick Text is required that will affect multiple templates using the Quick Text (such as hiding any Quick Text entry or Quick Text Grouping from a pop-up), use the Quick Text (Summary View).

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Using Quick Text (Summary View)

The procedure for using Quick Text (Summary View) should be used to add Quick Text entries that are global and span multiple templates. To add Quick Text entries for a group (referred to as a category in Summary View) for a specific template use Quick Text (Template View); for more information, see Using Quick Text (Template View).

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Adding Quick Text in Summary View

To add a Quick Text entry for global use, edit the Quick Text (Summary View) setting:

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Click the Edit button associated with the Quick Text (Summary View) setting. The Quick Text Editor screen displays for the specified department.
3. Choose one of the following ways to add a Quick Text entry:
   • To create an entry that will be global to all text fields in all templates: Click the Add Quick Text link in the left pane, enter the name of the Quick Text entry into the Name field and the text block to be substituted into the text field. Note that spell checking automatically identifies misspelled words by underlining them in both the Name field and text field. This entry will be available to all users in the specified department in any data entry field that enables insertion of Quick Text of any note template.

• To create an entry that is only available to text fields in a particular section of a note: On the right-hand side of the screen, click the Edit link associated with the category to which you want to add the Quick Text entry. Enter the name of the Quick Text entry into the Name field, and the text block to be substituted into the text field.

4. (Optional) If you want to create a keyboard shortcut for this entry, enter the keyboard sequence into the Keyboard Shortcut text field.
5. Click Save to save the entry and then click Close. All entries are added to Quick Text list of all users belonging to this department, and are created under the Global category to indicate that the entry can be used in any text field.

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Editing Quick Text in Summary View

To edit existing Quick Text entries or Groups (called categories in Summary View):

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Click the Edit button associated with the Quick Text (Summary View) setting. The Quick Text Editor screen displays for the specified department.
3. Click the Edit link associated with the category of either the Quick Text entry or a Group (Category). The Edit Quick Text screen displays.
4. In this window you can do the following edit functions:
   • To edit a category (Group) name, select the name of the Group in the left pane to make the text editable then type a new name for the Group, and then click somewhere in the window to commit the change.
   • To edit a Quick Text entry, click to select the Quick Text entry in the left pane then make the changes you want in the right pane.
   • To make an entry for a Group the default Quick text, select the Default checkbox. This will automatically fill this text into the associated text entry field.
   • Select the Hide from popup checkbox to hide a Category or Quick Text from the Quick Text entry pop-ups.
5. When you have completed all your edits, click Save to save your changes and then click Close to exit the screen.

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Creating a New Quick Text Group for Global Use

The steps for creating a new Quick Text Group from the Admin screen as the same once as doing it from within NoteWriter. These instructions help you to access the Quick Text screen from the Admin tab. To create a new Group:

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Click the Edit button associated with the Quick Text (Summary View) setting. The Quick Text Editor screen displays for the specified department.
3. Choose one of the following ways to add a Group:
   • To create a Group that will be available to all note templates: Click the Add Quick Text link in the left pane,
   • To create a Group that is only available to particular note template section or existing Group, click the corresponding Edit button in the right pane. The Quick Text screen displays.

For detailed instructions about using the screen, see Creating a Quick Text Group.

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Updating Global Quick Text Groups

You can rename or delete Groups that have been created for global use. To rename or delete a Group:

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Click the Edit button associated with the Quick Text (Summary View) setting. The Quick Text Editor screen displays for the specified department.
3. Click the Edit button corresponding to the note template section or group that you want to edit. The Quick Text screen displays.
4. Perform the following to edit or delete a Group:
   • To edit an existing Group, select the name of the Group in the left pane to make the text editable then type a new name for the Group, and then click somewhere in the window to commit the change.
   • You can delete any Group in the list by clicking Delete .
5. When you have completed all your edits, click Save to save your changes and then click Close to exit the screen.

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Using Quick Text (Template View)

You can add, edit, and define additional Groups (categories) and Quick Text entries for each template in your department or for your users.

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Adding Quick Text to a Template

You can add Quick Text entries for a specific template or a grouping within a specific template.

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Select a template from the drop-down associated with the Quick Text (Template View) setting and then click the Edit button. The NoteWriter Quick Text Editor (Admin View) screen displays the template.
3. Click the Quick Text icon associated with a text field and then click Manage Quick Text. The Quick Text for Template screen displays.
4. In the Name field, enter the name of the Quick Text entry. This name is used to identify the Quick Text entry in the Quick Text selection box. Note that spell checking automatically identifies misspelled words by underlining them.
   When you move to the text field, it is prepopulated with the text entered in the Name field.
5. In the text field, enter the text you want to display if you do not want the defaulted text from the Name field.
6. (Optional) In the Shortcut field, type a keyboard shortcut for the Quick text entry. Using shortcuts enables you to define a series of key strokes that you can use to insert a Quick Text entry instead of selecting it from the Quick Text selection box. If you do not want a shortcut, delete it. If you want a different shortcut, enter new text.
7. (Optional) Select a Group from the drop-down if more than one group (also known as categories) is available.
8. When you finish defining your Quick Text entry, click Add. (Optional) To add more entries, repeat Step 4 through Step 8 of this procedure.
9. When you finish defining your Quick Text entries, click Save. Your Quick Text definition is added to the list of available Quick Text entries.
10. Click Close to return to the template, and then click Close to exit the template.

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Editing Quick Text Entries in a Department Template

Within the Quick Text editor, you can edit, delete, change default, or move Quick Text entries as follows:

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Select a template from the drop-down associated with the Quick Text (Template View) setting and then click the Edit button. The NoteWriter Quick Text Editor (Admin View) screen displays the template.
3. Click the Quick Text icon next to a text field and select Manage Quick Text in the pop-up that displays. The Quick Text for Template screen displays.
4. Perform the following to edit, delete, change default, or move Quick Text:
   • To edit a Quick Text entry, click to select the Quick Text entry in the left pane then make the changes you want in the right pane and then click Save. For details about the options on the screen, see Creating Quick Text Entries.

• To delete a Quick Text entry, hover over the name in the left pane then click Delete. Click Yes in the confirmation box to remove the entry.
  • To make an Quick Text entry the default Quick Text, select the entry in the left pane and then select the Default checkbox. This will automatically fill this text into the associated text entry field. Deselect the Default checkbox to remove the entry as the default Quick Text.
• To move a Quick Text entry to another Group, hover over the name in the left pane to display the Reorder icon. Drag the Quick Text entry by its Reorder icon to move that entry into the Group where you want it.

5. Click Close when you have completed all your changes.

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Creating a New Quick Text Group for a Department Template

The steps for creating a new Quick Text Group from the Admin screen as the same once as doing it from within NoteWriter. These instructions help you to access the Quick Text screen from the Admin tab.

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Select a template from the drop-down associated with the Quick Text (Template View) setting and then click the Edit button. The NoteWriter Quick Text (Admin View) screen displays the template.
3. Click the Quick Text icon associated with a text field and then click Manage Quick Text. For detailed instructions about using the screen, see Creating a Quick Text Group.

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Updating Quick Text Groups in a Department Template

Quick Text Groups are a way to categorize your Quick Text entries to make it clearer to the user about their purpose. You can rename or delete Groups from the Update Quick Text for Template screen. To rename or delete a Group for a specific Quick Text entry field of a template:

1. Open the Department or User settings for NoteWriter.
   • For Department, click Admin > Department > [Select Department Name] > NoteWriter.
   • For User, click Admin > User > [Select User Name] > NoteWriter.
2. Select a template from the drop-down associated with the Quick Text (Template View) setting and then click the Edit button. The NoteWriter Quick Text Editor (Admin View) screen displays the template.
3. Click the Quick Text icon next to a text field and select Manage Quick Text in the pop-up that displays. The Quick Text for Template screen displays.
4. Perform the following to edit or delete a Group:
   • To edit an existing Group, select the name of the Group in the left pane to make the text editable then type a new name for the Group, and then click somewhere in the window to commit the change.
   • You can delete any Group in the list by clicking Delete .
5. When you have completed all your edits, click Save to save your changes and then click Close to exit the screen.

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Configuring Templates to Require Clinician Co-Signature

When your institution or facility has not delegated authority for one or more clinicians or groups within your facility to sign and submit notes autonomously, you can define co-signature rules for these clinicians or groups. When defining these rules, you can enforce co-signature rules at both the template and individual user level. Additional options let you configure these restrictions using Bulk User edit, so that you can apply co-signature rules to a larger group of clinicians by role or department. The process of configuring templates for co-signature involves performing the following basic steps. Note that there is some flexibility around how you configure co-signature for your institution; the order of the steps outlined below is provided merely as a general guideline in how you approach this, to ensure that you complete all of the necessary steps. Configuring co-signature involves completing the following basic steps:

1. Enabling co-signature for your institution and configuring the global rules affecting the behavior of this feature across your entire institution.
2. Performing bulk configuration of co-signature requirements that apply to any larger groupings of clinicians sharing the same co-signature restrictions and rules, including:
   • Co-signature requirements for the various templates. (For example, residents might require co-signature for all templates whereas nurse practitioners might require co-signature for only specific templates.).
   • Delegated co-signers (either specific departments or users) who have authority to co-sign the selected template(s) for any clinician belonging to a selected group (defined using the Bulk User Edit feature).
3. Performing configuration of co-signature requirements that are more specific to individual clinicians who have their own unique considerations in the application of co-signature restrictions and rules. As with configuration of larger groupings, configuration of individual co-signature requirements also involves:
   • Co-signature requirements pertaining to one or more specific templates
   • Delegated co-signers (either specific departments or users) who have authority to co-sign the selected template(s) for the selected clinician.

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Enabling and Configuring Co-Signature for Your Institution

In addition to enabling and disabling co-signature of notes across your entire institution, the institution-wide configuration settings let you configure the following behavior as it pertains to co-signature:

• Creating the co-signer’s attestation that informs clinicians when they are required to co-sign notes. Authorized administrators can create a custom attestation message that displays to designated clinicians when they are notified of the need to co-sign notes.
• Authorizing residents to edit notes that they already signed (or which the co-signer declines). An institution-level configuration lets you grant permission to clinicians requiring co-signature so that they can edit content of signed notes or whether they are restricted to only adding comments to their note once signed.
• Authorizing clinicians to re-assign notes for which they are designated co-signer. An institution-level configuration lets you grant permission to all designated co-signers to re-assign notes directly from their eSignature Inbox.

To configure co-signature rules that affect co-signature of notes across your entire institution:

1. Click the Admin tab and then the Institution tab.
2. Select NoteWriter from the Edit Settings drop-down list. The NoteWriter Settings are displayed.
3. Locate the setting Enable Co-Signature and set this to Yes to enable co-signature across your institution.
4. (optional) Locate the setting Co-signature Attestation Message, click the associated Edit link, and from the Define Co-Signature Attestation window, create a custom message. This is the message that displays to inform clinicians who are delegated with co-signature responsibilities. Note that this field is restricted to 4000 characters in length.
5. (optional) Locate and enable the setting Allow Note Creator to Edit a Note in Signed Status to authorize clinicians requiring co-signature to make further edits to notes that they have signed.
6. (optional) Locate and enable the setting Allow Users to Reassign Notes in Inbox to authorize clinicians to re-assign notes for which they are designated co-signer.
7. Click Save to apply these changes across your institution.

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Configuring Co-Signature for a Defined Group of Clinicians

Authorized administrators can use Commure Pro’s Bulk User Edit feature to more efficiently configure multiple clinicians at one time. You might choose to start with this approach if you plan to enforce co-signature rules that are identical for one or more groups of clinicians within your institution, such as a specific group of nurse practitioners. The configuration options in the Bulk User Edit interface are largely identical to the options available to you when configuring individual users; the primary difference is in the search criteria you define to obtain the list of clinicians that you want to configure with shared co-signature rules. A typical approach might involve configuring co-signature for all users with a shared role (for example, Nurse Practitioners) within a specific facility (for example, within the department ‘Hospitalist’). Once you define your search and add your selected users to your Users to Edit list in Bulk User Edit, you can then proceed by configuring this group of users with one shared set of co-signature rules. These rules let you selectively enforce co-signature for one or more of your templates. Then, after configuring the templates for which the specified group of clinicians is required to obtain co-signature, you can delegate who has the authority to co-sign the selected templates. You can configure your system to restrict this authority to one or more specific departments, and also to one or more specific providers. To configure co-signature rules that are shared among a defined group of clinicians:

1. Click the Admin tab and then the Bulk User Edit tab.
2. From the User Search pane, configure the search criteria (Access Level, Department, Roles) to return the largest group of clinicians with shared co-signature rules. Note that you can configure individuals within this group with user preferences to override bulk configuration.
3. Click Select All, then click Add Selected Users to move the group to the Users to Edit pane.
4. From the Users to Edit pane (lower-left), click Select All.
5. From the NoteWriter region of the Preference Settings pane on the right, enable the setting Select Templates Requiring Co-signature and select the template(s) for which your specified group of clinicians is required to obtain co-signature.
6. (optional) To limit co-signers to specific departments, enable the setting Restrict Co-signature to Department and select the department(s) authorized to co-sign the selected templates for your specified group of clinicians.
7. (optional) To limit co-signers to specific individuals, enable the setting Restrict Co-signature to Providers and select the individual(s) authorized to co-sign the selected templates for your specified group of clinicians.
8. Click Set Preferences to apply your changes to your specified users. If exceptional rules apply to one or more clinicians belonging to this group, you can make additional changes to these individual clinicians. For more information, see Configuring Co-Signature for Individual Clinicians.

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Removing Co-Signature Restrictions from a Defined Group of Users

You can configure your system to remove department or provider co-signature restrictions from a defined group of users. Two Bulk User Edit preferences (Remove Restrict Co-signature to Department, Remove Restrict Co-signature to Provider) provide an efficient alternative to disabling co-signature rules that you previously assigned to clinicians, either through Bulk User Edit configuration or through configuration of individual user preferences. To remove co-signature restrictions from a defined group of clinicians:

1. Click the Admin tab and then the Bulk User Edit tab.
2. From the User Search pane, configure the search criteria (Access Level, Department, Roles) to return the largest group of clinicians with shared co-signature rules. Note that you can configure individuals within this group with user preferences to override bulk configuration.
3. Click Select All, then click Add Selected Users to move the group to the Users to Edit pane.
4. From the Users to Edit pane (lower-left), click Select All.
5. To remove one or more departments authorized to co-sign for the selected group of users, locate the setting Remove Restrict Co-signature to Department and select the department(s) you want to remove.
6. To remove one or more providers authorized to co-sign for the selected group of users, locate the setting Remove Restrict Co-signature to Provider and select the provider(s) you want to remove.
7. Click Set Preferences to apply your changes to your specified users.

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Configuring Co-Signature for Individual Clinicians

Configuration of co-signature rules for individual clinicians is quite similar to configuring these rules for larger groups, involving configuration of nearly identical preferences and following a very similar configuration work flow. First, you choose the template(s) for which to enforce co-signature for the selected user. Then, after configuring the template(s) for which this clinician is required to obtain co-signature, you can delegate co-signature authority to one or more departments and/or providers. As noted above, individual co-signature rules are given precedence over co-signature rules defined for groups of clinicians using Bulk User Edit. To configure co-signature rules for a specific clinician:

1. Click the Admin tab and then the User tab.
2. Select the clinician you want to configure from the list and click Edit.
3. Select NoteWriter from the Edit Settings drop-down list. The complete list of available user preferences displays on the NoteWriter Settings screen.
4. Locate and enable the setting Select Templates Requiring Co-signature and select the template(s) for which this user is required to obtain co-signature.
5. (optional) To limit co-signers to specific departments, enable the setting Restrict Co-signature to Department and select the department(s) authorized to co-sign the selected templates for this user.
6. (optional) To limit co-signers to specific individuals, enable the setting Restrict Co-signature to Providers and select the individual(s) authorized to co-sign the selected templates for this user.
7. Click Save to apply your changes to your selected user.

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Configuring Addenda to Require Clinician Co-Signature

Co-signature rules requiring mid-level clinicians (such as Nurse Practitioners or Physician Assistants) to obtain note co-signature also apply when these same clinicians need to amend these notes with note addenda. To ensure that mid-level clinicians use the correct addendum for their note(s), administrators must configure these users for auto-selection of addenda that is specific to a particular template type (and linked by configuration). When mid-level clinicians subject to this restriction click the Add Addendum button, they are no longer prompted to select an addendum template, but instead are restricted to the addendum that has been linked to the template type in use. Configuring addenda for a mid-level clinician is a two-step process that involves linking addenda to all templates that the clinician can access, then enabling the template-specific addenda for the user. To configure note addenda for co-signature:

1. Only after you add all addendum templates (as noted above), select the note template requiring co-signature from the Note Template Maintenance window (Admin > Institution > Edit Settings [NoteWriter] > Note Templates [Edit]).
2. From the Add/Edit Note Template window, locate the Addendum Template setting and select the addendum to link to the selected template.
3. Click Save.
4. From the NoteWriter settings screen (Admin > User > [select user] > Edit Settings [NoteWriter]), locate and enable the Use Templated Addendum setting.
5. Also from NoteWriter settings, check to make sure that all templates available to the selected user are configured with a dedicated addendum template (locate the Note Pickers setting and click the associated Edit link to see which template(s) the selected user can access).
   Only enable the Use Templated Addendum setting after linking a dedicated addendum to each template that a user can access (via their Note Pickers). Clicking the Add Addendum button for a template without a dedicated addendum can result in errors for users with this setting enabled.
6. Click Save. Addenda is now selected automatically and co-signature will be required whenever the selected user clicks the Add Addendum button and submits content to amend a previously-submitted note

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Enabling and Configuring the Cancellation of Signed Notes

You can grant permission to your clinicians to cancel notes that they have signed and submitted, allowing them to revert notes created in error, such as after entering notes on the wrong patient. When notes are canceled, they are retained among all other notes on the clinician’s clinical notes list, but strike-through markup is applied to all of the note content (including the note summary that displays on the clinical notes list). While this basic functionality is configured at the institution level, permission for canceling signed notes can be restricted to one or more departments or clinicians. You can define how many days clinicians have to cancel their notes after signing and submitting them. Another configuration option lets you require clinicians to specify a reason for canceling a signed note. To enable the cancellation of signed notes and configure the rules involving cancellation:

1. Click the Admin tab and then the Institution tab.
2. Select NoteWriter from the Edit Settings drop-down list.
3. Locate and enable the preference Allow Notes to be Canceled.
4. Set the following preferences to configure how cancellation of signed notes works across your institution:
   • Allow Cancel “n” Days Past Note Date: Specify how many days clinicians have to cancel notes after signing and submitting them. You can configure this duration to allow for cancellation from 1 to 30 days after clinicians sign and submit a note. This setting only takes effect when the feature is enabled.
   • Require Reason to Cancel Note: Enable this setting if you want clinicians to be prompted with a mandatory field for specifying an explanation (free-text) when canceling a signed note. This reason then displays above the note content for notes on the Clinical Notes list. This setting only takes effect when the feature is enabled. For more information, see Canceling Signed Notes.
5. Click Save to apply these changes.
6. Navigate to the NoteWriter user preferences (Admin > User > Edit Settings [NoteWriter]), locate and configure the following user preferences to grant permission to a selected group of users or departments:
   • Restrict Cancel to Providers: Click Edit and select from the available providers if you want to restrict cancellation of signed notes to one or more individual users.
   • Restrict Cancel to Department: Click Edit and select from the available departments if you want to restrict cancellation of signed notes to one or more departments.
7. Click Save to apply these changes.

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Batch Provisioning of Note and Quick Text Picker Settings

Rather than having to create Note Pickers and Quick Text entries from scratch for each of your departments or users, the NoteWriter interface provides a few different methods for you to configure these settings through batch provisioning. You can provision these Pickers by copying them between departments or from department to users. You can also export and import them using CSVfiles which allows propagating department or user pickers to other departments and users You can also use batch provisioning to delete all Pickers that have been defined for a particular department or user. All batch provisioning of pickers is accomplished through procedures that are common to both Note Pickers and Quick Text Pickers. You can perform any of these tasks from either the Note Pickers or Quick Text (Summary View) screen at either the department level or user level.

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Copying Picker Settings

Many of your department settings for Note Pickers and Quick Text might be common to multiple departments or users. In such cases, the most efficient way to provision your department Picker settings is to define Picker settings for one of these departments, and then to copy these Picker settings over to other departments or users, making minor modifications as needed. To Copy Picker Settings from Another Department:

1. Click the Admin tab, followed by the Department tab if copying a between departments or User tab is copying department settings to a user. The list of your available departments or users displays.
2. Select either the target department or target user of the copy operation, and click the Edit button.
3. On the Department Settings screen or user’s General Settings screen, select NoteWriter from the Edit Settings drop-down menu.
4. Click the Edit button associated with either the Note Pickers or Quick Text (Summary View) setting. The Note Pickers screen displays all existing Note Pickers or the Quick Text Editor screen displays for Quick Text Pickers for the selected (target) department or user.
5. Click the Copy From Department button, and select the source department that has the Picker settings you want to copy.
6. Make sure that the Standard Pickers radio button is selected, and click OK. You are prompted to enter a category name for the Pickers.
7. Enter a name for the new category, and click OK. The Pickers are added to the selected (target) department, and are organized under the new category, which is added to the top-level default directory.
8. Click Close to return to the Department Settings screen, then Save to save your changes.

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Exporting and Importing Picker Settings

Instead of copying Picker settings directly from one department to another department or user, you can transfer this data by exporting your settings to a file. You can also export user specific Picker settings. This approach enables you to maintain a record of Picker settings for each of your departments and users. When you export Picker settings, this data is stored in a comma-separated values file, which includes the following details for each Picker:

• Department- The department from which the Picker was exported (optional for user exported Pickers)
• Code- The identifier used to identify the Picker selection in the interface
• Vocabulary- Identifies whether it’s a CPT, ICD10 or custom code for the Desktop Charge Capture module.
• Context- Diagnosis Group to which the Quick Text group is mapped.
• Description- The label used to identify the Picker
• Sort- The sort order in which the Pickers display in the drop-down menu
• QuickPick Indicates whether the Picker is defined as a Quick Pick entry. Quick Pick entries are a specific type of Picker that is used by the Desktop Charge Capture module.
• PKVisitTypes- Indicates whether the Pickers are filtered by Commure Pro visit types.
• ADTVisitTypes- Indicates whether the Pickers are filtered by ADT visit types.
• IsBranch- Specifies if this a group/branch or not.
• SelectableGroup- If the picker is part of a Diagnosis group or macro, this value identifies the group.
• ImportID- Numeric identifier for picker.
• ParentImportID- If this picker is part of a group, this value identifies the group.
• Wiki Markup text (for export of QTv2 entries and groups only)- The Wiki markup text (QTv2 only) that allows for more structured Quick Text entries with variables that users can select from is supported in export and import operations from Quick Text (Summary View) (Admin > Department > Edit Settings [NoteWriter]) (with the exception of multi-select lists).

When exporting pickers via Quick Text (Summary View), these additional report contents are available:

• Shortcut- The Shortcut defined for the Quick Text entry (if available).
• DisplayText- The Quick Text value that is defined.
• ExternalIds- The ID of the field to which the Quick Text belongs.
• HideFromPopup- Specifies the Hide From Popup checkbox is selected; when selected the item is hidden in the Quick Text popup.
• IsDefault- Specifies if the item is defined as the default Quick Text entry. To Export Picker Settings:

1. Click the Admin tab, followed by the Department tab or User tab. The list of your available departments or users displays.
2. Select the department or user from which to export the Pickers, and click the Edit button.
3. On the Department Settings screen or user’s General Settings screen, select NoteWriter from the Edit Settings drop-down menu.
4. Click the Edit button associated with either the Note Pickers or Quick Text (Summary View) setting. The screen displays all existing Note Pickers or Quick Text Pickers for the selected (target) department or user.
5. Click the Export Pickers button. You are prompted to choose between exporting all of the Pickers, or restricting the export operation to a single category of Pickers.
6. When prompted, confirm that you want to download the Pickers file, and then click Save to store the file to a local directory. Alternatively, you can open the file to view its contents. The Pickers file is stored to the selected directory as a compressed CSV file.

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To Import Picker Settings

1. Click the Admin tab, followed by the Department tab or User tab. The list of your available departments or users displays.
2. Select the department or user into which to import the Pickers, and click the Edit button.
3. On the Department Settings screen or user’s General Settings screen, select NoteWriter from the Edit Settings drop-down menu.
4. Click the Edit button associated with either the Note Pickers or Quick Text (Summary View) setting. The screen displays all existing Note Pickers or Quick Text Pickers for the selected department or user.
5. Click the Import Pickers button. You are prompted to navigate to and select the CSV file containing the Pickers you want to import. If you saved the compressed version of this file, you must extract the CSV file before you can import the department Picker settings.
6. Select the CSV file, click Open, and then Import. The Note Pickers or Quick Text Pickers are imported into your selected department or user.

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Deleting All Picker Settings

The batch delete operation affects all Picker settings belonging to a department. To restrict the delete operation to one or more Picker categories, you must delete the individual categories from their parent directory. To Delete All Picker Settings for a Department:

1. Click the Admin tab, followed by the Department tab or User tab. The list of your available departments or users displays.
2. Select the department or user that uses the Pickers you want to delete and click the Edit button.
3. On the Department Settings screen or user’s General Settings screen, select NoteWriter from the Edit Settings drop-down menu.
4. Click the Edit button associated with either the Note Pickers or Quick Text (Summary View) setting. The screen displays all existing Note Pickers or Quick Text Pickers for the selected department or user.
5. Click the Delete All Pickers button. You are prompted to confirm the delete operation.
6. Click Yes to confirm that you want to proceed. All Pickers are deleted from the selected department or user.

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Saving All Active Templates

Note templates are automatically upgraded and re-saved when a newer server version is installed. Occasionally, an Administrator may want to re-save all active templates to ensure all changes have been implemented. There are two ways to save active note templates:

• Save templates individually: Manually open each template and save it.
• Save all templates: A Save All task is available in the Note Template Maintenance window to save all note templates at once. This process can take some time to complete, and you should plan to wait for the save to complete before moving onto other administrative tasks. To save all active templates:

1. Click Admin > Institution > NoteWriter.
2. Click [Edit] next to the Note Templates setting. The Note Template Maintenance window displays.
3. Click Save All in the bottom-right corner of the window. When all of the active templates have been saved, a confirmation message displays stating “Save all templates has finished.”