Ways To View Patient Information

Commure Pro provides multiple ways to access patient data, including demographic, visit, clinical, and charge information. The data available for each patient depends on the patient type and your user permissions.

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Displaying Patient Information

The Commure Pro system provides the user with the ability to view patient data in different ways. For example, they can view any type of data (demographic, visit, clinical, or charge), for one individual patient at a time, or they can view a summarized list of the new, unviewed clinical data, for all of the patients on their patient list at once. This chapter describes how to view all the patient data display options and the types of information that are available for all of the patients in the system.

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Understanding What Information is Available for Patients

With three potential types of patients in the Commure Pro system, it is important to note that not all of the same information is available for all types. Patients who were manually registered are usually considered to be temporary patients. Clinical information such as lab results, clinical notes, allergies, and test results are not available for these patients. Only authenticated patients (those that have been fully registered in your source ADT/Registration system) will have these types of clinical data available. For temporary patients, only the basic demographic, visit, and possibly initial charge data that was posted when the temporary record was created are available. Once the patient has been fully registered in your source system, all the information is available. Regardless of the amount of data that is available for a given patient, you may or may not have permission to view all of that data. The amount and type of information that you are allowed to view or edit for any patient on the Patient List or Patient Search tabs is based the Clinical Results View Access (web only) setting and the Patient List Charge View Access setting. The Clinical Results View Access (web only) setting is used to restrict access to clinical data such as reason for visit, medications, lab results, test results, clinical notes, etc. The Patient List Charge View Access setting is used to control the amount of charge information that you can view (and possibly edit). Settings that control this feature:

• Admin - User - Patient List - Can View Clinical Results (Web Only)
• Admin - User - Charge Capture - Set Patient List Charge View Access

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Understanding the Patient Data Display

The Commure Pro system provides a Patient Data Display to view any individual patient’s demographic, visit, charge, or clinical information. The Patient Data Display contains display options that group the available information into useful categories. The Patient List screen consists of two major elements: your patient list and the Patient Data Display. The Patient Data Display is located on the right side of the Patient List tab and can also be accessed clicking the Details icon which is available from many different screens. It contains the following main elements:

• Timeframe drop-down list: Use this drop-down list to increase or decrease the amount of patient data that is shown in the Patient Data Display area. You may choose to see data from a variety of filters (configurable through the System Management reference list Date Range Filters) using the following criteria:
  • Visit-based filters begin calculations 48 hours prior to the admit date and time of the oldest specified visit. For example, if a patient had three visits – Visit 1 (Current visit) happened on 11/04/2011 at 10 am to present, Visit 2 happened on 10/31/2011 at 9 am to 11/01/2011 9 am, and Visit 3 happened on 10/15/2011 7 am to 10/15/2011 8 am and you selected the Most Recent Visit Filter, the filter calculates the data from 11/02/2011 10 am (48 hours prior to Visit 1’s admit date/time of 11/04/2011 10 am) to present. The Most Recent 2 Visits filter will return data from 10/29/2011 9 am (48 hours prior to admit date/time of Visit 2 - the oldest visit) to present. The only exception to this calculation is I/O data which is calculated from the admit date and time of the selected visit (does not include any data from 48 hours prior to the admit date) to present.
  • Time-based filters that begin calculations starting from midnight of the current day to the number of days chosen from the filter. For example, if on November 3rd, you select Last 30 days, the data presents the past 30 days starting at 12:00 am on November 3rd and ending at 12:00 am on October 4th.
  The list of values that display in the time-based filters list is determined by System Management configuration. For more information, see Date Range Filters.
  • Specific Date Range filter that calculates the data from the dates you enter.
  The list of values that display in the time-based filters list is determined by System Management configuration. For more information, see Date Range Filters.
  In certain cases where two visits have occurred on the same day (such as an ER visit and an Inpatient visit) and have the same account number, both may be displayed, as the filters do not differentiate between them.
• List of display options: This is a list of the different types of information that you may display for any given patient on your list. When you click on an item, the information in the display area changes to show you that particular subset of patient data. Each of the display options is described in detail later in this chapter:
  • Allergies (see Viewing Allergies for a Patient)
  • Charges (see Viewing Charges for a Patient)
  • Clinical Notes (see Viewing Clinical Notes for a Patient)
  • I/O (see Viewing Intake/Output for a Patient)
  • Lab Results (see Viewing Lab Results for a Patient)
  • Medications (see Viewing Medication Orders for a Patient)
  • New Results (see Viewing New Results for a Patient)
  • Order Status or Orders (see Viewing Orders or Order Status for a Patient)
  • Overview (see Viewing an Overview of a Patient)
  • Patient Detail (see Viewing Patient Details)
  • Patient Photos (see Viewing Patient Photos)
  • Problems (see Viewing Problems for a Patient)
  • Test Results (see Viewing Test Results for a Patient)
  • Visits (see Viewing Visit Information for a Patient)
  • Vitals (see Viewing Vital Signs for a Patient)
  • Custom links to external systems: If your organization has implemented a custom link to an external system, such as an on-line reference tool or another hospital information system, it may be listed here in the center column. For example, you might see a link to WebMD^® or a fetal monitoring system. Just click the link to access the system. You may be required to enter a username and/or password the first time you access the external system.
• Display area: This portion of the screen is where the detailed information for a particular patient is actually shown.
• Buttons for adding or editing data for a visit: Depending on the data you are currently displaying, there may be one or more buttons that allow you to add or edit data to the patient.
• At the top of the display area, near the Timeframe drop-down list, there is an Actions drop-down where you can choose different actions such as Add Problem, Create Visit, or Add Charge from the drop-down list for the patient.
• Print button : In the Summary window or Detail window when printing is available, you may print the contents of that pane to create an electronic copy (PDF) or a send a printout to a physical printer. This creates a formatted printout that is specific to the current pane you are printing. The window pane is printed just how it appears on-screen, including the current sort order or any filters that are applied. Do not use the CTRL+P keyboard shortcut as this prints the entire browser and not just the contents of a particular pane.

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Using the Patient Data Display on the Patient List Tab

All of the display options in the Patient Data Display window (located to right of the Patient List) function in a very similar manner. The basic steps to view patient information are always the same:

1. Select a patient on the Patient List, by clicking on their name.
2. Select a display option from the center column. For example, you might select Visits. The type of data that you selected (Visits in our example) is displayed in a summary window. The summary window is just what it sounds like: a summarized list of items.
3. Select a date range from the Timeframe drop-down list, located near the top right of the window (some display options use different date range selection methods or do not use date ranges). The data in the summary window now displays just the items (Visits, in this example) that fall within the Timeframe that you selected.
4. You can now perform any of these activities:
   • Use a filter to view a specific subset of the data in the summary window. Many of the displays have a filter option. For example, the filter on the Visits display allows you to select from a variety of visit types, such as inpatient, outpatient, or emergency room. Filters are always located in the title bar of the summary window.
   • Click on an item in the summary window to view additional details about it. When you do so, one or more detail windows open below the summary window. For example, when you click on a visit in the summary list, additional information about that one specific visit is displayed in the Visits Detail window.
   • Change the Timeframe (when it applies) to increase or decrease the span of data in the summary window.
   • Click on a different display option to view different information about the same patient. For example, you might now want to view Clinical Notes for the same patient.

Some display options have additional features or options that allow you to view the patient information in different manners (graphs for example). Some also allow you to add annotations or to mark items as viewed. These additional features are described under those display options whenever they are available. As you are using the Patient Data Display, you will use a variety of filters, timeframes, and display options. The system might recall your preferences as you click from display option to display option. For example, when using the Visits display option, you might select a Visit Type filter of Inpatient. The next time you select Visits, the system recalls that you had chosen Inpatient as your Visit Type filter and uses that filter again. The behavior of the Timeframe filter varies depending on a system-wide setting, as configured by your system administrator. The Timeframe value you select for a display option can be saved and used by other display options or saved per individual display option. For example, if the Timeframe value is configured to be saved across display options, if you are using the Visits display option and select the date range Last 60 Days, and then you select a different display option (such as Vitals), Vitals uses the Last 60 Days date range. If Timeframe is configured to save values per display option, if you select Last 60 Days for Visits and then select Vitals, the system uses the Timeframe value saved for Vitals, not the value you chose for Visits. These settings are maintained after you log out. When you log back in again, the last Timeframe, display option, and filter settings that you last used are automatically selected for you.

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Using the Details Icon to Access the Patient Data Display

The Patient Data Display can be accessed by clicking on the Details icon on the Patient Search, Patient Summary, Schedule, Holding Bin, Patient Charge Status, Worklist, and Search tabs. When you first click on any of these tabs, you may have to enter some search criteria before any patients or visits are displayed, or a report might be automatically generated based on default search criteria. You can always change the search criteria so that the report shows the patients or visits you want to see. Once a list of patients or visits is displayed, you can click on the Details icon located to the right of any patient name to open the Patient Data Display. Please refer to the sections below for detailed instructions on how to use each option:

• Patient Search (see Searching for Patients or Visits)
• Patient Summary (see Viewing a Summary of All Patients)
• Schedule (see Viewing Schedules)
• Holding Bin, found under the Charges tab (see Holding Bin (Classic))
• Patient Charge Status, found under the Charges tab (see Patient Charge Status (Classic))
• Worklist, found under the Charges tab (see Worklist (Classic))
• Search, found under the Charges tab (see Search (Classic))

The steps necessary to open the Patient Data Display from any of these options are very similar. Let’s walk through the steps, using the Patient Search tab as an example.

1. Click on the tab you want to open (the Patient Search tab in our example).
2. Enter some search criteria, and then click a button to search for a specific set of data. In our Patient Search example, you would click the Search for Patients or Search for Visits button. (For more information on using these search criteria fields, see Searching for Patients or Visits.) All patients or visits that match your criteria are displayed in the results section at the bottom of the window.
3. Click the Details icon beside the patient or visit you want to see.

The Patient Data Display opens. You can now click on the buttons and menu lists to more details about the patient. See Step 2 - Step 4 of Using the Patient Data Display on the Patient List Tab for more information.

4. Click the Close button to close the Patient Data Display and return to the option from which you started (the Patient Search tab, in our example).

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Viewing Allergies for a Patient

The Allergies display option lists all known allergies and reactions for a specific patient. You can see the allergy description, the patient’s reaction, the severity, and the type of allergy (food, drug, etc.). In addition to the summarized list of allergies, you can also view additional details about any allergy on the list. To view allergies, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on Allergies from the display list. The patient data display area shows the Allergies window.
   • You may change the order in which the Allergies are sorted, by clicking on a column heading. For example, clicking the Reaction heading would sort the allergies alphabetically by reaction.
   • You may filter the list of allergies, by type of allergy. To do so, click the drop-down filter located in the upper right corner of the Allergies window. The various categories of allergies defined by your institution are included in the filter list. Select an item from the list to view only those types in the Allergies window.
4. If you would like to see the details of a specific allergy, simply click on that allergy in the summary list. A detail screen opens below the summary list, showing you all known information about the allergy.
5. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing Charges for a Patient

The Charges option is used to display charge information for a particular patient. You can use the Show Visits check box to toggle between viewing a list of actual posted charges, or a list of visit dates on which charges were expected to be posted. You can also use the My Charges Only check box to toggle between viewing just your own charges, or all charges to which you have access. A setting in your user profile determines whether you are able to see just your own charges, just those charges within your department, or all charges. The My Charges Only check box is visible only if you have access to more than just your own charges. When you first click on the Charges display option, you see a summarized list of charges on file for the patient. The summary list shows you the following information for each charge transaction: date, billing provider/team, procedure codes and descriptions, quantity, and diagnoses. In addition to the summary, you can view the detailed information for any specific charge on the list. To view detailed information, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking on the Timeframe drop-down list.
3. Click on Charges from the display list. The patient data display area shows the Charges summary window. The contents vary depending whether the Show Visits checkbox box is selected.
   • When the Show Visits option is not checked, the summary window shows you the following information for each posted charge transaction: date, the hold reason(s) (if the transaction is currently held for review), billing provider/team, procedure codes and descriptions, quantity, and diagnoses.
   • When the Show Visits option is checked, the summary window calculates the charge status for each day of the patient’s visit(s). If charges have been entered for a given day, it shows you the date, the hold reason(s) (if the transaction is currently held for review), procedure codes and descriptions, rendering or billing provider, quantity, and diagnoses (billing provider/team can also be added to this display via an XML customization; contact your Commure Pro representative). If charges have not been entered for a given day, the display provides an easy mechanism to enter those charges.
   Your system administrator can determine which visit types are included in this display. For example, they might configure the display to calculate the charge status of inpatient and outpatient visits, while excluding pre-registration or recurring visits from appearing.
   • Items that display “Add” are visits for which charges have not yet been entered. Click on the Add link to enter a charge for this visit (with the correct service date), using the standard charge transaction screen. Please refer to Basic Steps for Entering a New Charge Transaction for instructions on how to enter charge information on this screen.
   You may see a brief message after the Add link to warn you when the visit date is still within the global post-operative period after a surgical CPT code has been entered. For example, if a 10 day global period were in effect, the Add link might look like this: Add (Global 10). Typically, you should not enter an E&M code during a global period unless a modifier is used. The exact wording of the message is configured by your administrator.
   • Charge codes and descriptions that are printed in red text are draft charges.
   • Charge codes and descriptions that are printed in black text are completed charges.
   • Charge codes followed by an (A) indicate that the charge was automatically added after the transaction was saved, as a result of the optional Automated Code Entry feature (see Managing Charge Transactions with Auto-Added Codes). You can see the auto-added codes only if this feature is enabled in your user preferences.
   • Charge codes followed by a (P) indicate that the charge was automatically added after the transaction was saved, as a result of the user answering the PQRS Clinical Metrics questions (see Answering the Clinical Metrics Questions). You can see the auto-added codes only if this feature is enabled in your user preferences.
   • You can filter the list to display just your own charges, by checking the My Charges Only box.
   • You can change the sorting order of the charges summary list by clicking on any heading. For example, if you click on the Date/Time column, the sort order toggles between ascending and descending order by service date.
4. If you would like to see further information about a particular charge transaction or visit, click on the row containing the charge or visit. A detail window opens below the summary list. This window gives you the full details of the charge or visit. Depending on the type of item (charge or visit), one or more buttons are available in the title bar of the detail window:
   • Edit and Delete buttons: If you are viewing a draft charge transaction, or a transaction that is still in the Holding Bin (charge status of Draft, Draft (HH), or Holding Bin), there are Edit and Delete buttons in the title bar of the Charge Detail window (see Editing a Charge Transaction from the Patient List or Patient Search Tab and Deleting a Charge Transaction from Patient List or Patient Search Tabs).
   • View button: If you are viewing a transaction that can no longer be edited or deleted because a) it has a charge status of _Outbox_and you do not have permission to edit charges in the Outbox, or b) it has a charge status of Sent to Billing, then the View button appears in place of the Edit and Delete buttons. Click the View button to open a read-only screen that displays all of the details of the charge transaction. At the bottom of the screen, an Add New Charge button is available, in the event that you need to enter additional charges for services (since the current transaction cannot be changed). See Entering or Editing Charges for more information. If you are a Level 0/1/2 administrator, you may also see a Return to Holding Bin button, if that feature is enabled in your use profile.
   • Copy button: If you are viewing a charge transaction with any charge status, a Copy button is available in the title bar of the Charge Detail window. Click Copy to create a copy of this charge transaction, with a different service date. See Copying a Charge Transaction from the Patient List or Patient Search Tab for more information.
   • Submit button: If you are viewing a draft transaction (status of Draft or Draft (HH)), there is a Submit button in the title bar of the Charge Detail window. After examining the details of the transaction, if you determine that it is now ready to submit to billing, click the Submit button. Or alternately, you can click the Edit button to open the draft transaction for editing, make any necessary corrections, and then click Submit on the Charge Transaction screen. In both cases, the transaction is then sent to either the Holding Bin or Outbox, based on your system’s configuration.
   • Mark as Reviewed button: If the charge transaction was held for review, the reason(s) that it was held for review will be listed at the top of the Charge Detail window, and if you are a Reviewing User, a Mark as Reviewed button will also be displayed in the title bar of the window.
   Transactions that are held for review for one or more reasons must be reviewed by a Reviewing User before they can be sent to the Outbox. If you are configured as a reviewing user, you can look over the charge information in the Charge Detail window, and if everything is correct, you can then click the Mark as Reviewed button to mark the transaction as reviewed. All hold reasons that you are authorized to resolve are cleared when you use this method. Or alternately, you can click the Edit button to open the transaction so that you can review it in more detail and possibly make corrections. On the Charge Transaction screen, you can then click the Up Arrow on the Mark as Reviewed button, uncheck any of the hold reasons that you have resolved, and click Submit. Please note that transactions can also be marked as reviewed in a variety of charge report options.
   • Add Charge button: If you are viewing a visit for which charges have not yet been posted (billing status of Not Coded), you will see a Not Coded Visit Detail window instead of the standard Charge Detail window. This screen gives you information about the visit, and contains an Add Charge button in the title bar of the window. Click this button to enter charges for the visit (or you can just click the Add link in the summary window for that visit day). For detailed information on how to enter a charge, please refer to the section entitled Basic Steps for Entering a New Charge Transaction.
5. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing the Print icon in Understanding the Patient Data Display.

Settings that control this feature:

• Admin - User - Charge Capture - Set Patient List Charge View Access
• Admin - User - Charge Capture - Show Auto-Added Charges to User
• Admin - User - Charge Capture - Show PQRS Charges to User
• Admin - User - Charge Capture - Level 0/1/2: Can Access Return to Holding Bin
• Admin - User - Charge Capture - Reviewing User

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Viewing Clinical Notes for a Patient

The Clinical Notes display option is an optional feature that may or may not be implemented for your organization. It allows you to review a summary list of the notes on file for a particular patient. All signed and draft notes created in Commure Pro NoteWriter display on the Clinical Notes list, along with other notes that were created using other applications. From the Clinical Notes list, you can:

• Sort all documents on this list according to date, author, and note type.
• Pre-select one or more notes from the Clinical Notes list to include in your next NoteWriter note. To pre-select notes that you created in NoteWriter, they must be signed.

You can view any of your own NoteWriter notes from the Clinical Notes display option, but you cannot make edits to a note unless it is in draft form and you are the note author. You can see the date the note was written, the type of note (admission, discharge, etc.), and the author. In addition to the summarized list of notes, you can also view the contents of any specific note on the list, including the content for PDF or scanned documents. The display properties of signed and draft notes on the Clinical Notes display can be differentiated in several ways. To view clinical notes, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click Clinical Notes from the display list. The patient data display area shows the Clinical Notes window that contains a list of the most recent clinical notes for the selected patient, including both text-based documents and scanned images of documents. It contains columns for Date/Time, Note Type, and Author. If you are looking for a note that you do not see in the results list, click the Load More Data button at the bottom of the list. If additional notes exist, they are added to the bottom of the existing list. For information on loading more data, see Displaying More Clinical Notes Data. Consult your Commure Pro representative if you would like to adjust the height of this window, to make it larger or smaller or to adjust the default number of results that are displayed. For scanned documents, the word “Scanned” precedes the description of the note type (for example, “Scanned: History and Physical”). In addition, the Author column shows the name of the person who scanned the document into the system, while the image of the document itself usually contains the true author. Your organization can suppress the Author column for scanned documents via an XML customization if they do not want the name of the scanner to show. If this customization is implemented, the Author column will be blank for scanned documents.
   • You may change the order in which the Clinical Notes are sorted, by clicking on a heading. For example, clicking the Author field would sort the notes alphabetically by author. Clicking any column header a second time reverses the sort order.
   If you click Load More Data the sort order is reset. Click a heading to sort the results again after loading more data into the list.
   • You may filter the list of clinical notes, by types of note. To do so, click the drop-down filter located in the upper right corner of the Clinical Notes window. The various types of notes used by your institution are included in the filter list. Select items from the list to view only those types in the Clinical Notes window and then click OK. The drop-down filter will display as Filtered to indicate that you have chosen a subset of filters instead of All.
3. If you would like to see the details of a clinical note itself, simply click on that note in the summary list. The Clinical Notes detail window opens below the summary list, showing you the full contents of the note. The tools available on the detail window depend on whether the note is a text-based document or a scanned document.
   • See Viewing the Details of a Text-Based Clinical Note for instructions on viewing the contents of a text-based document.
   • See Viewing the Details of a Scanned Clinical Note for instructions on viewing the contents of a scanned document.
4. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Displaying More Clinical Notes Data

The Clinical Notes window displays the most recent notes for the selected patient. If there are more notes to display, you can load them into the window until you see what you are looking for or until all of the available notes are displayed. The number of notes displayed at a time is based on the setting Number of Elements retrieved for “Load More” (Portal). This settings affects the number of notes that are initially displayed, and the number of additional notes displayed each time more data is loaded. You can refresh the list to reset it to the most recent notes by clicking Refresh . The most recent data is loaded when the list is refreshed. Consult your Commure Pro representative if you would like to adjust the default number of elements that are displayed. To display more data, follow these steps:

1. Scroll to the bottom of the Clinical Notes Summary list so that the Load More Data button is visible.
2. Click the Load More Data button to check for more notes. If additional notes are available, they are loaded and added to the bottom of the list. If there are still more notes to display, the Load More Data button remains available at the bottom of the current list. Continue to click the Load More Data button until you find the data you are looking for or until all of the data is loaded. When all of the available data is available the Load More Data button is no longer available.
   If any filters are applied, the Load More Data button is only visible when there are more notes to display that meet the filter criteria; if all of the notes meeting the filter criteria are displayed the button is not visible.

Settings that control this feature:

• Admin - Institution - Site Administration - Number of Elements retrieved for “Load More” (Portal)

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Viewing the Details of a Text-Based Clinical Note

To view the contents of a text-based clinical note, use the vertical scroll bars to move your view to the top or bottom of the document. Some reports may use a wide table or columnar format. In this case, a horizontal scroll bar allows you to move your view to the left or right in order to see the contents of a wide document.

• You can use the Change Font icon to toggle between a fixed-width and variable-width font when viewing clinical notes. The fixed-width font preserves the formatting of the note and makes it easier to read text that uses a table or columnar format.
• You can use the Search field at the top of the window to find all instances of a particular word or phrase in the note. First type in the desired phrase, and then click Search (or press the Enter key on your keyboard). Click repeatedly on the icon to move to each subsequent occurrence of that word or phrase in the note. The search function only searches through the body of the selected note.

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Viewing the Details of a Scanned Clinical Note

To view the details of a scanned document, you can use the vertical and horizontal scroll bars. There are also several controls at the top of the detail window that allow you to manipulate the scanned image for better viewing.

• Use the controls at the top left of the detail window to reduce the document, fit the document to the window, or enlarge the document.
• Use the controls at the top center to go to the first page, previous page, next page, or last page of the document.
• Use the controls at the top right to rotate the document to the left, or rotate it to the right.
  The Search field is not available for scanned documents.

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Viewing Home Medications in the Patient Data Display

In the Patient Data Display, there may be a Home Medication link available. You can view the patient’s list of home medications if your organization has configured this option. You can access this link as follows:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Home Meds link from the display list. The Home Medications link displays the name, the route, frequency, and dose of each home medication for the current visit. You can select any column to do an alpha numeric sort by the contents of that column.
   You can only view the list of home medications in the Home Medications display. To make changes for a visit, you must use the Medication Reconciliation features - Continue Home Medications, Admissions Medication Reconciliation, or Discharge Medication Reconciliation.
3. (Optional) You may print the Summary window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing Intake/Output for a Patient

The I/O option displays a history of intake/output measurements for a particular patient. This display option provides fluid balances, which represent the totals of fluid intake and fluid output, as well as Net, or the difference between the total intake and total output. Some intake and output components, however, are not fluids and are therefore not included in these calculations. Examples are stool count and number of breast feedings. To view a patient’s intake/output, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on I/O from the display list. The Intake/Output Summary window displays the various types of intakes and outputs in a tabular format. Each total or individual I/O is displayed on its own line. The left column shows the name of the total (such as Net, Intake, and Output) or the name of the individual I/O (such as CT, IVF, Urine, or po), along with the units in which it is measured. Next are one or more columns representing all of the measurements for a particular time interval, such as 8 or 24 hours. By default, the time interval for each column is eight hours. However, you can change the time interval for the columns as needed using the drop-down I/O Display Interval (hours), and selecting a time interval. Columns are always displayed in reverse chronological order, with the most recent data in the left-most column, and older data to the right. You can scroll left and right, as well as up and down, to see all of the data in the table.
4. To see more detailed information for a specific IO, click on the row in the Summary, or click on the name or any cell in the Table. Two small detail panes open below the summary window. The IO Detail pane (lower left) displays a list of all measurements within the interval currently selected. Each row lists the IO value and the date and time. Clicking a cell in the IO table highlights the details corresponding to that cell in this pane. The IO Graph pane (lower right) automatically graphs the values of the given IO value, which are usually numeric and are graphed as a standard line graph. The date/time is on the X-axis, the value is on the Y-axis and each data record is one point on the graph. An asterisk next to an I/O component indicates that a comment has been added for that intake or output. Hold your mouse pointer over the asterisk to display the comment(s).
5. (Optional) Click Graph in the upper right corner of the summary window to graph I/O items.

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Viewing Lab Results for a Patient

Use the Lab Results option to view the results of lab tests that have been administered for a specific patient. The Commure Pro system organizes lab results into panels and components. A panel can consist of a single component, or a group of components that are performed together. For example, a Prothrombin Time (PT) panel might consist of that single component, while a Complete Blood Count (CBC) panel might consist of a variety of components such as a hematocrit, a hemoglobin, a white blood count, and a platelet count. To view lab results, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Lab Results from the display list. The patient data display area shows the Lab Results summary window. The initial list that is displayed includes the most recent panel results for the selected patient. If you are looking for a result that you do not see in the list, click the Load More Data button at the bottom of the list. If additional results exist, they are added to the bottom of the existing list. For more information on loading more data, see Displaying More Lab Results Data.

This summary window lists the patient’s most recent lab results. You can view this list of lab results in any of the four summary view formats below, each of which is described in detail in later sections of this chapter. You can easily switch between the four summary views by selecting the view you want from the drop-down list at the top left of the lab results summary window.

• Panel Summary View
• Expanded Panels View
• Component List View
• Component Table View
  You can also opt to display information and generate reports that meet the College of American Pathologists (CAP) reporting requirements. For more information, see Using the College of American Pathologists (CAP) Reporting Option.

Lab results that fall outside of the normal range are highlighted in either yellow or red. Yellow highlighting indicates that the lab results are abnormal, while red highlighting indicates that lab results are critically abnormal. A blue asterisk next to a lab component indicates that the component has either a comment posted by a lab personnel, or an annotation that you have entered (see Annotating a Component). Holding your mouse pointer over the asterisk displays the comment or annotation. You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Displaying More Lab Results Data

The Lab Results summary window displays the most recent panel results for the selected patient. If there are more results to display, you can load them into the summary window until you see what you are looking for or until all of the available results are displayed. The number of panel results displayed at a time is based on the setting Number of Elements retrieved for “Load More” (Portal). This settings affects the number of results that are initially displayed, and the number of additional results displayed each time more data is loaded. You can refresh the list to reset it to the most recent results by clicking Refresh . The most recent data is loaded when the list is refreshed. Consult your Commure Pro representative if you would like to adjust the default number of elements that are displayed. To display more data, follow these steps:

1. Scroll to the bottom of the Summary list of lab results so that the Load More Data button is visible.
2. Click the Load More Data button to display more results. If additional results are available, they are loaded and added to the bottom of the list. If there are still more results to display, the Load More Data button remains available at the bottom of the current list. Continue to click the Load More Data button until you find the data you are looking for or until all of the data is loaded. When all of the available data is available the Load More Data button is no longer available.
   If a filter is applied, the Load More Data button is only visible when there are more results to display that meet the filter criteria; if all of the results meeting the filter criteria are displayed the button is not visible.

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Sorting Lab Results

The results in all four summary views are sorted in descending order by date, as a default setting. This means that the most recent results are shown first. However, you may change the order in which the results are sorted in any of the first three summary views by clicking on a column heading. For example, if you were looking at Expanded Panels and you wanted to sort the results by normalcy status, so that the critical or abnormal results were grouped together, you could click the Norm column heading. Please note that you cannot change the sort order of the Component Table view. Sorting applies to the data that is currently displayed. If more data is loaded, it is inserted into the list and it affects the sort order. The list must be sorted again after more data is loaded.

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Filtering Lab Results

You may filter the list of lab results, based on several different types of criteria. To do so, click the drop-down filter located in the upper right corner of the summary view window. When you select an item from the filter list, the current summary view (Panel Summary, Expanded Panels, Component List, or Component Table) shows only those lab results that meet the filter criteria. The count of the filtered lab results and the total number of lab results available is displayed in the Panel or Component heading, shown as (# of #). The various types of filter criteria are described here:

• All: Shows all of the patient’s lab results based on the current “Load More” setting (for more information on loading more data, see Displaying More Lab Results Data.
• Out of Range: Select this filter to view only those lab results which fall outside of the “normal” range for the lab test in question.
• Snapshots: Select a snapshot item to view a custom grouping of lab components. For example, you might want to see all components related to coagulation together (such as an INR, PTT, and PT), even though they might not have been administered in a group as a panel, or given on the same date. Your system administrator can set up departmental snapshots of the lab components that most physician’s like to view together, or you can also create your own personal snapshots of favorite groupings. Use the Lab Results Settings option on the Preferences tab to create personal snapshots. For detailed instructions describing how to create snapshots, please refer to Defining Your Lab Results Settings.
• Categories: Select a category to see all the results that fall within that category. If your institution uses them, categories are broad groupings of lab results that are defined by the institution. Categories are different from snapshots, as they are usually a more generalized grouping of lab component types, while snapshots contain a very specific set of related components. For example, you might see categories such as Cardiac, Chemistry, or Endocrine. Since each institution defines their own categories, the ones you see on your filter list may not be the same as those described here. Or if your institution does not use categories, none will be listed.
• Unfiled: Select this item to see the results that are not included in any of the categories defined by your institution. If your institution does not use categories, Unfiled does not appear on the filter list.

Items on the filter list are always listed in the same order as they are in the description above. Specifically, the filter items are listed in this order: All, Out of Range, departmental snapshots, personal snapshots (preceded by an underscore), categories, and then Unfiled.

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Searching for a Specific Panel or Component

The top of the summary view contains a search field and a contains/does not contain toggle that you can use to include or exclude specific panels or components from the summary view. To search for one specific type of panel or component follow the steps below. For example, you might want to see just the CBC panels.

1. Select the desired summary view. Use Expanded Panels or Panel Summary to see panels, or use Component List or Component Table to see components.
2. Select contains as your parameter (click contains or does not contain toggle between the two choices).
3. Type the name of the panel (for example, CBC) or component (for example, PT) in the search field and then click Search . Only those panels or components whose name contains the text you entered are displayed.

In some cases, you might want to exclude a specific type of panel or component from the summary list. For example, you might want to see all lab panels except the CBC panels.

1. Select the desired summary view.
2. Select does not contain as your parameter.
3. In the search field, type the name of the panel or component that you want to exclude and then click Search . All panels or components whose name does not contain the text you entered are displayed.

To return to viewing all panels or components again, clear the text in the search field and press the Enter key.

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Panel Summary View

Select Panel Summary from the drop-down list to see the most highly summarized view. This view contains a row for each panel of components that the patient has had performed. For each panel it shows the date/time of the lab panel, the panel name, the normalcy status of the panel as a whole (normal if all results were normal, abnormal if any component in the panel was abnormal, or critical if any component in the panel was critically abnormal), and the completion status. You can click on any row in the Panel Summary to display the details of that panel. Two small detail windows open: Panel Table on the left and Panel Details on the right.

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Expanded Panels View

Select Expanded Panels from the drop-down list to see a slightly more detailed listing of the patient’s panels. This view displays a row for each panel of components that the patient has had performed. In each panel’s row it shows the date/time of the lab panel, the panel name, the individual components included in the panel and their numeric results, the normalcy status of the panel as a whole (normal, abnormal, or critical), and the completion status. For Complete blood count (CBC), basic metabolic panels (BMP), and Chem 7 panels, the panel detail view also contains a diagram of the results. You can click on any row in the Expanded Panels view to display the details of that panel. Two small detail windows open: Panel Table on the left and Panel Details on the right.

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Component List View

Select Component List from the drop-down list to display the most granular view of lab results. This view displays a row for each component that the patient has had performed. So if, for example, the patient had a particular component performed three times, there would be three rows—once for each occurrence. For each component row it shows the date/time of the component, the panel name to which the component belongs, the individual component name, the numeric lab result value for the component (in either the Low, Normal/Unknown, or High column), the normal range for the component, and the completion status. You can click on any row in the Component List to display the details of that component. Two small detail windows open: Panel Table on the left and Component Details on the right.

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Component Table View

Select Component Table from the drop-down list to see a slightly different detailed display of component lab results. The Component Table is similar to the Component List, in that it is a very granular view, which displays components rather than panels. However, the Component Table uses a table format, while the Component List uses a list format. The Component Table displays the type of component on the vertical axis, with each occurrence of that component type listed on the horizontal axis. The cells of the table contain the numeric lab results for each occurrence of the component on a specific date. There is only one row for each type of component. (The Component List, on the other hand, lists each occurrence of a component in its own row. If a particular component is performed multiple times, there are multiple rows in the list.) Please note that this is the only view of the four summary views that does not allow you to change the sort order by clicking on a column heading. Each component is sorted by its associated category if available. A header row for each category will display and then the associated components are grouped by panels which are listed in alphabetical order. Within each grouping of panels, the components will be listed in the clinically relevant order sent by the backend system. For example, if the “CBC” panel contained eight components, and “Chem 7” panel contained seven components, the components would be sorted as follows: all eight of the CBC’s components first in the sequence as sent by the backend system (since “CBC” falls before “Chem 7” alphabetically), and then all seven of the Chem 7’s components. If components do not have an associated category, the Unified header row displays and the components are grouped by panel which are sorted in alphabetic order. All of a panel’s components will be listed in the order sent over by the backend system. Regardless of the value you enter in the Limit to field, all of the components within a panel are always shown; panels are never truncated. For example, if you entered “6” in the scenario described above, all eight of the CBC’s components would be shown (because it will not truncate a panel), but none of the Chem 7’s components would be shown (because the first component of that panel would be the ninth result, which would exceed the number you entered in the Limit to field). You can click on a table cell containing a numeric result to display the details of that particular lab result. Two small detail windows appear below the Component Table: Component Details on the left and a Component Graph on the right (see Graphing Lab Results). You can also click on a component name on the vertical axis of the table to graph all of the results for that type of component. The Component Graph is displayed below the Component Table.

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Viewing the Details of a Panel or Component

If you would like to see the details of a specific panel or component, simply click on that row or cell in any of the four summary views (Panel Summary, Expanded Panels, Component List, or Component Table). Depending on what you have selected, any combination of the following detail screens may appear below the summary view:

• Panel Table
• Panel Details
• Component Details
  If you have CPOE enabled, you have the ability to reorder any of the labs using the Order Again button from any of these details screens. See Repeating an Order for more information.

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Panel Table

If you click on a panel in either the Panel Summary or the Expanded Panels view, the Panel Table screen appears at the bottom left of the summary view. This detail screen displays a table containing a history of all instances when that same panel was performed for the selected patient. The panels are displayed in a table format with all of the components within the panel listed on the vertical axis, and the dates and times of each occurrence along the horizontal axis. The table cells contain the numeric results for each component. The date/time heading of the particular instance of the panel that you originally selected in the summary list is highlighted in orange. The ability to view the other occurrences of the same panel, along with the specific occurrence in which you were originally interested, allows you to identify any trends in the clinical data. If you click on any cell containing a component’s numeric result, the Component Details screen appears, where you can see further information about that specific lab result. If you click on a component name that is listed on the vertical axis, all of the lab result values for that type of component are graphed on the Component Graph screen (see Graphing Lab Results).

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Panel Details

If you click on a panel in either the Panel Summary or the Expanded Panels view, the Panel Details screen appears at the bottom right of the summary view. This detail screen displays the details of the specific panel that you selected in the summary view. It shows you the date and time of the panel, the components in the panel, the numeric results, and both the normalcy status and normal range for each component. If you click on any component row in this detail screen, the display changes to the Component Details screen, where you can see further information about that specific lab result.

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Component Details

If you click on a row in the Component List, a cell in the Component Table, or on a component’s result in the Panel Table or Panel Details (either of the two detail screens described above), the Component Details screen is displayed. This detail screen shows you information about that one specific component lab result. You can see the date and time it was performed, the numeric result, the normalcy status, the normal range for the component, the completion status, and any comments or annotations. In some cases, the lab component contains formatted results, such as columns or tables. In this case, it is automatically displayed in a fixed-width font to preserve the column/table layout. In addition, a Change Font icon appears, allowing you to toggle between a fixed-width font that does not wrap (useful for formatted results) and a variable-width font that does wrap (useful for viewing long comments). You can click Graph to graph this lab result along with other occurrences of the same type of component, over time (see Graphing Lab Results).

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Using the College of American Pathologists (CAP) Reporting Option

Physician Portal can also be configured to display lab results and reports that meet the College of American Pathologists (CAP) reporting guidelines. To activate this option, contact your Commure Pro representative. When activated, both the panel and component details panes (and associated CAP reports) display the following new information:

• Collected Date/Time: Date and time the panel was completed.
• Normalcy Flags: Flags (H, HH, L, and LL) for components.
• Units: Units of measure (for example, mmol/L or mg/dL) for components.
• Resulted Date/Time: Date and time the lab results were posted.
• Ordering Physician: Name of physician who ordered the lab work.
• Performing Lab Abbreviation/Name/Address: Abbreviation, name, and address of the lab that performed the lab work.
• Medical Director: Name of Medical Director for the facility.

You can also print CAP reports for both panel and component details that show the additional information for components.

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Graphing Lab Results

Lab results can be graphed so that you can see a pictorial representation of the results over time. There are two ways you can graph lab results:

• You can click Graph in the top right corner of any of the four summary windows (Panel Summary, Expanded Panels, Component List, or Component Table) to access the multi-graphing feature. Multi-graphing allows you to graph multiple clinical items together, such as lab results, medications, I/Os, and vital signs. Please refer to Multi-Graphing Clinical Data for a detailed explanation of multi-graphing.
• While viewing some of the summary or detail lab displays, you can graph the results of an individual component. You can graph just the selected component, or you can graph the selected component against one additional component. This section describes how to do this.

There are several screens from which you can graph an individual component’s results:

• Component Table: This is one of the summary views. It displays all component types, with the results of each occurrence of the component listed in columns from left to right. Simply click on a component name in the left-most column to display a graphical representation of that component’s results (see Component Table View).
• Panel Table: This is one of the detail views. It displays all of the components of a particular panel, along with the results of other occurrences of the same panel listed in columns from left to right. Again, simply click on a component name in the left-most column to display a graph (see Panel Table).
• Component Details: This is one of the detail views. It shows you the details of one specific occurrence of a component result in a textual format. A Graph button is located in the upper right corner of the Component Details window. Click on it to graph the results of this particular occurrence of the component’s results along with any other occurrences of the same type of component (see Component Details).

Regardless of which method you use to display the graph, the format of the graph itself is the same. The normal bounds for the component are shaded green. The high and low values appear outside the normal bounds, and are shaded red. To display the exact numeric value for a specific data point on the graph, hold your mouse pointer over that point (you do not have to click on the point). Most lab results are numeric. However, if a lab result contains any non-numeric characters (for example, “straw” or “+2” or “<.5”), then it is not included on the graph, and message to that effect is displayed. The graph shows the data for each component based on the overall time range displayed in the panel table for that component (30 days maximum.) To view the details of a component in the Component Details window, select the specific date and time in the panel table. The data is updated in the Component Details window. While viewing the graph of a single component, you can graph it against one additional component. Just select the second component from the drop-down list in the upper right corner, and it is added to the graph.

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Annotating a Component

You can add annotations to a component result at any time. These are your personal remarks, or reminders to yourself, about the patient’s lab results. Annotations are visible to only you—other physicians cannot see them. You can enter an annotation from either the Component List in the summary window, or from the Component Detail window. Note that an annotation is associated with a specific component in a panel. You cannot post an annotation to the panel as a whole. To enter an annotation, follow these steps:

1. Display the specific component lab result that you wish to annotate, using any of the methods described in the Viewing Lab Results for a Patient section.
2. Click Annotate, located in the top right corner of either the Component List in the summary window, or the Component Detail window. The Annotate Component window appears.
3. Type your free text annotation in the Annotation field.
4. Click OK to save your annotation, or click Cancel to close the window without saving the annotation. The annotation is now associated with the component lab result.

Once a component is annotated, the annotation itself, or a blue asterisk indicating that an annotation exists, appears in a variety of displays below. You can hover your mouse cursor over the blue asterisk to read the annotation.

• In the Panel Summary, an asterisk appears next to the panel name, if one or more of the components in the panel have an annotation.
• In the Expanded Panels view, an asterisk appears next to the names of any components containing annotations.
• In the Component List, an asterisk appears next to the names of any components containing annotations.
• In the Component Table, an asterisk appears in the table cell for any component results that have an annotation.
• In the Panel Table detail window, an asterisk appears in the table cell for any component results in the panel that have an annotation.
• In the Panel Detail window, an asterisk appears next to the lab result value, if any component in the panel has an annotation.
• In the Component Detail window, the full text of the annotation appears at the bottom of the textual lab result.

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Marking All Lab Results as Viewed

Any lab results which you have not yet viewed on the Commure Pro Physician Portal are displayed in the New Results option display or the Patient Summary tab, while those that you have viewed are not displayed in the areas. You can also mark all of a patient’s lab results as viewed without having to individually select and display each one. See Marking Clinical Data as Viewed for more information and instructions on this topic.

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Viewing Medication Orders for a Patient

The Medications option displays a history of medication orders for a given patient. You can view the original order from the physician for each medicine including its name, dosage, schedule, and possible conditions of administration to the patient such as PRN, conditionals and alternating IVs. If your source medication system tracks Medication Administration Record (MAR) information, the Physician Portal can also display MAR information for each medication order. The CPOE Medications setting is used to ensure that the Medications Orders window matches the Orders window view as it appears when the Medication Order Type is selected. If the Medications setting is enabled and CPOE Medications is disabled, the previous Medication Orders window is displayed in the patient data display area. To view a patient’s medication orders, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
   For sites with Commure Pro CPOE™ enabled, the timeframe can be expanded up to 5 years in the past.
3. Click on Medications from the display list. The patient data display area shows the Medication Orders window. It includes the medication name, the dose, and the sig (route and frequency), and the dates the order should start and stop. If MAR data is available, it also displays the last date and administration status of the medication. For sites with Commure Pro CPOE™ enabled, the patient data display area also includes PRN, status, therapeutic class, and who ordered the medication. Discontinued orders, or any orders with a stop date/time earlier than the current date/time, are displayed with a line struck through the text of the name.
   A medication with zero dosage displays a blank dosage field in the Medication Orders window. To view further information, including dosage instructions, click on the medication to open the Medication Detail pane.
   • You may change the order in which the medications are sorted, by clicking on a column heading. For example, clicking the Medication heading would sort the medications alphabetically by name.
   For non-CPOE sites, when sorting medications based on Status, the sort order is defined by an institution-level setting. Clicking the Status heading sorts the medications in an order that is defined by the following setting:
   Admin - Institution - Medications - Medication Status Sort Order
   • Click Graph in the upper right corner of the summary window to graph any medication against multiple clinical items (see Multi-Graphing Clinical Data).
   • (CPOE-sites only) You may filter the list of medications by class of medication. To do so, click the Drug Class drop-down filter located in the upper-right corner of the Medication Orders window.
   You may also filter the list of medications by type. To do so, select the Show drop-down located in the upper-right corner of the Medication Orders window, and then select the medication type from the list to apply the filter to the list of medications.
   • (Non-CPOE sites only) You may filter the list of medications, by type or types of medication. To do so, click the Filter button located in the upper right corner of the Medication Orders window.
   Select an item, or a combination of items, from the list to view only those types in the Medication Orders window. You can filter the list of medications to display only those in which you are interested. Each of the predefined filters is described below. Please note that discontinued medication orders can appear in any of the filters below, except the Active and On Hold filters.
   • All: A comprehensive list of all medication orders, including active, future, and discontinued orders.
   When All is selected as the filter, the Exclude Future Orders checkbox appears in the title bar of the summary pane. Check the box to exclude all future medication orders from the list of all medication orders. Future medications are medication orders that have a start date in the future.
   • Active: Medication orders that are currently being administered. This includes all medications that do not have an end date, or that have an end date later than the current date and time.
   When Active is selected as the filter, the Exclude Future Orders checkbox appears in the title bar of the summary pane. Check the box to exclude all future medication orders from the list of active medication orders. Future medications are medication orders that have a start date in the future.
   • Scheduled: Medication orders that are to be administered on a regular schedule (i.e., medications other than PRN). This includes both active and future Scheduled medications.
   • On Hold: Medication orders that are being withheld temporarily or are not being administered, based on the deactivation and reactivation dates that have been specified on the order. If your source system is Cerner^®, this filter shows medications with a Suspended or On-Hold status.
   • PRN: Medication orders that are to be given on an as needed basis, such as for pain. This includes both active and future PRN medications).
   • Conditional: Medication orders in which some aspect of the order is based on a piece of clinical data or a clinical judgment. For example, the dosage for an insulin order might be based on the patient’s current blood glucose level. This includes both active and future Conditional medications).
   • Alternate: Medication orders where two medications, or differing doses of the same medication, are given sequentially. This includes both active and future Alternate medications).
   • IV: Medication orders where the route is intravenous or contains the letters IV, such as IV or IVPB. This includes both active and future IV medications).
   • Discontinued, or Status: D/C, or Status: Discontinued : Depending on your source medication ordering system, any of these three filter names may be used to signify medication orders that are no longer being actively administered.
   • Unverified: Depending on your source medication ordering system, the Unverified filter may be available. This filter displays medications that are not flagged as having been verified in the back-end system.

The header row keeps track of the total number of medications for the patient and how many are displayed when a filter is used. For example, if All is chosen, you may see (7 of 7) displayed which means that all seven medications orders are displayed; however if you chose a different filter, you may see (2 of 7) which means only two of the seven medication orders are displayed.

4. If you would like to see the details of a specific medication order, click on that item in the Summary list. One or two Detail screens open below the Summary list. The first Detail screen (left pane) shows all known information about the medication order. The information shown depends on the type of medication and your source system (many of these fields are available only if your source system is MEDITECH). You might see the SIG, Strength, Rate, Dose Instructions, Admin Criteria, PRN Reason, Special Instructions, On-Hold Comments, Start and End Dates, Hold Date, Resume Date, Date Ordered, Ordered by (ordering physician), Order Status (from your source medication ordering system), Order ID, Notes/Comments, Label Comments, or Pharmacy RX Comments. In addition, you might also see information about linked orders or compound orders. The second Detail screen (right pane) appears only if Medication Administration Record (MAR) information is available. It displays every date and time for each medication administration event, the dose administered, and the person who administered it. It also includes a medication status, if available. The statuses vary depending on your organization’s source HIM system. For example, if a medication was not administered as ordered and this fact was documented, the Status column might contain the words “Not Given” or “Pt Refused.”
   • Some orders may have items listed in a Related Orders section of the left Detail screen. These are linked orders(as indicated by the Linked Medication icon). Linked orders are orders for medications that are related, typically because they are administered together. For example, Meperidine (Demerol) can be ordered for pain, along with Promethazine (Phenergan) to prevent the nausea that is often caused by the Meperidine. Both drugs are commonly administered together after surgery.
   If you see a linked order in the Related Orders section of a detail screen, you can click on it to change the detail screen to display the information about the related medication.
   • A compound order consists of a base medication with one or more additives or diluents that are subsidiary to the base medication. The most common examples of compound orders are found in IV medications. In the Summary list, the row for a compound medication displays as follows: the base medication is listed first, with the additives indented below it. In the Detail screen for the base medication, the additives are also listed under the base medication.
5. If your organization has implemented a link to one or more on-line drug reference tools, a link appears in the title bar of the medication summary window and/or the medication detail window. This feature can be customized via XML so that specific users, departments, or facilities can each link to different on-line references. When implemented on the summary window (Check Interactions), the Commure Pro system retrieves the patient’s full list of active medications so that you can check for drug interactions. When implemented on the medication detail window (Reference), the system pulls the currently selected medication so that you can look up general usage information for that particular drug. When retrieving medication information for use as the search string, the Commure Pro system uses the appropriate identifiers for the medications, such as the medication name, depending on the requirements of the on-line reference tool. Just click the link to access the on-line drug reference tool. You may be required to enter a username and/or password for the drug reference tool the first time you access it. 6. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing Orders or Order Status for a Patient

You may view the status of your existing orders within the Patient Data Display. Depending on your configuration, you may see either the Order Status display option or the Orders display option. The Orders option is available only if Commure Pro CPOE™ is enabled; otherwise the Order Status option displays.

• Viewing the Order Status Display Option
• Viewing the Orders Display Option

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Viewing the Order Status Display Option

If your organization has not implemented Commure Pro CPOE™, you can use the Order Status display option to check the status of any orders for a given patient. This option lets you see the status of the ordering process within your source order entry system, as well as the status from the department that processes the order. Depending on how your source order entry system is configured, you might be able to view the status of orders for the following types of items: tests, dietary needs, consults, notes, etc. This option is unique in that it not only shows you the orders for tests that have available results, but also shows you those in progress. This allows you to avoid redundant ordering for tests that have been taken, but for which the results are not yet available. To view orders, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on Order Status from the display list. The patient data display area shows the Order Statuses window. This summary list displays the date and time of the order, the name of the order, and the completion status.
   For systems with MEDITECH^® back-ends, the summary list contains a fourth column for the Service date and time (the date and time the order was resulted). Furthermore, for those orders that are associated with meal times such as breakfast, lunch, or dinner, an abbreviation for the type of meal replaces the numeric time.
   If you would like to change the sorting order of the Order Statuses summary list, simply click on a column heading. For example, if you click the Date heading, the sort order of the list toggles between ascending and descending chronological order by order date. You can also choose to view only active orders by clicking the checkbox next to Active Only in the Order Status title bar.
4. To view further information about a particular order, click on the row containing that order. A detail window opens below the summary list. The detail window shows you the full name of the order, the status of the order in your order entry system, the status of the order in the department that is processing it, the start and stop dates of the order, the ordering physician, and any additional details.
5. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing the Orders Display Option

If your organization has implemented Commure Pro CPOE™, you can view a patient’s existing and new orders in the following ways using different filters:

• Viewing Order Type Icons
• Viewing Patient Orders by Order Type
• Viewing New Orders
• Viewing Existing Orders
• Finding and Viewing Orders

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Viewing Order Type Icons

All orders, new or existing, have an icon to represent their order type. These icons will help you easily identify the types of orders in either the Existing Orders for this visit, Existing orders for other visits, or New Orders lists. They are located to the left of the order name. These icons represent each order type as follows:

• Diet — fork and knife icon
• Lab — flask icon
• Medication — capsule icon
• Nursing — nurse icon
• Other — clipboard icon
• Radiology — x-ray icon

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Viewing Patient Orders by Order Type

There are filters available that allow you to group or hide your patient orders for easier viewing. You can use both filters together or by themselves. For example, if you only want to see all orders except nursing and you want to see them grouped by order type (Labs, Medications, etc), you would use two filters simultaneously. You can find these filters in the Patient Orders heading of the Order Entry window next to Filter. By default, the Group by Type checkbox is checked. All orders in the New Orders, Existing Orders for this current visit, and Existing orders for other visits lists display grouped in the following sequence: Medications, Lab, Radiology, Other, Diet, and then Nursing. To ungroup your list of orders by order type:

• Uncheck the Group by Type checkbox in the Patient Orders heading.

All orders in the New Orders, Existing Orders for this current visit, and Existing orders for other visits lists are no longer grouped by type. To view only orders of a specific order type:

1. Select the Show drop-down in the Patient Orders heading. A list of available order type filters displays.
2. Select the order type filter from the drop-down to apply to the list of existing orders. The list of existing orders displays only the orders for the selected order type. For example, if you chose Medication PRN Only, the order type drop-down changes to Meds PRN Only and only the medication orders with a PRN display.
   Expiring orders that need to be renewed will always be listed at the top of the Existing orders for other visits list and are not affected by any sorting.

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Viewing New Orders

The New Orders list displays all new orders available for submission and, by default, lists them in the order in which you entered them with the last entered order at the top of the list. You can also view the details of each new order:

1. Select an order in the New Orders list. The Order Details window displays.
2. Click Cancel to return to the New Orders list.
   If you wish to make changes to the order, see Modifying the Details of a New Order.

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Viewing Existing Orders

From within the Order Entry window, you can view a patient’s list of existing orders for the current visit or existing orders from previous visits using different filters or you can view the specific status details of an existing order. Transfer orders if configured to be held for routing until the patient actually transfers will display as follows:

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

Displaying Orders from a Current versus Previous Visit When you are in the Order Entry window, the list of existing orders for the current visit displays in the upper right section of the Order Entry window under Existing orders for [current visit date and visit type]. If there are existing orders from a previous visit, you will see the Existing orders for other visits header at the bottom of the screen below the Existing orders for [current visit date and visit type] list. By default, these older orders are not displayed. You must click the Expand icon located in the upper right corner of the Existing orders for other visits header to display these orders. Sorting the List of Existing Orders

1. Select a column heading of either Start (start date of order), Status (order’s current condition such as active, pending, or complete), or the order description of Existing orders for this visit or Existing orders for other visits as the criteria for sorting and viewing your patient’s list of orders. A triangle appears next to the column name to indicate the selected sort order. The position of the triangle indicates if the orders are sorted in ascending or descending order using the following columns:
   • Status- in the following order: Submitted (all orders submitted in Commure Pro display as italicized), Held for Routing, Ordered, Active, Held, Pending, DC’d, Complete, Cancelled.
   Within each Status grouping, orders are then sorted by their Name/Description.
   • Start- the date and time the order started
   • Name- alphabetically by order name/description
   Non-medications, only: when sorting by Name, the Order Group that the order belongs to is considered first, followed by the order’s descriptive text. For this reason, the list may not appear to be alphabetical because in some cases the Order Group abbreviation appears at the front of the name and in other cases it appears at the end; the Order Group abbreviation is always considered before the Name/Description text, regardless of its position.

2. (Optional) Select the column heading a second time to reverse the sort.

Viewing Existing Orders within a Specific Timeframe You can choose to only view existing orders within a specific timeframe including past, current, and future orders.

1. Select the Show Orders from: drop-down and choose the desired starting timeframe.
2. Select the thru: drop-down and choose the ending timeframe. The Existing orders for the current visit list changes to display only the orders that are active (included pending or submitted) or completed within the selected timeframe. Medication orders that are completed will display grayed out and with a strike through.

Viewing Active Existing Orders Since list of existing orders will display any existing order that meets the specific timeframe that are active (included pending or submitted) or completed, you can choose to have only active orders display.

• To do this, select the Active Only check box located to the left of the Show filter.

The timeframe filters Show Order from and thru disappear as they are not used. Only active orders display. Viewing the Status Details of an Existing Order You can view the specific status details of an order. For example, you can view the medication detail (Start date, end date, ordering physician, etc.) and MAR information of an existing medication order.

1. Select an order from your patient’s Existing orders for this visit or Existing orders for other visits list. The Order Status window for the selected order displays.
   For diet orders, the Order Details window displays as it also contains the order status information.
2. Click Close to return to the Order Entry window.

Viewing the History for an Order If enabled at your organization, you can see the entire history for a particular order from the Order Details screen. For example, you can view information such as the date and time the order was placed, the physician who placed and signed the order, if the order was ever on hold, and the current status of the order. This historical information is available only on existing orders, since new unsubmitted orders do not yet have any history.

1. From the Orders Summary, select an order in the Existing Orders section. The Order Details screen opens and displays the information for that order.
2. In the Order Detail section, select View Order History. The Order History screen displays a complete history of the order from the time it was placed until the current moment.
3. Click Close to return to the Orders Summary window.

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Viewing an Overview of a Patient

This option shows you a high-level overview of the patient. This display is a composite of two, or possibly three other displays: Visits, Charges, and Clinical Notes, depending on the features your organization has implemented. The overview simply stacks these displays one above the other, to facilitate viewing different types of information all in one glance. At the bottom of the screen is a detail window, which displays the details of the currently selected item, whether it be a visit, charge, or clinical note. To display an overview, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on Overview from the display list. The patient data display area shows the Overview window. Each of the windows in the Overview functions in the same manner as it would when viewed individually. For information about how these display options function, please refer to the descriptions of these items in the preceding sections:
   • Viewing Visit Information for a Patient.
   • Viewing Charges for a Patient.
   • Viewing Clinical Notes for a Patient.
4. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing Patient Details

The Patient Detail option allows you to view detailed information about the patient. The following types of information are available:

• Demographics such as name, date of birth, gender, social security number, address, telephone, and MRN.
  In some cases, a patient record can have more than one MRN, if that patient is associated with more than one facility in your source system. This can occur in a single-domain environment when MEDITECH is your source ADT/Registration system. In this case, all MRNs associated with the patient are displayed.
• Visit information such as the patient’s InFacility visit (please refer to Understanding How a Patient List is Created for a definition of InFacility visit).
• Resuscitation/Code Status - includes the Code Status and any comments.
• Names of the physicians involved in the patient’s care. For Commure Pro Messaging users, a Patient Care Team link may be available under the Physicians section, if Care Team integration has been setup by your Administrator for your site and for your user.
• Guarantor and billing information.
• Other information specific to your organization, such as next of kin, code status, or advance directives may also be available.

Keep in mind that the amount of information available depends on your source ADT/Registration system, as it is from there that the information is derived. If a manually registered patient has since been merged with an authenticated patient, this display also provides the ability to unmerge the two patient records, if the merge was a mistake. You can do this if you have administrative privileges using the Merge History link at the bottom of the Demographics section of the display. For a full discussion of manually registering patients, merging patient records, and unmerging patient records, please refer to Registering Patients and their Visits. To view detailed information for a specific patient, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Patient Detail from the display list. The patient display area shows the Patient Detail window.
3. (Optional) You may print the Patient Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.
4. (Optional) If a Patient Care Team link is available under the Physicians section, click the link to open the Care Team screen in Commure Pro Messaging, and begin communicating with a member of the patient’s care team. See Communicating with a Patient’s Care Team in Commure Pro Messaging for more information.

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Viewing Patient Photos

The Photos display option lists available photos for the selected patient. This list may include photos taken to register a new patient (referred to as photo registration), photos taken of or about an existing patient, photos supporting charge documentation (see Associating a Photo with a Charge Transaction), photos of handwritten notes that a physician wants to capture quickly, or other useful items associated with a patient. Most photos available here are taken using the Commure Pro application on an Android or Apple device. However, your organization can also implement an XML customization that allows users on the web platform to upload photos or PDFs to a patient’s record. The default patient photo settings allow each user access to view, edit, and delete only photos or PDFs they have taken or uploaded. Access to other user’s photos/PDFs can be expanded to include items taken by users in the same department, facility, or users in all departments and facilities. This access, as well as other rights, is controlled by settings in your user profile. To view patient photos or PDFs, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Photos from the display list. The patient data display area shows the patient photos and PDFs that you are able to view.
   • Each photo or PDF is displayed in a row with the Date/Time the item was taken or uploaded, the Title given to the item (or the default if none was given), the user who created the item (Created By), a thumbnail image of the item, and icons to Delete the item or mark it as Purgeable/Non-Purgeable, if you have rights to do so.
   • You may change the order in which photos and PDFs are sorted by clicking on a column heading. For example, clicking the Title heading would sort the items alphabetically by name.
   • The most recent photos and PDFs are displayed initially, and the number of items listed is based on an institution-level setting. If you are looking for an item that you do not see in the results list, click the Get More Photos button at the bottom of the list. If additional items exist, they are added to the bottom of the existing list incrementally based on the institution-level setting.
   Consult your Commure Pro representative if you would like to adjust the default number of results that are displayed. For information on loading more data, see Displaying More Patient Photos.
3. To view a photo, click on the row in the summary list. The photo opens inside an image viewer.
   • You may adjust the photo using the viewer controls.
4. To view a PDF, click on the row in the summary list. The PDF opens inside an image viewer.
   • You may adjust the PDF using the viewer controls.
5. Click the Previous button or the Next button to navigate to additional photos or PDFs in the summary list.
6. Click Close to close the photo or PDF when you have finished viewing it. Or, if you click on a different patient from your list, the image automatically closes.

Settings that control this feature:

• Admin - User - Patient List - Patient Photo View Permission
• Admin - User - Patient List - Patient Photo Edit/Delete Permissions

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Displaying More Patient Photos

The Photos window displays the most recent photos or PDFs for the selected patient. If there are more items to display, you can load them into the window until you see what you are looking for or until all of the available items are displayed. The number of items displayed at a time is based on an institution-level setting. This settings affects the number of recent items that are initially displayed, as well as the number of additional items displayed each time more items are loaded. The default is 100 items. Consult your Commure Pro representative if you would like to adjust this value. To display more data, follow these steps:

1. Scroll to the bottom of the list so that the Get More Photos button is visible.
2. Click the Get More Photos button to check for more photos or PDFs.

If additional items are available, they are loaded and added to the bottom of the list. If there are still more items to display, the Get More Photos button remains available at the bottom of the current list. Continue to click the Get More Photos button until you find the data you are looking for or until all of the data is loaded. When all of the available data is available the Get More Photos button is no longer available.

3. (Optional) You reset the display to show only the most recent items by clicking Refresh . The most recent data is loaded when the list is refreshed.

Settings that control this feature:

• Admin - Institution - Site Administration - Number of Elements retrieved for “Load More” (Portal)

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Viewing Problems for a Patient

Use the Problems option to view a summarized list of diagnosis codes on file for a particular patient. The problems on a patient’s Problem List can come from a variety of sources, listed below. In all cases below, the Commure Pro system keeps track of the date a problem was last used, so that providers can easily identify the most recent or chronic problems for a patient.

• Problems might be entered in your source system and then interfaced to the Commure Pro system.
• Problems can be entered as the diagnosis on a charge transaction in Commure Pro’s Desktop Charge Capture and Mobile Charge Capture applications.
• Problems can be entered as part of a clinical note via Commure Pro’s NoteWriter and Mobile NoteWriter applications.
• Problems can be entered as the reason for an order in Commure Pro’s CPOE and Mobile CPOE applications.
• Problems can be entered for patients, independent of charges/notes/orders, using this Problems option (also available on mobile devices).

The summary list shows you the diagnosis code and description (either ICD-9 or ICD-10, based on your system configuration), the status of the problem, the date it was last used, and the person who last used it. In addition to the summary of problems, you can also view detailed information for any specific problem on the list. To view problems, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on Problems from the display list. The patient data display area shows the Problem List window. It contains columns for Description, Status, Last Used, and Last Used By.
   • If you would like to change the sorting order of the problems summary list, simply click on a column heading. For example, if you click the Description heading, the sort order of the list toggles between ascending and descending numerical order by diagnosis code.
   • By default, all of a patient’s problems are shown on the problems summary. You can use the Active filter to limit the number of problems that are displayed and view only those problems that are currently active for the patient. Active problems are those that have not been marked as Inactive or Resolved. To do so, click the drop-down filter located in the upper right corner of the Problems window and select Active.
   • You can mark an active problem as resolved by clicking the Resolve button. A status of Resolved and a Resolved Date of today are automatically assigned to the problem. If a problem is Inactive or Resolved, you can mark it as active again by clicking the Activate button.
   • You can delete a problem that was entered using either of these methods:
   • Click Delete on the problem’s row in the summary list.
   • Select the problem from the summary list and then click the Delete button on the Detail pane.
4. (Optional) You may print the Summary by clicking Print . For details on printing in the display area, see the text describing the Print icon in Understanding the Patient Data Display.
5. To view further information about a particular problem, click on the row containing that problem. The Problem Detail window opens below the summary list. The Problem Detail window shows you the problem Description, ICD-9 Code, ICD-10 Code, SNOMED code (if applicable), an HCC indicator, Status, Created Date, Created By, Onset Date, Diagnosed Date, Resolved Date, Last Used Date, Last Used By.

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Viewing Test Results for a Patient

The Test Results option shows you a summarized list of the clinical results of tests that have been performed on a patient. This includes text-based results and PDF files. The most common types of test results that you might be able to see include radiology, pathology, microbiology, blood bank, or other test types that involve clinical interpretation. To view test results, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click Test Results from the display list. The patient data display area shows the Test Results summary window. The summary window displays the date and time the test result was dictated, the test name, and the completion status. For institutions using MEDITECH^® as their back-end system, microbiology results may also display the organism isolated, if any, just under the name of the microbiology test. If the organism isolated field contains a value, then the row appears highlighted in the summary window so it is easily identifiable. Note that this highlighting is displayed on-screen only and does not appear in printouts.
   Radiology test results may be available to view when the exam result status is “Taken” in the source system. These results display in the summary window with “Taken” in the status column. Providers can then view the exam result before the report has been sent. When the test result report becomes available, the result status is updated in the summary window.
   Consult your Commure Pro representative if you would like to make this window larger or smaller via an XML customization.
   • Any test results that you have not yet viewed on the Commure Pro Physician Portal have their names displayed in bold typeface. Once you have selected a test result and viewed the details, the typeface changes to regular text. This feature helps you to quickly identify those results which require your attention. You can also mark all of a patient’s test results as viewed without having to individually select and display each one. See Marking Clinical Data as Viewed for more information and instructions on this topic.
   • You may change the order in which the Test Results are sorted, by clicking on a column heading. For example, clicking the Test heading would sort the tests alphabetically by type of test. You could then look at all of the results for a specific type of test together.
   • You may filter the list of test results, by type of test. To do so, click the drop-down filter located in the upper right corner of the Test Results window. The various types of tests used by your institution are included in the filter list. Select an item from the list to view only those types in the Test Results window. Notice that the count display changes to reflect the actual number of test results displayed out of the total number of test results available. For example, if you applied the Radiology filter and only 2 test results display out of a total of 10 test results, you will see (2 of 10) displayed in the Test heading.
4. If you would like to see the details of a test result itself, simply click on that test result in the summary list. A detail screen opens below the summary list, showing you the full contents of the test result. The test results are shown in either variable-width or fixed-width font, depending on the type of test result. For example, microbiology test results may be shown in fixed-width font to preserve any formatting required for tables within the results.
   If your source system is MEDITECH^®, the text of the report may include the report date/time from the MEDITECH system, which can be different from the dictated date/time in the summary window.
   • Use the Search field at the top of the detail window to find all instances of a particular word or phrase in the result. First type in the desired phrase, and then click Search (or press the Enter key on your keyboard). Click repeatedly on the icon to move to each subsequent occurrence of that word or phrase in the result.
   • Use the Change Font icon to toggle between a fixed-width and variable-width font. The fixed-width font preserves the formatting of the report and makes it easier to read results that use a table or columnar format.
   • Use the Order Again button to reorder the test if you have CPOE enabled. See Repeating an Order for more information.
5. If your organization has implemented a link to an external imaging system, such as a Picture Archiving and Communications System (PACS), or a cardiology system for EKGs, that link appears on the title bar of the test detail window. Just click the blue hypertext link to access the imaging system and view the image in question. You may be required to enter a username and/or password for the external system the first time you access it.
6. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing the Details of a Scanned Test Result

To view the details of a scanned document, you can use the vertical and horizontal scroll bars. There are also several controls at the top of the detail window that allow you to manipulate the scanned image for better viewing.

• Use the controls at the top left of the detail window to reduce the document, fit the document to the window, or enlarge the document.
• Use the controls at the top center to go to the first page, previous page, next page, or last page of the document.
• Use the controls at the top right to rotate the document to the left, or rotate it to the right.
  The Search field is not available for scanned documents.

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Viewing Visit Information for a Patient

Use the Visits option to review all the visits on file for a particular patient. The summary includes both inpatient and outpatient visit information. In addition to the summarized list of visits, you can also view detailed information for any specific visit on the list. The amount of detailed visit information available depends on your source ADT/Registration system, as it is from there that the information is derived. To see visit information, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click Visits from the display list. The patient data display area shows the Visits Summary window, which displays the following information:
   • Arrival: Depending on the type of visit, this can be either an admission date (as in the case of an inpatient or emergency room visit), an appointment date (as in the case of an outpatient visit), or a start date (as in the case of a recurring visit).
   • Provider: Depending on the type of visit, this can be either the scheduled provider (as in the case of outpatient or recurring visits), or the attending provider (as in the case of inpatient or emergency room visits, or when the scheduled provider field is blank on an outpatient or recurring visit).
   • Discharge: If the type of visit includes a discharge date (as in the case of an inpatient or emergency room visit), and one has been recorded, it is displayed here.
   • Type: This is the type of visit, such as inpatient, outpatient, emergency room, etc.
   • Reason for Visit: The reason the patient was admitted, or the reason the visit was scheduled.
   • Billable: This column contains a checkmark if the visit is considered eligible for billing. Whether or not a visit is eligible for billing is based on the # of Days Beyond the Visit End to Allow Editing a Charge setting in the current user’s preferences. This setting determines how many days past the visit’s end date (typically the discharge date or appointment date), that the user may enter or edit charges. Let’s look at an example where this field is set to 5. For visits that have admit and discharge dates, only visits that are currently still admitted, or that have been discharged within the last 5 days, would be considered billable. Or for visits with an appointment date, only those with appointment dates within the last 5 days would be considered billable. Level 3 users cannot enter charges for non-billable visits. However, administrators with level 1 or 2 access can still enter charges for visits that are outside of what is normally considered to be the “billable window” (thereby allowing them to make corrections when necessary, or bill for missed charges).

You can change the sorting order of the Visits display by clicking on any of the column headings. For example, if you wanted to sort the visits by the responsible provider, you could click the Provider field, which would sort the visits alphabetically by provider last name. You can filter the list of visits by type of visit. To do so, click the drop-down filter located in the upper right corner of the Visits window. The various types of visits used by your institution are included in the filter list. Select an item from the list to view only those types in the Visits window.

3. You can view MEDITECH linking of account information for a newborn baby and the mother of the newborn. This linkage is established in MEDITECH and is then pulled into Commure Pro by means of the Bridge. From the mother’s patient record, you can view a newborn patient record and vice versa. To view the linkage between a mother and her newborn, select the patient that contains the established link. Then, click Mom Baby Linkage. The linked patient (either mom or newborn) is displayed.
   You can view the linkage only when a link has been established between the two visits in MEDITECH. Any subsequent visits that have not been linked are not viewable.
4. If you would like to see further detail about a particular visit, simply click on it. A Visit Detail screen opens below the Visits summary list, which shows you items such as care center, visit number, medical service, billing information, resuscitation/code status (Code Status will also display next to patient name/MRN in the heading bar if enabled), and the physicians who were responsible for the patient during the visit. The details shown depend on the type of visit you are viewing. For example, if the patient visit is an Inpatient visit, you will see the Admit Date/Time, and if it is an Outpatient visit, you will see the Appointment Date/Time. If your organization has implemented Charge Capture, the Visit Detail window contains an Add Charge to this Visit button in the upper right corner. After viewing the details of a particular visit, you can post charges to that visit, or encounter, by clicking on this button. The Visit Detail window also contains an Edit Visit button, if you have privileges to edit visit information.
5. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing Vital Signs for a Patient

The Vitals option displays a history of vital sign readings for a particular patient. The physiological parameters that are displayed as vital signs varies by institution. The following are a few of the common parameters that hospitals may choose to display:

• Pulse Rate: The rate at which the patient’s heart is beating, usually in beats per minute.
• Respiratory Rate: The rate at which the patient is breathing, usually in breaths per minute.
• Blood Pressure: The pressure(s) at which blood flows through the peripheral vascular system. Systolic and diastolic pressures may be reported separately or as a compound measurement (for example, 120/80), usually in mmHg.
• Blood Pressure Mean, or Mean Arterial Pressure (MAP): A calculated blood pressure that may be available from some back-end systems. This weighted mean is calculated as MAP = (2/3) Systolic Pressure + (1/3) Diastolic Pressure
• Temperature (Fahrenheit): The patient’s temperature as obtained from a given anatomical location (such as, oral, axillary, ear, or rectal), reported in Fahrenheit.
• Temperature (Calculated Celsius): The patient’s temperature in Celsius, calculated from the value measured in Fahrenheit.
• O2 Sat by Pulse: The oxygen saturation (SaO₂) level of the patient’s blood as determined by a pulse oximeter, usually reported in percent (%).
• ED Arrival Time: Displays the date and time the patient arrived in the ED.

To view a patient’s vital signs, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Vitals from the display list.
3. Select the amount of information you wish to display using the Timeframe and Display at most n full day(s) options. These two options are used together to determine the date range of vital sign information that is shown in all of the vital sign displays, including the vital signs Summary, the vital signs Table, the Vital Detail pane, and the Vital Graph pane (see below for more information on each of these displays). The Timeframe is applied first, and then any necessary adjustments are made based on the Display at most n full day(s) value. For example, if your Timeframe is set to “Last 30 Days,” and then you enter “7” in the Display at most n full day(s) field, the vitals display will show data for the elapsed portion of the current day, plus the data from the seven full days prior to that. A “day” begins whenever your organization starts its first shift (designated as the First Shift Start Time in Commure Pro), and consists of three eight-hour shifts.
   Any Timeframe that starts with the word “Last” functions as described above. However, the date range will vary if you choose a Timeframe of “Specific Date Range,” or one that includes future dates such as “Next 30 Days.” For example, if today is 12/5 and you have a specific Timeframe of “11/1 - 11/30” along with a value of “7” in the Display at most n full day(s) option, you will see vitals data for 7 full days going back from 11/30.
   The Display at most n full day(s) option will not display if the setting Admin > Institution > Site Administration > Filters Sticky by Modules is set to Yes.
   The patient data display area now shows the Vitals summary window. It is broken into two sections: the top portion displays the vital signs Summary, and the bottom portion displays the vital signs Table.
   • The Summary contains a list of the patient’s vitals. Usually the vital signs are listed in alphabetical order, although your organization may have customized the sort order. There is a row for each type of vital sign, along with the units in which it is measured. The data for each type of vital sign is then summarized in three columns as follows: the Most Recent measurement along with the date and time it was taken, the Previous measurement with its date and time, and the Current 24 hour range (the minimum and maximum measurements taken within the last 24 hours). The Current 24 hour range column is blank if there are no readings within the last 24 hours, or if the vital sign value contains a date or any non-numeric characters (for example, “<2” or “>50” or “1/2”).
   You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.
   • The Table displays the various types of vital signs in a tabular format, with the vital sign type listed on the left vertical axis, and time intervals listed along the top from left to right. Information is displayed for each day in reverse chronological order, with the most recent date displayed on the left, and older dates continuing on to the right. Each date is broken into intervals of four hours (the default setting). You can adjust the number of hours in each interval by clicking the Options button and entering the number of hours that you want. You will notice that when you enter a larger block of time, more than one reading may be included in each interval. If more than one reading is included in an interval, the table cell shows the value of the most recent reading and also contains a notation indicating the _total number of readings_included in the time interval (for example, it would show (3) if the time interval contained three readings).
4. If you would like to see more detailed information for a specific vital sign, you can do any of the following: click on the vital sign’s row in the Summary, or click on the vital sign’s name or any cell in the Table. Two small detail panes open below the summary window.
   • The Vital Detail pane (on the left) displays a list of all measurements within the number of days currently selected in the Display at most n full day(s) field, for the given vital sign. Each row lists the vital sign value and the date and time the reading was taken. The readings are listed in reverse chronological order, with the most recent reading at the top. If you clicked on a cell in the Table view, the reading(s) taken during that specific time block are highlighted in orange. To include more or less readings in the list, use the Display at most n full day(s) field at the top of the Vitals window.
   The Display at most n full day(s) option will not display if the setting Admin > Institution > Site Administration > Filters Sticky by Modules is set to Yes.
   You can view comments that have been added to vital sign values. A blue asterisk next to a vital sign indicates that a comment has been added. Holding your mouse pointer over the asterisk displays the comment(s). Comments can be displayed in all three views (Summary, Table and Details), as well as in the Vitals Graph pane.
   • The Vital Graph pane (on the right) automatically graphs the values of the given vital sign. Vitals sign values are usually numeric and are graphed as a standard line graph. However, if a vital sign value contains a date or any non-numeric characters (for example, “<2” or “>50” or “1/2”), then it is not included on the graph, and message to that effect is displayed.
   • To change the starting and ending dates of the graph, use the Display at most n full day(s) field at the top of the Vitals window. If the patient has been administered any medications, you can also graph the selected vital sign against one medication, by selecting the medication from the drop-down list in the graph window.
   You can also click Graph in the top right corner of the Vitals display option to access the multi-graphing feature. Multi-graphing allows you to graph multiple clinical items together, such as lab results, medications, I/Os, and vital signs.

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Viewing Comments for Vitals and I/Os

You can view comments associated with vital sign values and Intake and Output measurements. Typically, whenever a nurse (or respiratory therapist, for example) records a patient’s vitals value or I/Os, they can add comments about the value. A comment contains descriptive information, which can include: component name, date and time the vitals or I/O measurement were taken, component value, and a note about the values as they relate to the patient’s condition or treatment. An asterisk to the right of a value or measurement indicates that there is a comment associated with the value. Holding your mouse pointer over the asterisk displays the comment(s). For example, a nurse might enter a temperature comment to indicate that a medication has worn off and should not be re-administered for another 2 hours. These comments can be a reminder to the attending nurse, as well as a set of instructions for a nurse coming on duty.

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Viewing New Results for a Patient

The New Results display option shows a summarized list of all unviewed clinical data for the currently selected patient. You can set up the display to list all of the unviewed items for some or all of the clinical categories such as Allergies, Clinical Notes, Medications, Lab Results, Problems, or Test Results. This is quick way for you to see “what’s new?” for a given patient. You can then click on any clinical data item in the list to see further details about it. To display a patient summary for a particular patient, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list.
3. Click on New Results from the display list. The first time you click the New Results option, you will only see the clinical data that your administrator set as defaults. You can change your preferences for the types of clinical data that you want to view using the Options… button. The display contains columns for the Type of clinical data item, the Date of the item, a brief Description of the item, and important Details. The actual information shown in these columns varies by the type of clinical data involved. Please refer to Viewing a Summary of All Patients to view a description of the column contents for each type of clinical item.
4. There are additional buttons and controls on the New Results display option that enable you to perform a variety of activities. All of the buttons and controls listed below function in exactly the same manner as they do on the Patient Summary tab. Please refer to Viewing a Summary of All Patients for detailed instructions on these topics.
   • Click on a column heading to change the sort order of the display.
   • Use the Limit to field to limit the number of clinical items that are currently displayed.
   • Click the Options button to select only those categories of clinical data that you wish to view.
   • Click the Mark All Viewed to mark a patient’s clinical data as viewed. When you do so, you are presented with two options:
   • Mark All Viewed: Click this option to mark as viewed all of the items in the summary display. All the items in the display will be removed.
   • Mark All Viewed Before Today: Click this option to mark as viewed all of the items that have a date earlier than today. Only items with a date of today will be displayed.
   Only those items that are currently displayed in the New Results Patient Summary view are marked as viewed when you select either of these options. For example, if your Timeframe were set to Last 7 Days, any items that were older than seven days ago would not be included in the summary display, and therefore would not be marked as viewed.
   Similarly, if you had set your Options to view only Lab Results, only the lab results would be marked as viewed. Since the nature of this option is to show only unviewed items, once you click Refresh , or log out and back in, the items you marked as viewed are removed from the display. Of course, you can always look at these items again by clicking on its respective display option in the Patient Data Display (available on the Patient List tab, or by clicking the Details icon ). In our example above, you could see the lab results you had marked as viewed by clicking on the Lab Results display option.
   • Click on any clinical item’s row to view additional details about it.
   When you do so, the system displays the same detail window(s) that would normally appear if you had clicked on the same type of data item in its own display option in the Patient Data Display. Please refer to the following sections for more information about the various detail displays:
   • Viewing Allergies for a Patient
   • Viewing Clinical Notes for a Patient
   • Viewing Lab Results for a Patient
   • Viewing Medication Orders for a Patient
   • Viewing Orders or Order Status for a Patient
   • Viewing Problems for a Patient
   • Viewing Test Results for a Patient
5. (Optional) You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

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Viewing a Summary of All Patients

Each patient’s clinical data is constantly changing: new lab tests are performed, new clinical notes are written, new medications are being prescribed, etc. The Patient Summary tab is designed to present the provider with all new clinical data for all of the patients on their selected patient list. This is a running summary of the clinical data they have not yet viewed. For a provider, this is a quick way to see “what’s new?” for their entire patient list. Once they view a particular item (for example, a particular lab result), whether via this option or any other option in the Commure Pro system, that item is marked as viewed and then is removed from the Patient Summary tab when the data is refreshed. To view the Patient Summary report, follow these steps:

1. Click the Patient Summary tab. The Patient Summary displays the unviewed clinical data for the patients on your list.
   When viewing for the first time, this list of unviewed clinical information uses the new user defaults set by your administrator. However, you can change your preferences at any time by clicking the Options button in the Patient Summary title bar.
   It contains columns for the Patient name, the Details icon , the Type of clinical data item, the Date of the item, a brief Description of the item, and important Details. The actual information shown in the Date, Description, and Details columns varies by the Type of clinical data involved. The table below describes the contents of the columns for each type of clinical item.

2. If desired, use any of the following options to control the amount, type, or format of the information you wish to display, as well as the patients for whom you wish to display it:
   • Patient List drop-down: Select the patient list that you wish to use for this web session. Patient lists can be a List, View, or Assignment list (or sublist).
   When you first access the Patient Summary tab, the initial setting for the Patient List drop-down is the same as that on the Patient List tab (or None Chosen, if no patient list was selected there). From that point forward, any patient list selection you make on the Patient Summary tab functions independently of that on the Patient List tab, enabling you to have different patient lists selected on each. Furthermore, once you select a patient list for the Patient Summary tab, that setting is retained as you switch from tab to tab, until you change it again.
   • Timeframe drop-down list: Select the date range of the information you wish to display.
   • Limit the amount of information to view: You can limit the number of clinical data items that appear in the Patient Summary window using a combination of the Limit to field and the current sort order. Simply type a number in the Limit to field and then press the Enter key on your keyboard. For example, if the report were sorted in reverse chronological order by date, and you entered 50 in the Limit to field, it would show only the 50 most recent items.
   • Select the type(s) of clinical data to view: Click the Options… button to select which of the clinical data items you wish to view at any given time. For example, if you are considering prescribing a medication, you might be interested in viewing only the allergies, medications, lab results, and problems. Simply click the checkboxes for those items that you wish to display.
   You may note that the Lab Panels item allows you to select the criticality of the lab results that you want to see, if any at all:
   • Critical: Include only critical unviewed lab results
   • Abnormal: Include only abnormal and critically abnormal unviewed lab results
   • All: Include all unviewed lab results (critical, abnormal, and normal)
   • None: Do not show any lab results
   • Click Mark All Viewed to mark a patient’s clinical data as viewed. When you do so, you are presented with two options:
   • Mark All Viewed: Click this option to mark as viewed all of the items in the summary display. All the items in the display will be removed.
   • Mark All Viewed Before Today: Click this option to mark as viewed all of the items that have a date earlier than today. Only items with a date of today will be displayed.
   Only those items that are currently displayed in the Patient Summary view are marked as viewed when you select either of these options. For example, if your Timeframe were set to Last 7 Days, any items that were older than seven days ago would not be included in the summary display, and therefore would not be marked as viewed.
   Similarly, if you had set your Options to view only Lab Results, only the lab results would be marked as viewed. Since the nature of this option is to show only unviewed items, once you click Refresh , or log out and back in, the items you marked as viewed are removed from the display. Of course, you can always look at these items again by clicking on its respective display option in the Patient Data Display (available on the Patient List tab, or by clicking the Details icon ).
   • Change the sort order: You can change the sort order of the report by clicking on any column heading. By default, the items are sorted by Type of item, so that all of the allergies are grouped together, then all of the clinical notes, etc.
3. Once the summary display is showing the clinical items that are of interest to you, you can view additional details for any clinical item. Click on any clinical item in the summarized list to see further details about it. When you do so, the system displays the same detail window(s) that would normally appear if you had clicked on the same type of data item in its own display option in the Patient Data Display. Please refer to the following sections for more information about the various detail displays:
   • Lab Results Panels: There are several detail windows for lab results. The ones that appear in Patient Summary are the Panel Table and Panel Details windows (see Panel Table and Panel Details).
   • Viewing Test Results for a Patient
   • Viewing Clinical Notes for a Patient

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Marking Clinical Data as Viewed

The system tracks whether or not you have viewed certain clinical data items. These include lab results, test results, and clinical notes. Any of these clinical items that you have not yet viewed on the Physician Portal application are displayed as follows:

• The New Results display option in the Patient Data Display lists all unviewed clinical data for the currently selected patient, including clinical data from all of the categories listed above.
• The Patient Summary tab lists all unviewed clinical data for all of the patients on your patient list, including clinical data from all of the categories listed above.

Once you have selected a particular clinical item, such as a test result, and viewed the details on either your handheld or the Physician Portal, the clinical item will be removed from view once you click Refresh . The clinical item is also removed from the New Results display option and the Patient Summary tab. You can also mark clinical data as viewed in groups, without having to individually select and display each specific item.

• You can mark as viewed all of a particular patient’s clinical data, or several categories of their clinical data, all in one step, using the New Results display option. You might do this, for example, if you had just reviewed a patient’s entire paper medical record. Instructions for this are in the section entitled Viewing New Results for a Patient.
• You can mark as viewed all of the new clinical data for all of the patients on your patient list, in one step, using the Patient Summary tab. You might do this, for example, if you had just reviewed all of the new clinical data via that same tab. Instructions for this are in the section entitled Viewing a Summary of All Patients.

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Multi-Graphing Clinical Data

As described in previous sections, vital signs, IO, and lab results can be graphed from their respective display options:

• Vital signs are automatically graphed when an individual vital sign is selected. You can also graph the selected vital sign against a medication. (See Viewing Vital Signs for a Patient.)
• IO data is automatically graphed when an individual component is selected. (See Viewing Intake/Output for a Patient.)
• Lab components are automatically graphed when an individual component is selected. You can also graph the selected component against another component. (See Graphing Lab Results.)

In addition to functionality above, multi-graphing is available from the Medications, Lab Results, I/O, and Vitals display options. Multi-graphing allows you to select several medications, vital signs, IO, and lab results, and put them together in either a table or a graph. You can create standardized flowsheets using snapshots that can be used for all your patients and you can edit and manage these snapshots.

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Viewing Clinical Data in a Table or Graph

Within the Multi-Graph window for a patient, you can select several medications, vital signs, IO, and lab results, and put them together in either a Table View or a Graph View. To multi-graph clinical data, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list. The date range you select here affects the items that are available for selection on the multi-graph screen. For example, if you select a Timeframe of Last 30 Days, only those medication administrations, lab results, and vital signs within the last 30 days will appear as selectable items on the multi-graph screen.
3. Click either the Medications, Lab Results, I/O, or Vitals display option, and then click Graph, located in the upper right corner of the summary window. The Multi-Graph window displays listing all the available medication, lab, I/O and vital components for the patient in a column on the left side of the screen.
4. Click on the lab components, medications, I/O, and vital signs that you want to graph or view in a table. You may select more than one of each. To deselect an item, click on it again.
5. As you select each item, it is automatically put in either a table or graph. You can choose the view you want by selecting either Table View or Graph View (located at the top left of the display area). The default is Table View.
   To clear the table and your selections, click the Clear button
   As you select each component in Table View, a table is built displaying the following:
   • The date range and the time is listed in the horizontal headings and is based on the Timeframe that you selected on the Patient List tab. If you originally selected a large date range and not all the data is displayed, you can use the horizontal scroll bar to scroll through and view all the data. If you change the Timeframe in the Multi-Graph window (at the top right), the timeframe selected on the Patient List tab is not affected.
   • Each clinical item is listed in separate rows and any data associated with the date and time is displayed. You can continue adding or removing clinical items for the table by clicking on them from the drop-down lists.
   As you select each component in Graph View, a graph is built displaying the following:
   • The date range is always graphed on the horizontal axis and is based on the Timeframe that you selected on the Patient List tab. If you originally selected a large date range, and the items are too compressed to read on the graph, you can decrease the timeframe by selecting a new range from the Timeframe drop-down here on the Multi-Graph window. If you change the time frame in the Multi-Graph window, the time frame selected on the Patient List tab is not affected.
   • Each clinical item is graphed on a vertical axis. If the clinical items share a similar numeric range, they are graphed on the same vertical axis. If you select many items with differing ranges, additional graphs may be displayed, stacked one above the other, so that you can compare them over the same date range. You can continue adding or removing clinical items for the graph by clicking on them from the drop-down lists.
   • Any component values that contain any non-numeric characters (for example, “<2” or “>50”) are not included on the graph, but the components are listed in the legend.
   • You can display the exact value for a specific point on the graph by holding your mouse pointer over that point
   There are a few important points to note about graphing medications. When graphing medications, you are in fact graphing the recorded medication administrations. The numeric value at which each administration’s data point is graphed is the medication dosage. In addition:
   • If the medication dosage field contains a comment instead of a numeric value, it is graphed at zero.
   • If a medication was ordered but has not had any administrations, it is included in the drop-down list, but no data points are graphed.
6. After you are done viewing the information, click Close to exit the Multi-Graph window. Your view with the clinical data component selections will not be saved when you close out of the Multi-Graph window. If you wish to save the view for future use, you need to create a snapshot of it.

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Creating Flowsheets using Snapshots

If you wish to save your clinical data components settings so you can use it with any patient’s clinical data without having to reselect all the components, you can create a snapshot of the settings. A snapshot is a saved view (usually a flowsheet using Table View) of preselected medication, vital, and lab components.

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list. The date range you select here affects the items that are available for selection on the multi-graph screen. For example, if you select a Timeframe of Last 30 Days, only those medication administrations, lab results, and vital signs within the last 30 days will appear as selectable items on the multi-graph screen.
3. Click either the Medications, Lab Results, IO, or Vitals display option, and then click Graph, located in the upper right corner of the summary window. The Multi-Graph window display listing all the available medications, labs, IO, and vitals components for the patient.
4. Click Clear, if data is already displayed from another snapshot. Once you have no data displayed, click on the lab components, medications, and vital signs that you want to graph or display in a table. You may select more than one of each. For example, if you wish to set up a flowsheet that shows how a patient with diabetes is responding to treatment, you can select the Glu lab component, the Glyburide medication component, and the FSBG vital component.
   To deselect an item, click on it again.
   As you select each item, it is automatically put in either a table or graph depending if Table View or Graph View is selected at the top left of the display area (Table View is the default view).
   All snapshots can be viewed in either Table View or Graph View by selecting the desired view. The Commure Pro system remembers that view last chosen and when the snapshot is next selected, will display the last selected view.
5. Enter a name for your snapshot, in our example it is My Flowsheet, in the Save New Snapshot text box.
   If the snapshot is a commonly used flowsheet for all your patients, you may wish to make this snapshot the default view every time you use the Multi-Graph feature. Select the Make Default checkbox next to the Save New Snapshot text box before you save the snapshot.
6. Click Save to create your snapshot. The snapshot is now available in your Select Snapshot drop-down for use.

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Viewing Clinical Data Flowsheets Using Snapshots

You can also use snapshots to view your patient clinical data. Snapshots are typically your saved flowsheet views of preset clinical data components. You will need to have created snapshots to use this feature. To use an existing snapshot for patient:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Select the amount of information you wish to display by clicking the Timeframe drop-down list. The date range you select here affects the items that are available for selection on the multi-graph screen. For example, if you select a Timeframe of Last 30 Days, only those medication administrations, lab results, and vital signs within the last 30 days will appear as selectable items on the multi-graph screen.
3. Select the desired snapshot from the Select Snapshot drop-down. The window will change to display the preset clinical data components for the selected patient. For example, if you selected the snapshot called “Diabetes Flowsheet” which uses the lab component Glu, medication component Glyburide, and the vital component FSBG in the Table View, you will see a table with these components displayed for the timeframe you selected. If you do not have any snapshots in your Select Snapshot drop-down, you can create snapshots and then manage those snapshots.

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Managing Flowsheet Snapshots

You can make the following changes to your snapshots:

Renaming a Snapshot

To rename a snapshot:

1. Click the Manage Snapshots link in the Multi Graph window. The Manage Snapshots window displays with all the available snapshots.
2. Click the Rename link next to the snapshot you wish to change. The Edit Snapshot dialog displays.
3. Enter the new name.
4. Click OK which will display a dialog stating “Snapshot has been renamed,” and then click OK from this dialog. You are returned to the Manage Snapshots window. From here you can continue to make changes to your snapshots.
5. Click Close to exit when you have completed all your changes.

Changing the Component Sort Order in a Snapshot

To change how components are sorted in a snapshot:

1. Click the Manage Snapshots link in the Multi Graph window. The Manage Snapshots window displays with all the available snapshots.
2. Click the Sort Components link next to the snapshot you wish to change. For example, if we had a snapshot called Coag Flowsheet (which has two lab components - INR and PT and one medication - Coumadin), we would click this link next to it. The Sort Components window displays with tabs for each component type.
3. Select the desired component tab where you want to change the sort order of components. In our example we wish to sort lab components which is the first tab selected by default. INR and then PT are displayed as the sort order.
4. Select and drag the component whose order you wish to change, and then drop it into the new sort location. Continuing with our example, we select and drag the PT lab above the INR lab and drop it there. Now the sort order is PT and then INR.
   You should make all your sort changes to each component tab before saving your changes as saving will return you to the Manage Snapshots window.
5. Click Save which will display a dialog stating “Sort Components have been saved,” and then click OK from this dialog. You are returned to the Manage Snapshots window. From here you can continue to make changes to your snapshots.
6. Click Close to exit when you have completed all your changes.

Changing the Default Snapshot

To change what snapshot is used as a default for your Multi Graph window:

1. Click the Manage Snapshots link in the Multi Graph window. The Manage Snapshots window displays with all the available snapshots.
2. Select checkbox next to the snapshot you wish to make the new default.
3. Click Make Default which displays a dialog stating “Default Snapshot has been set,” and then click OK from this dialog. You are returned to the Manage Snapshots window. From here you can continue to make changes to your snapshots.
4. Click Close to exit when you have completed all your changes.

Deleting a Snapshot

To delete a snapshot from your Multi Graph window:

1. Click the Manage Snapshots link in the Multi Graph window. The Manage Snapshots window displays with all the available snapshots.
2. Select checkbox next to the snapshot you wish to delete.
3. Click Delete which displays a question dialog stating “Are you sure that you want to delete selected snapshots?” and then click Yes from this dialog. You are returned to the Manage Snapshots window. From here you can continue to make changes to your snapshots.
4. Click Close to exit when you have completed all your changes.

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Viewing the Source of Clinical Data

If your organization has implemented the Heath Information Exchange (HIE) option, then you can see the source (from which your patients’ clinical data was derived) on the Details panes of most clinical displays. For example, if your organization shares data with other organizations in your area, then you could see from which organization a particular item (such as a clinical note, a lab result, or an allergy status) was derived. Depending on how your profile is configured, you may also be able to view the source of the clinical data on the Summary screens of the clinical displays, as well as filter the Summary screen by source (for example, view only those results that were derived from a particular hospital). When the HIE option is implemented, it affects all of the displays below. It works in a similar manner in all of these displays.

• Allergies
• Clinical Notes
• Lab Results
• Medications
• Order Status (standard)
• Problem List
• Test Results
• Vitals
  At this time, HIE is not available for the I/Os or CPOE Orders displays. Also, please note that HIE works slightly differently on the Vitals and the Lab Results displays, as described in the following:
  For the Vitals display, the Source column is not present on the Vitals Summary. Consequently, filtering or sorting by source is unavailable. You can view the Source for an individual vital sign (for example, Blood Pressure) via the Source field that is displayed on the Details pane. The Lab Results display works differently in one respect: you cannot change the sort order of the Component Table on the Lab Results Summary. However, you can click on a table cell containing a numeric result to display the details of that specific result. The Source field is then displayed under the Status field on the Details pane.

If implemented by your organization, HIE functionality is also available on the Patient Summary tab where you can view and sort patient data by source via the Source column. You can also filter the Patient Summary list by source via the Sources filter.

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Viewing Source on the Patient Data Display

When HIE is implemented for your organization, a Source field is included on the Detail panes of most of the clinical displays. Its exact location may vary by display option.

• Allergies: Near the top of the Details pane, just after the allergy name.
• Clinical Notes: Near the top of the Details pane, just after the Status field for all types of Clinical Notes, except those notes that have a MANUALREG source.
• Lab Results: On the Details pane, as either the last field on the screen or under Status field.
• Medications: On the Order tab, above the Notes/Comments field.
• Order Status (standard): this pertains to all orders in which source appears under Physician Details.
  When both CPOE and HIE have been implemented, the Orders display option is available instead of Order Status. The Source field appears last on the Orders Details pane. Please see your Commure Pro representative for more information.
• Problems: On the Details pane below the Status field.
• Test Results: Near the top of the Details pane, just below the Search field.
• Vitals: On the Details pane, just after the Time column.

In addition, a new column for Source may be present on the Summary pane of the clinical displays, if enabled in your user profile. The Source column allows you to quickly see where the data came from. Just like any other column on a Summary pane, you can use the Source column to sort the Summary list, effectively grouping all the results from the same source(s) together:

• Click Sort Ascending or Sort Descending in the Source column header to sort the summary list by Source.

Settings that control this feature:

• Admin - User - HIE - Display Source in Clinical Summary (Web)

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Filtering by Source on Patient Data Display

You may be able to filter the Summary pane of the clinical display by source, if enabled in your user profile: The Sources filter, located in the upper right corner of the Patient Data Display, allows you to trim down the Summary list and view just the clinical items that were derived from a particular source or sources that have been designated as HIE sources. The Sources filter also works in combination with the standard filters for a given clinical display.

1. From the Summary pane for a clinical display, click Sources.
   An asterisk appears on the Sources* filter to indicate when one or more sources have been excluded. No asterisk indicates that All Sources are included. In some cases, there may be other Sources referenced by Commure Pro that are not listed in the Sources Reference list. These too can also appear in the Source Options.
   The Source Options screen is displayed, showing a list of all available sources. All is the default.
2. Select the source(s) of data that you want to include from Source Options screen. You can either:
   1. Select All to show clinical data derived from all sources; or
   2. Uncheck All and select one or more specific sources.
3. When done, click OK.
4. (Optional) Select a standard filter for the current display option. The clinical items that match the selected sources (and also the standard filter criteria, if you chose one) are displayed. The sources and standard filter remain selected until you choose something different.

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To go back to showing all of the source and clinical data for the patient

1. Select the standard Filter and check All.
2. Select Sources*, and check the All check box.
3. Click OK.

Settings that control this feature:

• Admin - User - HIE - Filter on Source (Web)