CPOE

The following topics are discussed on this page. Use the links to jump to the desired area:

About CPOE

To create orders

To transfer orders

To edit order details

Order Related questions

Order Alerts

Finished on this screen

Introduction to CPOE

Computerized Provider Order Entry (CPOE) allows practitioners to enter medication, nursing, and departmental orders from multiple locations using department and physician specific order sets. The orders are then electronically forwarded to the appropriate departmental desktops so they can be processed and charged.

CPOE utilizes the Clinical Decision Support (CDS) system to display the patient's medical history, current results, and evidence-based clinical guidelines to support treatment decisions.

To access CPOE, select the desired patient using the Select button on the Hospital Main page. Then, click the CPOE button. The Order Creation page is displayed and the patient name and visit information are displayed in the yellow bar at the top of the screen. Additional Patient Demographic information, which includes height, weight, BMI, and BSA, is also displayed on the screen below the Physician and Date selection section.

In addition, you may see links to CPOE from other pages within the Hospital module, e.g. Assessments page, Orders Tracking page, and Quick Registration.

TIP: To access additional patient information during Order Entry, access the green Summary and/or Allergy tabs in the upper right corner.

To create orders

As you select orders, an Alert message may be displayed. These important messages warn you of possible interactions between the orders you are placing or indicate additional required information regarding the order. See the Order Alerts section of this page for more information.

1. Begin by selecting the Physician, Start Date/Start Time, Source, and Diagnosis. These fields will automatically populate in the order details for the orders you select in step 2:

   • The Physician field defaults to the logged in user (if a physician or provider). Otherwise, in the Physician field, begin typing the first few letters of the ordering physician. Available matches are displayed. Click to select the desired physician/provider name. When applicable (for verbal and telephone orders), the Supervising Physician field defaults to the assigned supervising physician. (Note: If a physician is entering the order, the Physician field defaults to the current user.)

   1. In the Source field, select the type of order you are entering: Written, Email, Fax, Telephone, Verbal, Signed Order on File, or Protocol. If you select Telephone or Verbal, the Read Back check box is displayed. Check this box to indicate that you read the order back to the practitioner. If you select Signed Order on File, this indicates that you have a physical signed copy of the order and this order is automatically signed and can be completed/processed immediately. If you select Written, providers will need to review the order and sign it electronically in Dr. Signature or the PWC. If you select Signed Order on File, the order is automatically signed and can be completed – it does not require a separate signature process. However, it does require that the order be scanned into the medical record as a document.

   • The Start Date and Start Time default to the current date/time. If necessary, modify these values by using the calendar and clock buttons.

   • To attach a diagnosis to the order(s), click Diagnosis. The Problem List is displayed listing the patient's existing diagnosis list. Check the appropriate diagnosis(es) and click Save. To add a new problem to the list, click the "+" button.
     

2. Then, select the desired order or order set using one of the following methods:

   • Search for the order: In the Order Lookup field, begin typing the first few letters of the order you are looking for. Matches to the text you type are displayed in the drop-down list in 4 categories: Orders, Order Sets, Favorite Lists, and Home Medication Formulary. (You may have to scroll down to view each list.)
     Note: To add this order to your list of Favorites, click the Add to Favorites check box.

Note: This field does not utilize a wildcard search, only the Order Sets look up field utilizes a wildcard search. If you type the % symbol in the Order Lookup field, results are displayed that actually have the "%" symbol in the description.

Click on the desired item to select it. Click the desired item to select it. You may see the following identifiers appended to the order:

1. • • [F] - This indicates a formulary medication.

     • [C] - This indicates that the order is a custom order (hospital-defined) and does NOT come from the standard order catalog.

   • Use an order set: In the Order Sets field, begin typing the first few letters of the order set. Matches to the typed text are displayed.

You can also use a wildcard search in the Order Sets look up field. The wildcard search is enabled by typing the % symbol in the look up field. This displays the complete list of Order Sets. Note: This wildcard search does not work in the Order Lookup field, only the Order Sets look up field. If you type the % symbol in the Order look up field, results are displayed that actually have the "%" symbol in the description.

Select the desired order set. The Order Set box is displayed listing the orders included in the set in Medication and Department Orders sections. Begin typing the first few letters to go directly to the desired set. Check the appropriate items you wish to create. (You may have to uncheck items that default to "checked" if you wish to exclude them.) To edit the item, click the edit button and make the desired modifications. (TIP: You have the ability to set a default Reason for PRN orders so that you aren't required to enter a reason for every PRN order in the order set. To set this default, go to Clinical Documentation > Master Files > Patient Chart > Order Management > Order Sets.)

1. • Use the favorite list: For physician order entry, the physician can click Physician Favorites to display their personal favorite list. From this box, check the desired order(s) and click Save. From the favorite box, you can edit and/or remove the item from your list using the appropriate button.

   • Enter a non-formulary order: To enter a non-formulary medication, click Add Non-Formulary. The Add non-formulary medication box is displayed. Enter the Brand Name, Generic Name, and Dosage. Then, select the appropriate Dosage UOM, Form, and Route using the drop-down lists. Once finished, click Save. (Note: Once saved, this item is added to the Home Medication Formulary and can be used again.)

Important: Non-formulary medications are indicated in the lists by "NF". It is important to note that these non-formulary medications are NOT included in interaction checking!

• Enter a future order: To enter a future order, select the order as usual (using the Favorite list, Order Set, Order Lookup, etc.) on the Order Creation page. When the Order Details fly over is displayed, complete the details as required and click the yellow Click for Future Visit button (see below) located in the upper right hand corner of the fly over. The button turns red to indicate that this order is a future order and is being entered at the MPI level. Once you have finished entering the details, click Save Future Order. Future orders are displayed on the Department Orders page.  

When Editing Future Orders, some changes require the Provider to sign the order again. Some edits do not require a Provider Signature following the change:

- In the case where a user clicks ASSIGN SELECTED and changes the fields below, the user remains as the ASSIGNED and that order is not sent to the provider for signature in Provider Signature. The same applies if a user (non-provider user other than ordering provider) edits a Future Order, and re-saves to Future Order queue in CPOE we will not send that order to the provider for signature in Provider Signature:
- Priority
- Start Date/Time
- Special Instructions
- Diagnosis
- Comments
- Source
- Ordering Facility
- Times
- Reason/Indication
- Duration - Stop Date/Time ( for LAB/RAD/OTHER order types)

- In the case where a user clicks ASSIGN SELECTED and changes the fields below, the user becomes EDITED and ASSIGNED and that order is sent to the provider for signature in Provider Signature as the key components of the order have changed, creating a new order. The same applies if a user (non-provider user other than ordering provider) edits a Future Order, and re-saves to Future Order queue in CPOE we will send that order to the provider for signature in Provider Signature as the key components of the order have changed, creating a new order. In the scenario of editing a key component of a Future Order and re-saving to Future Order Queue, the user will have to add a *Reason for edit.
- Dosage
- Provider
- Dose Range
- IV Rate/Details
- IV Rate Range
- Sig/Frequency
- Additives
- Route
- Duration - Stop Date Time (MED order types)

3. As you select each order, the Order Details box is displayed. Medication orders will display the following tabs: Order Details, Monograph, Recommendation, and Lab Results. From the Order Details box, you can enter/edit the order details, view lab results, attach a diagnosis(es, view the monograph, and/or view recommendations. For order sets and favorites, you can access the order details to edit them by clicking the edit icon next to the order in the list.

4. Complete the required fields for each order. Required fields are indicated by an asterisk (*). These fields vary by order, i.e. Pharmacy orders have different required fields from Lab orders or Radiology orders. The following fields are required:

5. Complete additional fields as needed (non-required):

6. Use the following buttons/options on the screen to perform additional functions:

Range (under the Dosage field and Rate field): The Range check box appears under the Dosage field and the Rate field (IV meds. Check this box (next to the appropriate field) if the dose (10-30 mg) or rate (100-150 cc/hr) is a range. When checked, an additional field is displayed. Enter the low end of the range in the first field and the high end of the range in the second field, e.g. 10-30.

Dose Calculator: Click this button to launch the Dose Calculator. See Dose Calculator for more information. This button is located next to the Strength field.

Diagnosis: This button displays the patient problem list. From the Problem List box, check the desired problems and click Save. To add a problem, click the button. For additional information, see Problem List.

Lab Results: To view the patient's current lab results, click the Lab Results tab. Use the Department field and the Panel/Test field to filter/narrow down the results by lab department and/or panel/test.

Sliding Scale: If required, click the Sliding Scale button to create a sliding scale. In the Sliding Scale field, use the drop-down list to select a pre-built sliding scale. The details of the scale are displayed in the Start Range, End Range, Dose, and UOM columns.  Make modifications as necessary to the values. Click Add More to add additional ranges. For Actions, use the drop-down list in the Add Action field to select actions to attach to the sliding scale. To remove actions, click the button. Once finished, click Save.

Home Medication: Use this check box to indicate that the order (medication) is a home medication.

Use Home Supply: This check box is enabled when the Home Medication check box has been checked. Use this check box to indicate that the patient's own supply of the home medication be used. This information, when selected, is also displayed on the eMAR to the alert the user during administration.

Save and Taper Dose: After entering the details of the order, click this button to save the current details and enter a tapering dose, e.g. 30mg for 3 days, 20 mg for 2 days, and 10 mg for 5 days. The tapering dose window is displayed with the "just-saved" order and a duplicate of the order just beneath it. Click the edit button next to the second order to modify the dose, frequency, times, and duration. Click Save. The Start Date/Time and Stop Date/Time are auto-calculated based on the selected duration. To add an additional tapering dose, click the Add button [+]. Or, to remove one of the doses, click the remove button [-]. Once finished with all of the tapered doses, click OK to return to the Order Creation page. (Note: Each tapered dose will be listed on the Order Creation page as a separate line.)

Additives: (For IV medications only) Click the Add button to display the Additive(s) fly over, type the first few letters of the additive that you are looking for in the text box. Matches to the typed text are displayed so that you can click the desired additive to select it. The additive is displayed in the box. Review and edit, if necessary, the Dose, Volume (ml), and Qty fields. Then, click Save.

Save and Check Necessity: Click this button to save the order and perform medical necessity checking on the item you are ordering and if required, print the ABN (Advance Beneficiary Notice). You may be presented with Pass/Fail questions regarding the procedure. Please respond to the questions,  as appropriate. If you choose not to select the answer, the response is recorded as HOLD.

Electronic: This check box identifies if this order was received electronically from the ambulatory provider. This check box is only enabled when your facility checks the E (Electronic) setting in Maintenance > General > MU Reporting > External Lab Order Setup. Check the Electronic check box while placing the lab order in CPOE to mark the order as electronic for the calculations for EH Stage 2 Meaningful Use Menu Set Measure #6: Lab Results to Ambulatory Provider.

7. After you have completed the order details, click Save. (Or, Save and Taper Dose (see details above).) The order is added to the list of orders by category at the bottom of the screen: Active Orders and Future Orders. (See To assign future orders for additional information regarding future orders.)

8. To view the patient's current lab results, click Lab Results. The Lab Results box is displayed. Use the Department field and the Panel/Test field to filter/narrow down the results by lab department and/or panel/test.

9. Repeat steps 1-8 to select additional orders.

10. OPTIONAL: Each category list allows you to sort, edit, or remove the orders.

1. • To remove orders, check the boxes of the orders you want to remove or check Select All, then click delete selected located in the category header.

   • To edit order details from a category list, click the pencil icon located to the right of the order. To edit multiple orders for a category, check the boxes of the orders you want to edit or check Select All, then click edit selected in the category header.

   • To change how the category list is sorted, select Date, Test Description, Priority, Department or Scheduled in the Sort by field.

   • For Future Orders, you can assign them to the current visit. Check the box next to the order, then click Assign Selected. This will assign the orders to the currently selected visit.

11. Click Submit Orders. A Submit Orders confirmation message is displayed.

12. Since some orders are completed and/or administered in the department, you have the option of marking orders complete at the time of order entry.

1. • To skip this process, click Continue when the Submit Orders message is displayed.

   • To administer/complete one or several of the orders, click Administer Order. The Submit Orders box is displayed.

   1. 1. Check the desired orders that you wish to mark complete/administer. For each order that you check, the Date, Time, Performed by, Route, and a Notes field are displayed.

      2. Review and modify any of the displayed order information for each of the selected orders.

      3. Click Save. You are returned to the Orders Creation page.

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To assign future orders (activate future orders for a current visit)

1. Future orders are assigned to a patient at the MPI level. To activate orders, it is important to select the appropriate patient and visit number. Then, go to the CPOE page.

2. If desired, click the Medical Necessity Checking button to determine the LMRP status. The current status is displayed in the Future Order section in the MNC column.

3. Locate the desired future order(s) in the Future Orders section in the lower portion of the page and check the box(es) to the left of the desired orders.

4. Click Assign Selected (located in the gray bar). The Assign Selected Future Order(s) confirmation message is displayed. Click OK to continue. The order is displayed in the active order section.

5. Review the order, make edits, as appropriate, using the Edit Order and/or Remove Order buttons.

6. Click Submit to process the order.

To transfer orders

When a patient is transferred from one location to another and a new visit is generated, it may be necessary to transfer orders from one visit to another. To transfer orders, click Transfer Orders to display the Order Transfer window.

1. In the Visit field, use the drop-down list to select one of the patient's visits. The orders for the selected visit are displayed in the box. (Note: Orders that were On Hold from the previous visit are noted with an orange circle icon.)

2. Check the desired orders for transfer. To edit the order, click the edit button. See To edit order details for additional information.

3. Click Copy. If required, the order detail window is displayed. Modify the order as needed.

4. Click Save. The orders are displayed on the Order Creation page.

5. Follow steps 6-9 of To create orders to complete the order process.

When transferring orders, the Start Date and Time default to the time of the transfer. However, the user can manually change it. The Stop Date and Time default to the original order's stop date and time.

Examples of Order Transfer Scenarios

CASE 1: Future start dates (from the current date) carry over to be exactly the same stop date.

Current Order:

Transferred Order:

CASE 2: Orders that have a start and stop date before the current date will have the current start date and time and add on the original duration days for the stop date.

Current Order:

Transferred Order:

CASE 3: If the order started before the current date, but transferred before the stop date, the transferred orders start with the current date and carry over the remaining duration days. Stop days will remain the same as what was on the original order.

Current Order:

Transferred Order:

CASE 4: For orders based on the amount of doses given that will create the stop date, the Stop date and time are carried over to current date and time for start date.

Current Order:

Transferred Order:

To edit order details

When placing orders, the order details box is displayed. This box allows you to customize the order for the patient and includes the following fields:

To edit orders

To edit existing orders, go to the Orders Tracking page to make these changes.

Important Notes re: Editing the Order

Certain changes to key components in the order will affect the application in the following ways:

• Duration: If the user extends the duration (changes the duration to be greater than the original value), new schedules of this order are created for the extended time period. If the user decreases the duration (changed the duration to be less than the original value), order schedules that are past the new duration are removed.
• Home Medication and Use Home Supply: User can toggle on/off these check boxes. If the Home Med designation is not checked and the user checks it, the medication is added on the Home Medications list. If the Home Med designation was previously checked and the user unchecks it, the Home Medication list in unaffected.
• Times: Any individual/scheduled orders that have a date/time prior to the current date/time are not changed. Any individual/schedule orders that have a date/time greater than the current date/time are updated to reflect the new time(s).
• Priority and Source: Priority affects the display/sort order in the eMAR. Changes to Priority will also be reflected in the eMAR.

Order-related questions

Sometimes during the order selection process, you will be presented with order-related questions. These questions help to aid the appropriate patient-specific information for the receiving department. Sometimes these questions may relate to signing consent forms for procedures, patient education, and transportation method. The description of the test that triggered the question is displayed in the white bar at the top of the question box. Once you've answered the questions, click Save to return to the order details screen. You can return to the Questions box at any time by clicking the Questions button in the order details box.

Order Alerts

Orders that were entered with relevant notes/special instructions or prep information are indicated with an alert icon located to the left of the order. An orange icon displays for prep information, and a note pad icon displays for a comment.

While placing orders, you may receive warnings regarding dosage, duplicate therapy, drug to drug, drug to allergy, and/or drug to food interactions. When these alerts occur, the Alert message is displayed. For each alert, the details, description and an Override Notes field are displayed. You have the ability to continue with the orders or cancel the orders before placing them. When the Conflict Alerts box is displayed, there are 5 colored buttons: Red (Severe), Yellow (Moderate), Green (Mild), Orange (Other), and Gray (All). These buttons display the number indicating the quantity of that severity level alerts. For example, if the red (severe) button displays a number 5, that means that there are 5 severe alerts available for this medication. Click the desired colored button to view the alerts for that severity level. Or, click the Gray (All) button to view all alerts.

When placing orders from CPOE, if you have the conflict checking set to Display During Order Entry (in Clinical Documentation > System Parameters > Order Management), if there is a conflict it will display as a C in the CC column in the Pharmacy application in the Clinical Reviews window. If you have the conflict checking parameter set not to Display During Order Entry and there is a conflict it will display as a P for the CC column in Pharmacy in the Clinical Reviews window. It also displays in Orders Tracking (when the Include inactive orders box is checked) with a pending conflict icon (red triangle). The user will have to address the conflict before they can place the orders.

Standard Order Catalog and Evidence-Based Order Sets

The use of the Standard Order Catalog (SOC) and Evidence-Based Order Sets (EBOS) requires licensing and setup. Contact your Account Manager for details.

The Standard Order Catalog (SOC) is a collection of standardized orders that includes orders orders, schedules, and dose order forms. This set or orders comes from a standardized database from a Healthland 3rd party partner.

And, the Evidence-Based Order Sets is a collection of standardized order sets (based on evidence in the Clin-eguide database). EBOS are composed of the orders in the SOC. This compilation of order sets comes from a standardized database from a Healthland 3rd party partner.

Finished on this screen?

If you are finished on this screen, there are links to help you navigate quickly to other areas of the Hospital module. Click Orders Tracking (in the lower right corner) or Lab Results (in the lower left corner) to access these areas. Or, click Back to main (in the top right corner) to save the information and return to the Main page. If you wish to return to the Main page without saving, click Back to Main.

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