1. Auto Discontinue Configuration

2. Auto-DC Functionality OE/RR AUTO-DC RULES file #100.6 –Create only those parameters or rules your site needs –Customize many attributes Define the business rules –All rules may specify types of orders to dc –Exceptions are possible Auto-DC may be inactivated to turn off Audit history Rule Editor

3. Initial Auto-DC Rules

4. Auto-DC Rules Auto-DC rules work when a “Trigger Event” occurs (i.e. Admission, Discharge) Then the Rules discontinue Orders according to pre-defined Business Rules

5. Admission Rules Trigger event Name, Display Text Division patient will be admitted to Event = Admission Usually include all admission types Business rules Included Packages Excluded Display Groups Excluded Orderable Items DC Reason =“Admit”

6. Sample Admission Rule

7. Discharge Rules Trigger event Name, Display Text Division patient will be discharged from Event = Discharge May want separate rules for Death and all other Discharges Except from Obs Business rules Included Packages Excluded Display Groups Excluded Orderable Items DC Reason

8. Sample Discharge Rule

9. Sample Discharge/Death Rule

10. Specialty Change and Transfer Rules There can be Auto Discontinue Rules set up to Trigger when there is a Specialty Change or Transfer from one Ward to Another. So far we have not used these in an IHS setting since most sites are not complex.

11. Editor Using the standard EHR menu: ORD => DOC => DOE => AUTO-DC RULES

12. Auto-DC Rule Editor

13. Add/Edit a Rule

14. Inactivate a Rule

15. Activate a Rule

16. Using MAS Rules BDGPM MOVEMENT EVENTS protocol event Activity Log maintained in the OE/RR PATIENT EVENT file #100.2 No action taken when movements are deleted, or old movements are changed Active orders are Auto-DC’d if division and movement type match an active rule, though it may be skipped if an exception matches (MAS is VA speak for ADT)

17. Manual Release If a situation occurs where there are Delayed Orders, but you know there will be no Trigger Event occurring to release them, you may use Manual Release

18. Manual Release Set-up ORD => DOC => PAR => Select one of the following: 1 Write orders list by event 2 Default release event 3 Common release event list 4 Manual release controlled by  This one 5 Set manual release parameter  This one 6 Exclude display groups from copy

19. Manual Release Set-up Manual release controlled by : Usually set at System level Select one of the following: K Keys Only (ORES/ORELSE) P Manual Release Parameter Only (OREVENT MANUAL RELEASE) B Both (K and P) The usual choice is Both (K and P) so that specific clerks could also release orders if necessary.

20. Manual Release Set-up Set manual release parameter: Usually set at System or Division level Allows you to add a User or Class able to Manually Release Orders (when you set K and P above) Allow use of manual release option may be set for the following: 1 User USR [choose from NEW PERSON] 2 Class CLS [choose from USR CLASS] 3 Team (OE/RR) OTL [choose from OE/RR LIST] 4 Location LOC [choose from HOSPITAL LOCATION] 5 Service SRV [choose from SERVICE/SECTION] 6 Division DIV [DEMO HOSPITAL] 7 System SYS [DEMO.MEDSPHERE.COM] Enter selection:

21. Manual Release Now on the Orders Tab, if you right click on a Delayed Order you have a new menu “Release Delayed Orders”

22. Manual Release There is also a menu in RPMS that can be used to release delayed order: ORD => DOC => REL =>

23. Troubleshooting Detailed Display Custom View/Event Released Orders Activity Log in Patient Event file #100.2 Release to Service action Copy to new order Note: -Auto-DC’d Orders do not display on Active Orders view

24. Detailed Display on Orders Tab

25. Auto-DC/Release Event Orders

27. OE/RR Patient Event file

28. Set-Up Planning

29. Setup Suggestions Plan your rules on paper first Build all auto-dc rules then build all release rules (or visa versa) Create separate division auto-dc and release rules as appropriate Use copy function If you never plan to auto-dc on, e.g. pass, don’t activate the pass rule

30. Questions and Discussion