CPOE User Roles & Permissions

CPOE User Roles & Permissions

Role Definitions

Attending Physician

  • Description: Board-certified physician with full, independent ordering privileges.
  • Scope: Can order medications (including controlled substances), laboratory tests, imaging studies, and procedures for patients under their care.
  • Credentials Required: Active medical licence (DOH or DHA), MOH unified licensing record, UAE MOH controlled substance authorisation (for CDa/CDb prescribing).

Resident Physician

  • Description: Physician in post-graduate training with supervised ordering privileges.
  • Scope: Can order most items; CDa controlled substances require attending co-signature; may have formulary-level restrictions per training programme.
  • Credentials Required: Active training licence (DOH/DHA), assigned supervising attending.

Nurse Practitioner / Physician Assistant

  • Description: Advanced practice provider with ordering privileges within defined scope of practice.
  • Scope: Can order within collaborative agreement; CDa ordering dependent on individual MOH controlled substance authorisation.
  • Credentials Required: DOH/DHA licence, collaborative practice agreement on file, MOH controlled substance authorisation if applicable.

Pharmacist

  • Description: Clinical pharmacist with verification and advisory role. Cannot create orders but critical for controlled substance dual verification.
  • Scope: Verify orders, flag safety concerns, perform dual verification for CDa medications, recommend alternatives.
  • Credentials Required: DOH/DHA pharmacist licence, MOH registration.

Registered Nurse

  • Description: Cannot independently create orders. Can enter verbal/telephone orders on physician's behalf (requires co-signature within 24 hours).
  • Scope: Read-only access to orders; verbal order entry; order clarification requests; MAR acknowledgement.
  • Credentials Required: DOH/DHA nursing licence.

Unit Clerk

  • Description: Administrative staff supporting order management workflows.
  • Scope: Can enter verbal orders on behalf of physicians (requires physician co-signature within 24 hours); can print, track, and manage order queues.
  • Credentials Required: Facility employment; role assignment by department manager.

Permission Matrix

Function Attending MD Resident MD NP/PA Pharmacist RN Unit Clerk
View orders
Create medication order ✓ ^1^ ✓ ^1^
Create lab order
Create imaging order
Enter verbal/telephone order ✓ ^2^ ✓ ^2^
Order CDa controlled substance ✓ ^3^ Co-sign required ^4^ ✓ ^3^
Order CDb controlled substance ✓ ^3^
Modify active order Own orders Own orders Own orders
Cancel / discontinue order Own orders + supervised Own orders Own orders Safety cancel ^5^
Override CDS alert (soft-stop)
Override CDS alert (hard-stop co-sign) ✗ — requires attending ✗ — requires attending
Execute order set
Dual-verify CDa prescription
Pharmacy queue: verify order
View order audit log
Break-the-glass access
Manage order set templates Dept chairs only ✓ ^6^

^1^ May have formulary-level restrictions per training programme or collaborative agreement. ^2^ Requires physician co-signature within 24 hours; CDa verbal orders blocked. ^3^ Only if MOH controlled substance authorisation is on file. ^4^ Resident enters order; supervising attending co-signs before transmission to UEP. ^5^ Pharmacist may place safety-related hold or cancel with documented clinical justification; ordering provider notified. ^6^ Pharmacist (clinical pharmacy lead) can propose order set content; final approval by P&T committee.


UAE Controlled Substance Ordering Privileges

Per Federal Decree-Law No. 30/2021 and Ministerial Decree No. 379/2019 (UEP):

Role CDa-Narcotic (Sch 1–3) CDa-Psychotropic (Sch 4–6) CDb (Sch 7–8) UEP Access
Attending MD (with MOH CS auth) Submit + query
Attending MD (without MOH CS auth) Query only
Resident MD Co-sign by attending Co-sign by attending Query only
NP/PA (with MOH CS auth) Submit + query
NP/PA (without MOH CS auth) Query only
Pharmacist Verify / dual-verify Verify / dual-verify Verify Query + dispense confirmation
RN Verbal order (CDb only, 24 h co-sign)
Unit Clerk

Self-prescribing prohibition: Article 82 of Decree-Law 30/2021 prohibits any provider from prescribing controlled substances to themselves. The system enforces ordering_provider_id ≠ patient_id for all controlled substance orders.

Telehealth prohibition: Controlled substance prescribing is prohibited during telehealth encounters. The system blocks CDa and CDb order entry when encounter_type = 'telehealth'.


Context-Based Restrictions

Patient Relationship

  • Attending: Can order for patients on their service (attending of record) or patients for whom they have covering privileges.
  • Resident: Can order only for patients on their rotation assignment; system validates against rotation schedule.
  • NP/PA: Can order for patients per panel assignment or coverage agreement; validated against collaborative agreement scope.
  • Emergency department: All ED providers can order for any patient registered to the ED (location-based override).

Time-Based

  • Resident orders placed between 22:00–06:00 trigger notification to supervising attending.
  • Controlled substance orders placed outside business hours (20:00–06:00) flagged for next-day compliance review.
  • Verbal orders entered during night shift have 24-hour co-signature clock starting from the timestamp of entry (not from the next business day).

Location-Based

  • Remote access (VPN from outside hospital network) requires multi-factor authentication (MFA) — ADHICS V2 mandate.
  • High-risk medication orders (chemotherapy, anticoagulants, insulin drips) require on-site presence — blocked from remote workstations.
  • Operating room context: Only anaesthesia and surgical attending can order for patients with active surgical encounter.

Role Hierarchy

Chief Medical Officer
├── Medical Director / Deputy CMO
│   ├── Department Chairs
│   │   ├── Attending Physicians
│   │   │   ├── Senior Residents (PGY-3+)
│   │   │   ├── Junior Residents (PGY-1–2)
│   │   │   └── Fellows
│   │   └── Nurse Practitioners / Physician Assistants
│   └── Pharmacy Director
│       ├── Clinical Pharmacists
│       └── Staff Pharmacists
└── Chief Nursing Officer
    ├── Nursing Directors
    │   ├── Nurse Managers
    │   └── Charge Nurses
    │       ├── Registered Nurses
    │       └── Unit Clerks

Permissions inherit downward: a Department Chair has all Attending MD permissions plus order set management. The CMO has break-the-glass authority and can override any role restriction with full audit logging.


Escalation Paths

Scenario From To SLA
Order clarification needed RN / Pharmacist Ordering provider 1 hour (routine), 15 min (STAT)
CDS hard-stop override approval Resident / NP/PA Supervising attending 30 minutes
Formulary exception request Ordering provider Pharmacy director → P&T committee 24–48 hours
Controlled substance co-signature Resident Supervising attending 4 hours
Verbal order co-signature overdue System Ordering physician → department chair → compliance 12 h reminder, 24 h escalation
Pharmacy safety hold Pharmacist Ordering provider 1 hour
UEP rejection System Ordering provider + compliance officer Immediate

Break-the-Glass Emergency Access

Scenario

Medical emergency requiring immediate order entry for a patient outside the provider's normal assignment, or when normal authentication is unavailable.

Procedure

  1. User clicks "Emergency Access" button on the CPOE locked screen.
  2. System displays warning: "This action will be audited and reviewed. Proceed only for genuine patient safety emergency."
  3. User enters: - Reason for emergency access (required free text, minimum 20 characters) - Patient identifier (MRN or Emirates ID)
  4. System grants temporary elevated ordering privileges for that patient: - Duration: 15-minute timeout (auto-revokes) - Scope: All order types except CDa controlled substances (CDa requires UEP approval regardless)
  5. All actions logged with: - User ID and role - Timestamp (start and end) - Reason provided - IP address and workstation ID - Every order placed, viewed, or modified during the session
  6. Notifications sent automatically: - Compliance officer notified within 1 hour - Patient's attending physician notified - Department chair notified if user is outside their department
  7. Post-access review: Compliance team reviews within 24 hours; valid uses documented in patient chart; invalid uses result in progressive disciplinary action.

NABIDH Break-the-Glass Alignment

Per NABIDH Standards for Health Information Consent & Access Control v1 (Feb 2025):

  • Break-the-glass events are reported to NABIDH
  • Patient receives notification of emergency access via portal (if registered)
  • Audit log shared with NABIDH on request

Audit

  • 100% of break-the-glass events reviewed by compliance
  • Monthly aggregate report to CMO
  • Invalid use results in access suspension pending investigation
  • Audit log retention: 5 years (ADHICS V2)
content/clinical/cpoe/02-roles-permissions.md Generated 2026-02-20 22:54