Differing Information Needs and The Impact on the Organization The healthcare system includes six hospitals and multiple physician practice organizations. EPIC is used by physicians, nursing therapy, etc. for inpatient and EPIC Ambulatory for outpatient and physician practice. The laboratory uses a system called SoftLab and radiation oncology uses Aria. For each of these systems to share patient data, an HL7 interface passes the information between the systems. Health Level Seven International (HL7) is the standard used to map data fields between systems and allow for the communication of the data (Nursing Informatics: Scope and standards of practice, 2015). The EHR has been configured with evidence-based order sets and documentation templates to guide patient care. In February 2016, an international task force was convened to define sepsis and septic shock (Singer, Deutschman, Seymour, & et al., 2016). Which is impacting several areas of the healthcare system technology, including the EBP order sets and the 3M 360 application.
Interfaces have been developed across 3M 360 and EPIC, but they are not complete. For example, all documentation from EPIC is interfaced into 3M 360 to all the clinical documentation improvement (CDI) nurse to review the record for completeness of the documentation to support the diagnosis and to meet quality measures. The CDI nurse if they find a lack of documentation or need for clarification, for example sepsis as a diagnosis, the nurse creates a query in EPIC. Because there is no interface for query information, the nurse must copy and paste the information back into 3M 360 for tracking. 3M 360 is supported by multiple EBP references by mapping information through Natural Language Processing (NLP) and through buttons. For example, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is built into the system. The NLP will suggest diagnoses or needs to query based on the documentation from EPIC and if it meets certain EBP data within the documentation. EPIC and 3M 360 have the old definitions of sepsis and the EBP built into the systems to document and care for patients with sepsis. The issue now, is that the EBP has changed with SEPSIS 3 to include organ dysfunction based on Sequential [Sepsis-Related] Organ Failure Assessment Score (SOFA) (Singer et al., 2016). Recommendations to use codes R65.20 and R65.21 have also been made on the ICD-CM-10 codes to use, because the current codes do not match the new definitions (Singer et al., 2016). Even when a healthcare organization is trying to support EBP within HIT, when changes are made to the EBP it has clinical and billing impacts on the organization.
Hanson, D. (2011). Evidence-Based clinical decision support. In M. J. Ball, J. V. Douglas, & P. H. Walker (Eds.),
Nursing informatics: Where technology and caring meet (Fourth ed., pp. 243-258). London New York:
Springer. Nursing Informatics: Scope and standard