EPIC patient CSN issues

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We went live with EPIC this past June and have since encountered issues related to CSNs when scanning patient armbands using our Nova Glucose meters interfaced with RALS.

Our system includes four hospitals and numerous physician offices. The problems we’re seeing include:

  1. Invalid Sample ID Flag: After scanning a patient’s armband, the CSN is flagged as an invalid sample ID in RALS. When we search that CSN in EPIC, there is no admission listed for the corresponding hospital.

  2. Incorrect Facility Association: The CSN scanned by the glucose meter is flagged as invalid in RALS, and upon checking EPIC, the admission tied to that CSN belongs to a different facility within our system.

  3. Future or Outpatient Association: The CSN scanned is flagged as invalid in RALS, and EPIC shows the CSN is linked to either a future appointment or an outpatient visit at one of our physician offices.

We are actively working with our IT and registration teams to investigate the root cause, but at this time, the source of the issue remains unclear.

Any insights or suggestions you might have would be greatly appreciated.
Thank you,
Deborah Martuch
deborah.martuch@hf.org



6 Replies

We have seen the same issue in the past and it is all OPERATOR ERROR.

CSN – need to be related to the current encounter, the patient need to have the encounter on the location where the testing is performed. In the clinics they print the label the day before and attached to the paperworks that the patient will be using the following day. That will not work if the test is performed before the patient has been admitted into that encounter.

If you use the CSN from previous encounter it will not work.

The workflow needs to be that the patient needs to be admitted/check-in in an encounter that is current, that will create a CSN and that is the CSN that need to be use for testing.

Sincerely,
Alma
“Far and away the best prize that life offers is the CHANCE to work hard at work worth doing” – Theodore Roosevelt

Alma Calzado-Knudson, MBA, CLS, MT (ASCPi & AMT)
Manager, Lab Quality and Point of Care Testing
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I deleted my first response as I replied to the wrong issue!
Invalid sample flag is likely an operator issue with scanning or entering the wrong CSN.
Wrong facility - yes this happens and the CSN has to be updated to the correct CSN for the facility.  This happens frequently with transfers and the CSN's cannot be shared between locations.  Since the CSN is an encounter contact, the contact would be at a different facility and this matters for billing.
Future CSN's used - that won't work either as the patient is "here" yet on a future appointment.  I believe there is something about making sure you are on the right encounter when printing armbands or labels and not on their future encounter. I am not 100% on that though for this.  If a future appointment is used, it needs to be updated to the correct current CSN.

Deborah, we don't use the NOVA meter although do use EPIC and RALS. In seeing the other two responses so far, both of those would apply to 'us' so I have a 3rd comment about CSNs and RALS/EPIC.
We run into a problem, moreso in Urgent Care than we do other ambulatories, if during an Urgent Care visit (encounter) the POC test ordered by MD is not 'covered' within the Urgent Care visit (I've been told it's related to diagnostic codes/diagnosis) then the nurse has to go back to registration desk and get a different encounter generated for the patient generates a new/different CSN and that new CSN has to be used otherwise the flag is 'sample ID error'.  

I have a question that is somewhat related to this thread. If you are using NOVA meters-NovaNet and RALS in a ~1,000-bed facility with ancillary locations: How many locations are set up in your RALS/NovaNet? We have over 300 locations, which was configured before I started. When the NovaNet-RALS programmed meters scan a patient from a different location, the encounter is flagged as invalid. If I use a meter programmed exclusively for RALS, it will "fetch" the patient's information and populate.  I have requested that NOVANET program fetch in their system, but over the past five years, there has been no effort to add this feature. My opinion is that RALS has the programmers and willingness to modify their system to meet customer requests, but Nova does not.

We've been experiencing mis-scans of the CSN barcode on occasion, but often enough to know there's an issues.  It happens with the glucose meters, the iSTATs and the Rovers so we know it's not the devices themselves.  And it's not a matter of the CSN from a different encounter - they are usually just a "wrong number."  Anyone else seeing this?  We use Roche AccuChek II meters, iSTAT as mentioned, and Roche cobas Infinity POC, and of course, EPIC.

Deb Capraro Phaup- Yes!  We have had this issue since 2021!  It happened when we went to Epic single instance across our entire system and it switched to Epic Optime printing.  In addition, we notice the mis-scans when print heads are wearing out and also general bad armband printing.  Email us!  miranda.cotter@mercy.net and julie.blasini@mercy.net

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