View Full Version : [Infectious Diseases] No EHR Flaw After All in Ebola Case, Says Hospital

Sat 11th October '14, 6:31pm
Robert Lowes (http://www.medscape.com/author/robert-lowes)

October 08, 2014

The Texas hospital that first appeared to blame its electronic health record (EHR) system for not hospitalizing Thomas Eric Duncan when he first showed up in its emergency department (ED) with Ebola (http://emedicine.medscape.com/article/216288-overview?src=wgt_edit_news_lsm&lc=int_mb_1001) symptoms has tweaked its story.

There was no "flaw" in the software after all, it now maintains.

The gist of the controversy is that Duncan, who died Wednesday morning (http://www.medscape.com/viewarticle/832958), told an ED nurse at Texas Health Presbyterian Hospital Dallas on September 25 that he had been in Africa recently, but the information didn't make it to other members of the care team — physicians in particular. They sent the Liberian national home with antibiotics. He returned to the hospital ED 3 days later in worse shape and was immediately hospitalized. He had been on a ventilator and receiving both dialysis and the investigational drug brincidofovir before his death.

Shortly before he arrived in the United States on September 20, Duncan was exposed to Ebola in his native Liberia — one of several West African nations ravaged by the virus — when he tried to help a woman dying of Ebola obtain medical care.

At one point, he carried her in his arms — the kind of physical contact that can spread the disease.

Details on his delayed hospitalization emerged on October 1 when Mark Lester, MD, executive vice president of Texas Health Resources, the hospital's parent company, spoke at a news conference. According to Dr. Lester, an intake nurse recorded in the EHR that Duncan said he had been in Africa during the previous 4 weeks.

"Regretfully, that information was not fully communicated throughout the full team," said Dr. Lester. "As a result, the full import of that information wasn't factored into the clinical decision-making."

The next day, Texas Health Resources issued a 2-page news release (http://www.medscape.com/viewarticle/832823) discussing Duncan's first visit to the ED. Although an intake nurse had documented the tell-tale travel history in the nursing portion of the EHR, "we have identified a flaw in the way the physician and nursing portions of our electronic health records interacted in this specific case." Noting that there are separate EHR workflows for physicians and nurses, the hospital said that "as designed, the travel history would not automatically appear in the physician's standard workflow." It said it had relocated the travel history information "to a portion of the EHR that is part of both workflows" and modified it to flag Ebola-endemic parts of Africa.

In EHR parlance, "workflow" refers to the data displays, online forms, tools, automatic alerts, and links that a clinician would use depending on the task at hand — such as prescribing a medication — and his or her role in the healthcare team.
On October 3, Texas Health Resources issued a second news release, much briefer, to clarify a point made in the first one. "As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including the physician's workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event."

Texas Health Resources' EHR program is from Epic Systems, a leader in both the inpatient and outpatient EHR markets.

Source: Medscape: Medscape Access (http://www.medscape.com/viewarticle/832984)