A New Application Matches Patient’s Travel and Family History With Medical Symptoms
By MELINDA BECK
A month ago, Massachusetts General Hospital in Boston had no way to flag in its electronic medical records if an incoming patient had been to West Africa and had symptoms suggesting Ebola.
Now it does. Five days after the first U.S. case was confirmed in Texas, the hospital deployed a new Ebola application made by QPID Health Inc. that automatically matches a patient’s travel and family history with medical symptoms. If Ebola is suspected, the application flashes a blinking “Q” to alert hospital personnel.
Medical experts say concern over Ebola cases entering the U.S. has become a “teachable moment” for electronic medical records systems, or EMRs.
EMR vendors have scrambled to add new screening questions and alerts to their systems in the wake of the missteps with the Ebola patient at Texas Health Presbyterian Dallas Hospital. That patient, Thomas Eric Duncan, who had recently come to the U.S. from Liberia, was initially misdiagnosed as having “sinusitis” and sent home, only to return three days later, gravely ill.
“This was a caregiver communication issue, not an EMR issue,” said Wendell Watson, a spokesman for the hospital, which initially said that a flaw in its EMR system prevented the physician from seeing Mr. Duncan’s travel information, then said it had been noted in his records.
Mr. Duncan subsequently died of Ebola at the hospital on Oct. 8.
“Before we had a case of Ebola, no one had programmed these systems to say, ‘Here’s a patient with a fever who has just come from West Africa: He needs to be isolated,’” said Robert Wachter, a patient-safety expert and chief of hospital medicine at the University of California, San Francisco. “Now, they all are.”
Athenahealth Inc., which makes cloud-based systems for 23,000 medical practices, has made new screening questions available to its users in case infected patients turned up at doctors’ offices. “You’d be surprised how many practices don’t have a travel-history question or country of origin in their EMRs,” said Todd Rothenhaus, the company’s chief medical officer.
St. Claire Regional Medical Center, a 158-bed hospital in rural Morehead, Ky., is revamping its EMR system to record temperatures and travel histories of patients arriving at its ER and primary-care and specialty clinics. A group of local missionaries is due back from West Africa soon “so we want to be prepared,” said its chief information officer, Randy McCleese.
At Mass General, beyond alerting triage nurses to possible Ebola, the QPID system also displays the words “Ebola Screen” in red on a dashboard in the patient’s record, with all relevant symptoms, lab tests and personal history visible in a pop-up window.
“Let’s say you’re just coming on shift. One doctor might know about the patient’s diarrhea, another might know about the West African travel, but they might not have talked—that’s when this would help most,” says Garry Choy, the hospital’s assistant chief medical information officer. “It helps doctors not miss anything.”
Carl Dvorak, president of Epic Systems Corp., which made the Dallas hospital’s EMR, said in an interview that after the Duncan case, the company contacted all of its 320 global hospital clients and suggested they consider changes to their systems. Among them: asking patients about travel history earlier in the triage process and implementing a “hard-stop pop-up” alert that requires staffers to acknowledge the possibility of Ebola before progressing through the record.
Hospitals can also program the alerts to suggest next steps to isolate a patient and automatically alert infectious-disease personnel.
Some Epic clients have opted for the hard-stop pop-ups and some haven’t, Mr. Dvorak said. “You don’t want things popping up so often that people ignore them.”
Some critics hope that Ebola awareness will prompt vendors to make additional changes to EMR systems. Doctors have long complained that many EMR systems, originally designed for billing functions, make it difficult to find critical data quickly.
“The signal-to-noise ratio can be very low. That’s the problem we’re all working on,” said Glenn Tobin, former chief operating officer of Cerner Corp. , another EMR vendor, who is now with Advisory Board Co. , a consulting firm.
Even before Ebola, some vendors and software developers were working on programs to mine records and present data in a more usable way. QPID Health makes add-on applications that allow doctors to search patient records for information pertinent to, say, a cardiovascular or kidney condition and amalgamate it in accessible form.
“A lot of great information in EMRs never sees the light of day,” said Mike Doyle, CEO of QPID Health. “The key is to think like a physician.”
Hospitals, vendors and software developers say it’s critical that EMR systems be able to adapt to new infectious diseases or other threats, but that humans still play a key role.
“Somebody has to decide what is concerning enough to have the computer shout out about,” said Mr. Dvorak. “I’m very excited about artificial intelligence, but it’s nowhere near capable of being a doctor yet.”
