In testimony before a House subcommittee last week, a Texas Health Resources official sought to clarify conflicting statements regarding the role of the hospital’s electronic health record system in its handling of the first patient diagnosed with Ebola in the U.S.,Health Data Management reports (Goedert, Health Data Management, 10/17).
Background
Thomas Eric Duncan arrived in the U.S. on Sept. 20 and was sent home from Texas Health Presbyterian Hospital after seeking help for a fever, stomach pain and sharp headache on Sept. 25. Duncan returned to the hospital on Sept. 28 where he was diagnosed with Ebola and placed in isolation (iHealthBeat, 10/6).
Duncan died less than two weeks later (McCann, Healthcare IT News, 10/17).
According to the hospital, Duncan told a nurse during his initial hospital visit about his recent travels to Liberia, and the nurse correctly entered his travel history information into the hospital’s EHR system.
On Oct. 2, THR released a statement saying that although the nurse had included the information about Duncan’s travel history in the EHR, a flaw in the system had prevented his physicians from seeing the note.
However, on Oct. 3, officials effectively retracted the statement, explaining that “the patient’s travel history was documented and available to the full care team in the [EHR], including within the physician’s workflow.” The hospital noted that “there was no flaw in the way the physician and nursing portions interacted related to this event.”
The hospital uses EHR software developed by Epic Systems (iHealthBeat, 10/6).
Testimony Details
During testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations, THR Chief Clinical Officer and Senior Executive Vice President Daniel Varga attributed the initial release of the patient to two big failures. He said:
- The hospital did not obtain Duncan’s travel history during the admission process at the emergency department; and
- The EHR system did not have proper pop-up visibility and travel documentation capabilities regarding travel history.
As a result, Varga said the hospital has changed its screening process to ensure that travel history is captured at the initial point of contact in the ED (Healthcare IT News, 10/17).
Further, Varga said the hospital’s EHR system has been updated to increase the visibility of travel-related information. He noted the changes include:
- Additional screening questions, including some about high-risk activity and possible exposure to Ebola-infected patients;
- Enhanced placement and title of the screening tool; and
- Pop-up alerts that notify providers whether a patient is at high-risk for Ebola.
In addition, Varga said that staff members received additional training on how to use the EHR system correctly during such situations (Bowman, FierceEMR, 10/17).
Former National Coordinator for Health IT Weighs In
Former National Coordinator for Health IT David Blumenthal in a blog post wrote that the hospital’s “reflex” to blame its EHR system for the mistake revealed that such systems are easy targets for scapegoats as the health care industry transitions to electronic information systems.
He added that physicians are largely dissatisfied with EHRs, noting that because they are “imperfect,” pinning the blame on them “for whatever ails American health care is an understandable, if not wholly justifiable, reaction to the dramatic changes with which providers are grappling.” However, he added, “The dissatisfaction with the technology will recede as EHRs improve,” as there “is no going back in the electronic health information revolution” (Blumenthal,Commonwealth Fund blog, 10/17).
