Missed Ebola diagnosis leads to Epic EHR debate

Texas Health revises statements to: 'no flaw in the EHR'
By Erin McCann
01:56 PM
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A statement from the 25-hospital Texas Health Resources explaining why critical travel information was not communicated regarding the nation's first Ebola patient has left many wondering where the problem occurred – and, more importantly, how to fix it.

On Oct. 1, Texas Health Resources, or THR, issued a statement, which appeared to point fingers at THR's Epic electronic health record system versus potential human error, saying that a flaw in the interaction between the physician and nursing portion of the EHR resulted in the patient's travel history failing to appear in the physician's standard workflow.

Epic contacted Healthcare IT News to highlight that THR had issued an Oct. 3 correction to its initial statement. THR declined to comment further.

In its Oct. 3 statement, THR officials recanted their original account, saying instead that there was "no flaw in the EHR in the way the physician and nursing portions interacted related to this event" and that the patient's travel history "was available to the full care team" in the EHR including the physician's workflow.

The controversy and contradictions started when Thomas Eric Duncan, diagnosed with the Ebola virus Sept. 29 at Texas Health Presbyterian Hospital in Dallas, told his nurse he had been in Liberia prior to his arrival in the U.S. The information, THR officials say, was entered into the EHR. But the information somehow did not reach the appropriate clinicians. Duncan was then discharged from the ER and did not return until nearly three days later, increasing the likelihood of spreading the virus further.

The chain of events has sparked public debate between both clinicians and IT professionals over whose mistake caused the failure to communicate Duncan’s critical travel history to physicians.

There is one group who avers that the Epic electronic health record was not the problem in this case.

“Truly, there was no EHR issue here,” said John Halamka, MD, chief information officer at Beth Israel Deaconess Medical Center in Boston, in an emailed statement. Typical EHRs, he continued, have alerts, reminders and tasks – all of which “were in production in Texas.”   

Healthcare IT News readers also weighed in on the debate.

“It is NOT a problem with the EHR,” commented Stephen Maro, RN and Epic go-live support at Johns Hopkins Medicine’s Suburban Hospital. “The health system did THEIR BUILD wrong. Making travel history appear for the physician is easy. The health system just has to decide that they want it to appear and have their build team make the adjustment.”

Outspoken patient privacy advocate Deborah Peel, MD, weighed in on THR's initial statement. "Paper records and electronic records both have errors, that's why the physician has always been responsible for making his/her own independent assessment – which means talking with the patient," she said. "EHRs can't replace the patient-physician relationship."

Athenahealth CEO Jonathan Bush had something to say, also. "The worst supply chain in our society is the health information supply chain," Bush told CNBC regarding the incident. "It's just a wonderfully poignant example, reminder of how disconnected our healthcare system is."

There were also those who seemed to think the fault was due to both an EHR issue and a human issue.

“When an EHR claims to have clinical decision support, shouldn't that not only warn the doctor on the face sheet, but also highlight the nurse's note and pull up the CDC's alert and a CPOE order set, and create a contact report for the local health department?” another comment pointed out.

As the debate continues over who or what was at fault, in the meantime the World Health Organization has updated its numbers on Ebola deaths. And they’re chilling.

Calling it the deadliest outbreak of Ebola in history, the WHO has reported that 3,431 people have lost their lives as of Oct. 1. More than 7,470 people have been diagnosed with the virus, which has a fatality rate of up to 90 percent.