The numbers on one of the world's deadliest viruses are chilling. The World Health Organization has confirmed nearly 20,000 Ebola cases, with more than 7,588 people having died from the deadly virus. Despite the virus outbreak originating in West Africa, many health officials projected the virus would eventually arrive on American soil. And they were right. The first U.S. Ebola case, however, put one hospital in the spotlight, facing harsh criticism over how it both handled the case and wrongly pointed fingers at the hospital electronic health record. Photo: Transmission electron micrograph or Ebola virus virion – CDC Global 2014
Officials at Texas Health Presbyterian Hospital Dallas, the hospital that reported the first case of Ebola on American soil, first pointed fingers in an Oct. 2, 2014 statement at a "flaw" in the hospital's electronic health record as part of the cause behind hospital officials' failure to communicate the patient's vital travel history and their oversight in initial diagnosis, which eventually led to Thomas Eric Duncan being discharged from the hospital. Photo: Texas Health Presbyterian Hospital Dallas
On Oct. 3, the 25-hospital Texas Health Resources corrected its original statement, which indicated a "flaw" in the way the nursing portion of the EHR interacted with the physician's portion, causing the patient's travel history to Liberia not to appear in the physician's workflow. In its restatement, officials said there actually 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. Epic, the EHR used by THR, contacted Healthcare IT News to highlight that the health system had issued a restatement.
"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." Photo: Ebola response training in Texas, Army Medicine 2014
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In a Congressional hearing Oct. 16, THR's Chief Clinical Officer Daniel Varga detailed the sequence of events and missteps that led up to Thomas Eric Duncan being initially discharged from the hospital emergency room. In his statement, Varga detailed two big failures at play. One being that Duncan's travel history to Liberia was not captured at the initial point of contact in the ER's admission process.
The second? The hospital's Epic EHR did not have adequate pop-up visibility and travel documentation capabilities related to travel history Ebola exposure, Varga explained. "We have modified our electronic health record in multiple ways to increase the visibility and documentation of information," he said.
The modifications made included improving the placement and title of the screening tool; adding a pop-up that flags the patient as high-risk for Ebola with subsequent instructions if the patient answers 'yes' to certain screening questions; and exposure to known or suspected Ebola cases. Photo: Daniel Varga, MD
The events that transpired at Texas Health Resources elicited an overflow of industry responses. Chief among them John Loonsk, MD, chief medical information officer at Johns Hopkins Center for Population Health IT, who said that the outbreak anxiety proves "distressing," but it plays an integral role in "motivating action."
"An EHR did not cause the initial Ebola illnesses in the U.S., but health IT is also not yet aligned to substantially help with outbreaks either," he said. His big takeaways: Outbreak management needs are much more than an EHR interface and EHRs should provide information and communication – not conclusions.
See also: Ebola cases put focus on health IT needs
Despite the mistakes that transpired at Texas Health Resources, there have been myriad Ebola success stories, with health IT often at the center. For instance, shortly after the WHO declared on Oct. 20, 2014 that Nigeria was free of the Ebola virus transmission, Nigerian Minister of Communication Technology Omobola Johnson credited a social media campaign and a real-time reporting Android app used during the outbreak as integral in containing the deadly virus.
"The phone app helped in reducing reporting times of infections by 75 percent," said Johnson, speaking at the International Telecommunication Union's Plenipotentiary Conference Oct. 21, 2014. "Test results were scanned to tablets and uploaded to emergency databases, and field teams got text message alerts on their phones informing them of the results." Photo: Omobola Johnson, World Economic Forum 2013