Questions raised about EHR workflow in Ebola case

'The travel history would not automatically appear in the physician's standard workflow'
By Erin McCann
11:02 AM
Photo EC/ECHO/Cyprien Fabre
Texas Health Resources has issued a correction to their initial statement underscoring a "flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case." According to the clarification, issued Oct. 3, "there was no flaw in the EHR in the way the physician and nursing portions interacted related to this event." Despite initially stating that the patient's travel history was documented in the nursing workflow but not immediately available in the physician's workflow, THR officials have corrected their statement by saying the patient's travel history was available to the full care team in the EHR. 
 
For updated coverage, see "Missed Ebola diagnosis leads to debate."
 
An electronic health record 'flaw' involving the country's first diagnosed Ebola patient may have serious repercussions after it resulted in critical information missing from the EHR.
 
Thomas Eric Duncan, who was diagnosed with the Ebola virus Sept. 29 at Texas Health Presbyterian Hospital in Dallas, reportedly told his nurse he had been in Liberia prior to arriving in the U.S. Due to an oversight in how the physicians and nurses workflow portion was designed in the EHR, however, the vital travel history entered into the EHR by the nurse did not appear in the physician's standard workflow.
 
 
As a result, Duncan, who first showed up in the hospital's emergency room Sept. 25, was released the following morning, potentially exposing individuals to the deadly virus. He returned to the hospital Sept. 28, where he was relocated to an isolation unit, according to a World Health Organization global alert notice.  
 
In an Oct. 2 statement, Texas Health officials said that in the "interest of transparency," they confirmed the chain of events leading up to Duncan's travel history not being initially known by or communicated to physicians.
 
"We have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows," Texas Health officials explained in the Oct. 1 media statement. "As designed, the travel history would not automatically appear in the physician's standard workflow."
 
THPH, part of the 25-hospital Texas Health Resources, is an Epic shop. 
 
Duncan, who has been the subject of criticism after originally denying he had been in contact with Ebola patients before leaving Liberia, reportedly had been helping those diagnosed with the deadly virus. He was screened three times before he was able to leave Liberia, CNN reports. His family and partner are currently being quarantined in Texas. 
 
The World Health Organization has called this the deadliest outbreak of Ebola in history, one that has claimed the lives of 3,338 people as of Oct. 1. More than 7,178 people have been diagnosed with the virus, which has a fatality rate of up to 90 percent.