Missed Ebola diagnosis leads to debate

Texas Health revises statements to: 'no flaw in the EHR'
By Erin McCann
10:55 AM
CDC Global, August 2014
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, 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 caused the patient's travel history to not appear in the physician's standard workflow. Epic contacted Healthcare IT News to highlight that Texas Health Resources had issued an Oct. 3 correction to their initial statement. They declined to comment on anything further. 
In its Oct. 3 statement, THR 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. 
The controversy and contradictions started when Thomas Eric Duncan first was admitted to the emergency department at Texas Health Presbyterian Hospital Dallas Sept. 25. He told his nurse he had been in Africa 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 that day, only to return to the hospital's ER four days later, where he was then diagnosed with the Ebola virus. THR declined to comment further. 
The chain of events has sparked public debate amongst clinicians and IT professionals over whose mistake caused the failure to communicate Duncan’s critical travel history to physicians. 
On one side, there's those who aver 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 HITN commenter 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.
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