Dallas Ebola Patient Sent Home Because of Defect in Software Used by Many Hospitals

Here at Rice Consulting, we have been making the message to heathcare providers for over two years now, that the greatest risk they face is in the integration and testing of workflows to make sure electronic health records are correctly made available to everyone involved in the healthcare delivery process - all the way from patients to nurses, doctors and insurance companies. It is a complex domain and too many heathcare organizations see EHR as just a technical issue that the software vendor will address and test. However, that is not the case as demonstrated by this story.

From the Homeland Security News Wire today, October 6:

"Before Thomas Eric Duncan was placed in isolation for Ebola at Dallas’ Texas Health Presbyterian Hospitalon 28 September, he sought care for fever and abdominal pain three days earlier, but was sent home. During his initial visit to the hospital, Duncan told a nurse that he had recently traveled to West Africa — a sign that should have led hospital staff to test Duncan for Ebola. Instead, Duncan’s travel record was not shared with doctors who examined him later that day. This was the result of a flaw in the way the physician and nursing portions of our electronic health records (EHR). EHR software, used by many hospitals, contains separate workflows for doctors and nurses."

"Before Thomas Eric Duncan was placed in isolation for Ebola at Dallas’ Texas Health Presbyterian Hospital on 28 September, he sought care for fever and abdominal pain three days earlier, but was sent home. During his initial visit to the hospital, Duncan told a nurse that he had recently traveled to West Africa — a sign that should have led hospital staff to test Duncan for Ebola. Instead, Duncan’s travel record was not shared with doctors who examined him later that day.

'Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case,” the hospital wrote in a statement explaining how it managed to release Duncan following his initial visit.

According to NextGov, EHR software used by many hospitals contains separate workflows for doctors and nurses. Patients’ travel history is visible to nurses, but such information 'would not automatically appear in the physician’s standard workflow.' As a result, a doctor treating Duncan would have no reason to suspect Duncan’s illness was related to Ebola.

Roughly 50 percent of U.S. physicians now use EHRs since the Department of Health and Human Services (HHS) began offering incentives for the adoption of digital records. In 2012, former HHS chief Kathleen Sebelius said EHRs 'will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care.' Many healthcare security professionals, however, have pointed out that some EHR systems contain loopholes and security gaps that prevent data sharing among healthcare workers.

The New York Times recently reported that several major EHR systems are built to make data sharing between competing EHR systems difficult. Additionally, a 2013 RAND Corporationstudy for the American Medical Association found that doctors felt 'current EHR technology interferes with face-to-face discussions with patients; requires physicians to spend too much time performing clerical work; and degrades the accuracy of medical records by encouraging template-generated doctors’ notes.'

Today, Dallas’s Texas Health Presbyterian Hospital has made patients’ travel history available to both doctors and nurses. It has also modified its EHR system to highlight Ebola-endemic regions in Africa. 'We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola,' the hospital noted."