Texas Hospital Blames EHR For Ebola Mishandling - InformationWeek

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Texas Hospital Blames EHR For Ebola Mishandling
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Thomas Claburn
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Thomas Claburn,
User Rank: Author
10/3/2014 | 4:27:47 PM
automation
So here's the question: If the patient's travel history had been reported to clinician and conveyed to other medical personnel via oral or written report, would the handling of the patient have been different? If so, EHRs need some rethinking.
Alison_Diana
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Alison_Diana,
User Rank: Author
10/3/2014 | 5:02:11 PM
Re: automation
According to everything I've read, yes: Had the doctor known the patient had been in Western Africa and had those symptoms, he would have kept the patient in the hospital and tested him for Ebola. 
jastroff
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jastroff,
User Rank: Ninja
10/4/2014 | 12:56:44 PM
Re: automation
I'm reminded of the old expression "a bad workman blames his tools" – seems to fit somewhat here.

This case was charted in everyday workflows that don't demand special attention? The nurse should have known enough to note this issue under a workflow that says "RED FLAG" or "URGENT" – why doesn't anyone think this needs another workflow other than everyday stuff?

And there's also a telephone to call the appropriate physician and talk to them.

I hope I never get sick in Texas.
Alison_Diana
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Alison_Diana,
User Rank: Author
10/6/2014 | 10:28:32 AM
Re: automation
I agree with you, @Jastroff. You've got an illness that is making headlines on everything from CNN and Fox to the New York Times and business media, an individual who has apparently all the medical symptoms and says he has traveled to a region afflictled with Ebola, and you don't pick up the phone, mutter in a colleague's ear, or escalate the patient's treatment in triage?! 
jastroff
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jastroff,
User Rank: Ninja
10/4/2014 | 1:06:44 PM
Automation Correction -- Human Error
From the Wall Street Journal –

Looks like they can't blame the system

 

"DALLAS—A day after saying that doctors didn't receive a Liberian patient's travel history due to an electronics records glitch, the Dallas hospital that initially failed to admit the first person diagnosed with Ebola in the U.S. has changed its version of events, stating that information that he had come from Africa was in fact available to doctors.

 

Texas Health Presbyterian Hospital Dallas said in a terse clarification late Friday evening that Thomas Eric Duncan 's travel history was available to physicians as well as nurses in its electronic health records when Mr. Duncan first arrived at the hospital's emergency room on the night of Sept. 25, complaining that he felt ill."
Alison_Diana
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Alison_Diana,
User Rank: Author
10/6/2014 | 10:31:09 AM
Re: Automation Correction -- Human Error
Thank you, @jastroff. I saw that too -- and was going to post it separately. The notice from the hospital came long after I filed the story. What's striking, however, is the readiness with which many experts agreed it COULD happen in the way the Texas hospital first said; that separate workflows might well prevent doctors from seeing nurses' notes. While, thankfully, that was not the case (apparently, according to this second statement) here, if I was the chief medical officer of a hospital I'd be making sure all workflows either integrated or had some kind of sharing capability, post-Texas.
jastroff
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jastroff,
User Rank: Ninja
10/4/2014 | 1:06:58 PM
Automation Correction -- Human Error
From the Wall Street Journal –

Looks like they can't blame the system

 

"DALLAS—A day after saying that doctors didn't receive a Liberian patient's travel history due to an electronics records glitch, the Dallas hospital that initially failed to admit the first person diagnosed with Ebola in the U.S. has changed its version of events, stating that information that he had come from Africa was in fact available to doctors.

 

Texas Health Presbyterian Hospital Dallas said in a terse clarification late Friday evening that Thomas Eric Duncan 's travel history was available to physicians as well as nurses in its electronic health records when Mr. Duncan first arrived at the hospital's emergency room on the night of Sept. 25, complaining that he felt ill."
PedroGonzales
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PedroGonzales,
User Rank: Ninja
10/3/2014 | 4:49:54 PM
EHRs still in progress
I agree with the last point of the article.  The nurse could have made a note and notify his/her supervisor about this patient.  Such systems continue to support the fragmented environment of a healthcare setting.  I wonder whether other EHR providers continue this method or allow for health information to be shared among various health care professionals.
Alison_Diana
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Alison_Diana,
User Rank: Author
10/3/2014 | 5:04:54 PM
Re: EHRs still in progress
I get the sense from speaking to execs for this and other articles on EHRs that some hospitals have more integrated systems, others have less integrated ones but most are working toward more interoperability both between teams (doctors and nurses) and departments. That said, we can't solely rely on technology if a patient comes in with something like MERS or Ebola. We can rely on good old-fashioned common sense and talk to each other as well. I realize we're all busy but some things take precedence over others, with or without automation. It's easy, of course, to criticize from afar and apparently this hospital has handled many other contagious diseases in the past. 
GAProgrammer
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GAProgrammer,
User Rank: Ninja
10/9/2014 | 4:02:39 PM
Re: EHRs still in progress
Also, never forget the unintended consequences that come with EHRs - the nurses expect that the doctors have access to all the same information, so instead of using common sense and mentioning it in person, they leave it to the computer to relay the info the doctor.
Charlie Babcock
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Charlie Babcock,
User Rank: Author
10/3/2014 | 6:21:10 PM
There will be more Ebola cases
I think it's fortunate that this incident occurred so early in the appearance of Ebola in the U.S. We still face the prospect of a much more widespread occurrence of the disease, even though it seems largely confined to W. Africa. Now every health care facility in the U.S. is on notice that it doesn't want to be the next Texas Health Presbyterian. I think it's inevitable that more cases will appear.
Alison_Diana
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Alison_Diana,
User Rank: Author
10/6/2014 | 10:26:08 AM
Re: There will be more Ebola cases
I agree with you, Charlie, that there will be more cases of Ebola beginning in the United States (as opposed to patients coming to the States after being infected elsewhere). That said, I am more afraid of the enterovirus that has paralyzed several children, killed at least one boy, and sent tens of youngsters to the hospital.
ITSkeptic
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ITSkeptic,
User Rank: Apprentice
10/5/2014 | 3:50:49 PM
Stop blaming the systems
Systems are a reflection of the human processes. What happens at this hospital and others is coded into the EHR systems.

Doctor - nurse communication is so disjointed already that nurses ask all the questions, enter them in. Then two hours later doctor walks in and repeats all the questions. Then reenters everything. 

Entering the data has become such an obsession that the nurse or the doctor barely look at me these days. They are "uh-uhing" me while trying to punch the right keys on the tables or on the laptops. Idiots should have paid more attention to the patient and his state.

Stop blaming the systems. Think about how you work.
Alison_Diana
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Alison_Diana,
User Rank: Author
10/6/2014 | 10:34:24 AM
Re: Stop blaming the systems
Another problem I see with the surplus of data these days is a surfeit of CYA among medical professionals. This, unfortunately, is coming from personal experience with a family member who has been "diagnosed" with an array of horrible conditions, none of which (so far) has, thankfully, been true. All doctors who have "diagnosed" her have come to their theories from good places; they want to heal or at least treat her and use all these test results to arrive at their diagnoses. But, in some ways, this huge array of data is making the condition worse because of the stress caused by all the wrong readings of data and misdiagnoses. 
shericadore
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shericadore,
User Rank: Apprentice
10/8/2014 | 3:34:04 PM
Re: Stop blaming the systems
The nurse should have paid attention to the patient in front of her and inform the doctor verbally of her findings, instead of relying on a machine.  The computer or application is as smart as the person who is using it.
bbrown878
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bbrown878,
User Rank: Apprentice
10/13/2014 | 5:38:56 PM
Re: Stop blaming the systems
"The nurse should have paid attention to the patient in front of her and inform the doctor verbally of her findings, instead of relying on a machine"

You are right ... BUT that is what automation of processes do. The users get to a point of complacency, relying on technology to take the place of what used to be something much more personallized. It happens all over, we (that is the population as a whole) are becoming more and more reliant upon technology. Things that used to be personal and interactive are now being replace by technology. Just try calling an insurance company, or a technical company for support... What are your chances of talking to someone. 

Technology is good, but it is also very dangerous. This is a perfect example.


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