EHR system changed after Ebola patient released from emergency room
Understanding why exactly an Ebola patient was released from a hospital emergency room is pretty easy. We can blame it all on EHR systems, right?
The recent discharge of Ebola patient Thomas Eric Duncan from Texas Health Presbyterian Hospital, Dallas, highlights a tricky side of electronic health system records that are designed to reduce health care cost, improve patient safety, enhance consumer experience and help coordinate care across the board. But it seems it might not always work that way.
And no, we can’t blame what happened entirely on electronic health records.
As a nurse who works with technology every day, several reasons why EHR systems require vigilance come to mind.
The reality is computer systems use multiple programs that don’t integrate well. What one person sees may not be accessible to another department that is also involved in patient care.
This wasn't necessarily the case regarding Thomas Duncan, though that’s what the hospital initially seemed to suggest.
In this case a nurse had made an entry that Duncan had visited Africa, but the physician did not see that information.
In essence, it was in the nurses’ electronic health entry that just wasn’t reviewed– a detail that could has been remedied easily.
This is what the hospital now says:
“We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”
The problem, they go on to explain, is that the records are in separate places.
They also explain how the triage nurse does an assessment and then the intake nurse does an even more thorough assessment to include several questions along with vital signs, included travel history outside the U.S. in the past 4-weeks.
With so much information available, it isn't easy to know what you should be reviewing day to day. Sometimes health care professionals learn after-the-fact that EHR systems contain information they should have or at least could have been accessing all along.
If you work with EHR systems currently, you know what can happen in a day. You may have access to some, but not all information on a patient. Any part of your computer program can develop a glitch, which means delays and suboptimal information about your patients.
It can also happen when you’re trying to make an entry. Sometimes you think you saved an important piece of data. Often times you do, but a glitch in the system dumps the info.
Computer updates, as any IT person can tell you, leave much to be desired. When systems update, information can get ‘lost’ in cyberspace. It happens all the time, but updates are necessary.
The failure of EHR systems to catch the fact that a patient had been exposed to Ebola is a frightening prospect for all of us. It’s doubtful that we can entirely blame electronic health records for unleashing an Ebola patient on the public. After all, if the physician had just read the information provided the entire scenario would be different.
As with everything, perhaps the answer lies somewhere in the middle. EHR systems are great, but they are not foolproof. As consumers we should not expect them to be.
Ask your own questions from patients and don’t limit yourself to what you read about those under your care, whether it's handwritten or documented electronically. And if you're a patient, tell your doctor important facts, even if it means you're repeating yourself to more than one health care worker.
After all, couldn't the same thing happen if a physician was reviewing a paper chart containing pages of bulky information?
Texas Health Presbyterian Hospital has now incorporated travel history documentation into both the nurses’ and physician’s workflow. The hospital says they are being transparent, in hopes that other hospital systems can learn from the experience.