Ebola Patient's Travel History Got Buried in Hospital EHR

October 03, 2014

The tell-tale travel history of a patient with Ebola who had just arrived in Texas from Liberia got lost in the electronic health record (EHR) system of a Dallas hospital that treated him in its emergency department (ED) and sent him home only to admit him 3 days later.

The avoidable delay in hospitalization meant several more days of the patient, Thomas Eric Duncan, exposing others to the deadly Ebola virus.

Roughly 50 individuals who crossed his path in various ways, including ambulance workers, hospital staff, and people in the community, are being monitored daily for fever and other Ebola symptoms for 21 days, the Centers for Disease Control and Prevention (CDC) announced today. The agency described 40 of these individuals as having a low risk of contracting Ebola and classified the rest as high-risk. Four individuals close to Duncan — he was staying at their apartment — remain under involuntary quarantine.

Duncan came to the ED of Texas Health Presbyterian Hospital on the evening of September 25 with a 100.1°F fever, abdominal pain for 2 days, reduced urination, and a sharp headache, according to a news release issued yesterday by the hospital. When an intake nurse asked whether he had traveled outside the United States in the last 4 weeks, Duncan said he had been in Africa.

"The nurse entered that information in the nursing portion of the electronic medical record," the hospital stated.

However, ED physicians who took over the case did not see this travel information because it did not automatically appear in the physician "work flow" of the EHR system, the hospital stated. "In our EHRs, there are separate physician and nursing workflows."

In the context of digital medicine, "workflow" refers to the series of data displays, online forms, tools, automatic alerts, and links that a clinician would use to complete particular tasks, such as examining a patient or prescribing a medication.

To fix what it described as a "flaw," the hospital said it would relocate travel history documentation "to a portion of the EHR that is part of both workflows" and modify it to flag regions in Africa where Ebola is endemic.

The EHR system used by Texas Health Presbyterian is made by Epic, a leader in both the inpatient and outpatient EHR markets.

Duncan returned to the hospital ED in an ambulance on the morning of September 28 and was admitted. The hospital described his condition today as serious.

Hospital Touted EHR's Ability to Share Patient Data in Real Time

What happened at Texas Health Presbyterian flies in the face of its track record as a high-tech hospital where everyone is supposedly on the same electronic page.

In July, the hospital's parent company, Texas Health Resources, made the list of the nation's most wired hospitals compiled by the magazine Hospital and Health Networks. And in March, Healthcare Information and Management Systems Society Analytics recognized Texas Health Presbyterian as 1 of 162 hospitals operating "at the highest level of EHR adoption," according to a hospital news release.

"The use of the electronic health record has greatly improved the communication of healthcare information for our entire medical team," Aurora Estevez, MD, the hospital's chief medical officer, said at the time. "It allows us to share a patients' medical information in real time."

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