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Saturday, October 4, 2014

#EbolaGhazi update

Bloomberg News
Hospital Explanation of Ebola Man Release Opens Questions
By Caroline Chen and Kelly Gilblom, October 04, 2014
Dallas doctors apparently never saw a nurse’s note that an emergency room patient with fever and pains had recently been in Africa, and he was released into the community while infected with deadly Ebola.

It remains unclear why, despite the hospital’s attempt at an explanation yesterday. Early in the day, Texas Health Presbyterian Hospital said in a statement that a nurse’s notes on the infected patient, Thomas Eric Duncan, were contained in records that a physician wouldn’t see. Last night, a spokesman for the institution said that wasn’t so.

“We would like to clarify a point made in the statement released earlier,” Wendell Watson, a spokesman for the hospital, wrote in an e-mail. “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,” Watson said.

The changing message came after the hospital faced criticism from other medical professionals about the actions taken prior to the patient’s release. Ashish Jha, a health policy professor at Harvard University’s School of Public Health in Boston, said no matter what, the doctor responsible should have double-checked the man’s travel history before he was sent back out into the community.

‘Logic Flaws’
“There are so many flaws in the logic of ‘The EMR system made us to do it,’” Jha said in a telephone interview yesterday, referring to the hospital’s initial statement. “When a patient walks in the ER with a fever, the standard question is ‘Have you traveled?’ I don’t understand why that question wasn’t asked by the physician.”

Wendell Watson, a spokesman for the hospital, said earlier yesterday that the hospital had wrongly designed its digital record system so not all of a nurse’s notes are visible to doctors. Its not clear from the clarification sent to media just before midnight what actually happened.

Reconfigured System
Early yesterday, Watson had said the software, made by Epic Systems Corp., had been reconfigured since the release occurred to bring patient travel history immediately to the physician’s screen. It had also been modified “to specifically reference Ebola-endemic regions in Africa,” the hospital said in its earlier statement yesterday.

Robert Rudin, an associate policy researcher at Rand Corp., a non-profit research center based in Santa Monica, California, who has studied the use of electronic medical records,, said he sympathizes with any doctor and nurse who might have been involved at the Dallas hospital.

Some systems “have an unbelievable number of tabs and pages,” Rudin said in a telephone interview yesterday. In the case of the Dallas patient, “did the nurse assume -- and many people assume this -- that when the information was entered, it would be visible and prioritized?”...
Yeah, of course it now has its own twitter hashtag, #EbolaGhazi.

Lost amid all this fervent Epic EHR bashing is the question of what would likely have happened amid the initial ER encounter with this case had the hospital still been on paper charts? Would this patient have been asked about his recent travel history? And, if so, would this information been conveyed to the dx'ing ER doc?

So many Ghazi's, so little time. Keeps my Photoshop humming.

Ebola, the “heart of darkness” and the epidemic of fear
It's a dangerous virus and Africa is suffering. But the American media-political panic is ugly and narcissistic

Eerie 2001 movie:



Ebola dropped-ball diagnosis linked to hospitals' IT culture
Dan Mangan, Meg Tirrell, CNBC

Initial reports that a Dallas hospital's electronic medical record system failed to flag a man who turned out to be infected with the Ebola virus underscores how clunky, outdated and inefficient health information systems typically are in the U.S., a medical IT CEO charged Friday.

"The worst supply chain in our society is the health information supply chain," said Jonathan Bush, head of Athenahealth. "It's just a wonderfully poignant example, reminder of how disconnected our health-care system is."

"It's just a very Stone-Age sector, because it's very conservative," Bush said. "Hospital health care is still in the era of pre-Internet software."...

In an interview with CNBC conducted prior to the hospital's reversal, Bush cautioned that he is not blaming either Texas Health Presbyterian Hospital, nor its electronic health software vendor Epic Systems, for the breakdown in communication.

Instead, he said, there is a problem among U.S. medical providers overall of relying on electronic health record systems that tend to be customized for individual providers, and not networked together nationally so that they can be updated in response to situations like the current Ebola epidemic in parts of West Africa.

"The hyperbole should not be directed at Epic or those guys at Health Texas," Bush said. "The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network."...
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 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...
To the extent that a full patient clinical workflow comes to be operationally defined by the EHR, that's indeed a serious internal data silo problem.

 "Do not forget, the B.O. in Ebola stands for Barack Obama."


Todd Kincannon, former director of the South Carolina GOP:

If there had been no EHR implemented, we could have blamed it on the pencil.

More to come...

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