Ebola in Dallas: Electronic Health Records Partly to Blame
Policy + Politics

Ebola in Dallas: Electronic Health Records Partly to Blame


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medical record system to flag a man who turned out to be infected with the Ebola virus underscores how clunky, outdated and inefficient health information systems typically are in the U.S., a medical IT CEO charged Friday.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

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"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."

The infected man, Thomas Eric Duncan, first went to the hospital Sept. 25 with flu-like symptoms but was released that same day. Just days later, he returned to the hospital, where he eventually tested positive for the Ebola virus. 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."

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"People trying to recreate their own micro-Internet inside their own little biosphere . . . that'll never, never, never be excellent," Bush said. "There's no 'network effect' in health care today."

"I hope soon that nobody will be on enterprise software and these things will be managed by people across thousands of hospitals."

Duncan was only diagnosed with the Ebola virus this past Monday during his second visit to Texas Health Presbyterian—becoming the first person to be diagnosed with the deadly virus on U.S. soil. Before then, for four days, he had been increasingly ill at an apartment in Dallas, where he was staying with relatives. He is now listed in serious condition at the hospital. Officials on Friday said 50 people who had contact with him are being monitored daily to see if they develop symptoms.

The hospital Thursday night said when Duncan was first examined Sept. 25 by a nurse, he was asked a series of questions, including whether he had traveled outside of the U.S. in the prior month. "He said that he had been in Africa," the hospital said in a statement. "The nurse entered that information in the nursing portion of the electronic medical record."

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But it turns out that answer—which could have alerted doctors of the possibility Duncan had Ebola—was not relayed electronically to them because of "a flaw" in the way doctors' workflow portions of the electronic health records interacts with the nursing portions of the EHR.

"In our electronic health records, there are separate physician and nursing workflows," the hospital said. "The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician's standard workflow."

The hospital said it has fixed that flaw to both make travel history part of both workflows and to specifically reference regions of West Africa where Ebola has spread.

"We have made this change to increase the visibility and documentation of the travel question in order to alert all providers," Texas Health said. " We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola."

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Bush noted that typically when problems like the flaw in Texas Health's EHR system are fixed, "they're fixed only at the place where they appeared."

"Those mistakes are happening constantly," Bush said. But, "philosophically I think hospitals should get out of the business of trying to program computer systems, and expand in the business of treating patients. But that's a standard thing that goes wrong with millions of configurations" of EHRs, he said. 

This article originally appeared in CNBC.

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