I don’t laugh easily, but I did chuckle when I heard that a Texas hospital was blaming its electronic medical record for the hospital’s mishandling of the first Ebola case in the US –a patient who had flown in from Liberia. According to the hospital, the patient told the nurse he’d been in Liberia, she documented it, but somehow that information didn’t make it to the doctor due to a workflow problem. The patient was released, got sicker, may have exposed others in the community, and then returned to the hospital. Somehow I knew this explanation wouldn’t be the end of the story.
Sure enough, a few days later the hospital issued a “clarification,” stating that “there was no flaw in the way the physician and nursing [workflows] interacted.” But there was still no word on why the patient was discharged.
iHealthBeat (Dallas Hospital Issues ‘Correction,’ Says ‘No Flaw’ in EHR System) does a very nice job of summarizing the situation and speculating on what really occurred. Here’s my guess at the truth, in order of likelihood. I’ll also note that all of these factors may be true:
- Doctors stumbled through an awkward EHR workflow. Responsibility for the mess-up is shared by the EHR vendor (Epic) and whoever supervised and trained the physicians using the system
- Epic –big gorilla that it is– put pressure on the hospital to issue a retraction. (Epic denies this but I’m skeptical)
- Doctors tend to ignore nurses’ notes. “They ignored them when they were on paper, and now they ignore them on the computer,” according to a Biomedical Informatics professor
It’s worth mentioning that cloud-based athenahealth adjusted its workflow right away to emphasize Ebola-related questions, something that would be a lot harder to do with Epic.