A flaw in electronic health records has been offered as one explanation for errors in the treatment of Thomas Duncan, the Ebola patient who died at Texas Health Presbyterian Oct. 8.
Duncan arrived in the emergency room on Sept. 25. The nurse who took his information recorded that he had recently traveled into the United States from Liberia.
When the doctor who treated Duncan looked at his records, however, that geographic information was apparently not included. Despite Duncan’s 103-degree fever, he was told to take Tylenol and sent home with antibiotics. He didn’t return until Sept. 28, when he was admitted and diagnosed with Ebola — and died 10 days later.
The hospital initially indicated that a technical flaw, instead of a medical error, had occurred.
“We have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case,” read a statement released by the hospital Oct. 2, when it was first criticized over its handling of the case (even before Duncan’s death). “As designed, the travel history would not automatically appear in the physician’s standard workflow.”
The next day, however, the hospital tweaked its story to say that the travel information was, in fact, available in the physician’s display.
There is still no reliable indication of which release is more factual. The hospital responded to questions by saying that it had not been pressured by its EHR system provider to change the statement, but declined to comment further.
Regardless, the incident has sparked debate in the medical community regarding the effectiveness of EHR systems.
The 2009 stimulus enacted under President Barack Obama required the adoption of electronic records by all physicians and hospitals by 2014, a provision that has been widely delayed by physician concerns.
Privacy concerns and implementation cost objections have also been raised.
But some nurses have said that doctor use of electronic records, and not the records themselves, is to blame. According to some, it is common practice for doctors to ignore nurses’ notes recorded in electronic files — speaking more to doctor-nurse interaction than the validity of electronic records as a tool.
“Electronic Health Records are excellent tools to utilize when establishing and following specific healthcare protocols,” says Ernie Chastain, Vice President of Benchmark Systems. “Just like any other tool the healthcare providers must receive the proper EHR training and must follow the EHR protocol to receive the expected results. Electronic Health Records facilitate, rather than replace, communications and data analysis between healthcare providers. The bottom line is if the tool isn’t used properly the results will be substandard.”