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EHR Issues Become Part of Ebola Story in Texas (Update: THR Clarifies Position on EHR)

October 3, 2014
by Gabriel Perna
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Texas Health Presbyterian Hospital, a Texas Health Resources facility, is blaming issues derived from its electronic health record (EHR) system from the Verona, Wisc.-based Epic Systems as to why Ebola patient, Thomas Eric Duncan, was prematurely released from the hospital.

The Dallas-based hospital released a statement explaining how Duncan was sent home after visiting the emergency department with a temperature of 100.1 degrees Fahrenheit, abdominal pain, decreased urination, and a sharp headache. He was went home with antibiotics. The hospital is facing scrutiny over its decision to release Duncan.

The fact that Duncan, a Liberian, had traveled from Africa, where the disease has spread rapidly and caused more than 3,000 deaths was not disclosed to the doctors on staff that night. Officials from the hospital released a statement saying "the travel history would not automatically appear in the physician’s standard work flow” as part of the EHR design. They say it was instead in the nursing work flow of the EHR and are working to fix this issue. Here is the full statement from the hospital:

Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case.  In our electronic health records, there are separate physician and nursing workflows.
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.
As result of this discovery, Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows. It also has been modified to specifically reference Ebola-endemic regions in Africa. We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola.

Update: Texas Health released a clarifying statement on Friday night absolving the EHR of any blame in the release of the Ebola patient. 

Read the source article at Texas Health Resources



As a contractor I have worked on Epic EHR. Normally I have seen the nurse document on the patient chart and then the MD will overtake the same chart that the nurse has documented on, in essence agreeing with everything entered by the nurse unless the MD elects to edit.....


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