Texas Hospital Says EHR Workflow Flaw Led to Initial Release of Ebola Patient

Ebola Virus

A flaw in the EHR workflow process related to the first diagnosed Ebola patient may have serious implications. Thomas Eric Duncan was diagnosed with the Ebola virus on September 29, 2014 at Texas Health Presbyterian Hospital in Dallas. On Duncan’s first visit to the hospital ED the evening of September 25th, he reportedly told the nurse he had been in Liberia prior to arriving back in the U.S. on September 20th. While his travel history was entered into the EHR by his nurse, the information didn’t appear in the attending physician’s standard workflow.  Duncan was released the following morning, returning back to the hospital on September 28th,  he was placed in an isolation unit, according to a global news alert issued by the World Health Organization.

In a statement released on October 2nd, Texas Health official confirmed that Duncan’s travel history was not initially known by the physician assigned to his case. From the media statement:

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.

Read the full statement here.

USA Today is reporting Liberia has accused Duncan of lying on his exit documentation, say “they will prosecute Dallas Ebola patient Thomas Eric Duncan when he returns home for allegedly lying on his airport departure screening questionnaire about whether he had had contact with a person infected with the virus.” Read the full story here. And in other news The Washington Post is reporting Maryland hospitals are evaluating two patients with travel histories associated with Ebola. Read the story here.

Additionally, HealthcareITNews is reporting on the push back from some leading EHR vendors on the notion that a flaw in the hospital’s Epic EHR system is to blame for the patient’s release. Read the full story here.

The World Health Organization is tracking the outbreak of the disease and provides the public with resource links related to Ebola infection and prevention guidelines.