Carl Dvorak, president of Epic Systems Corporation, is standing behind his companys electronic health records system installed in the emergency department at Texas Health Presbyterian Hospital in Dallas.
Earlier this month, the hospital that initially misdiagnosed the nations first Ebola patientThomas Duncanblamed a flaw in the Epic EHR, specifically a problem in the workflow between nurses and physicians at Texas Health Presbyterian. However, just a day later, the healthcare facility retracted their statement absolving Epic of any responsibility for the misdiagnosis.
In the Texas situation, a native African man told a nurse he had just come into the country from Liberiawhich is ground zeroand had a 103-degree fever while he was there and he still got sent home, Dvorak told Health Data Management. And, then secondarily, the physicianmaybe they didnt read the nursing note, I dont knowbut obviously it was on the opening screen of the physicians workflow.
So, it got missed by the nurse who actually documented that the patient came from Liberiathats a knowledge gap, he said. And, it got missed by a physician.
Consequently, Duncan was treated and released, only to return to the hospital where he was admitted for treatment of Ebola and later died from the disease. In testimony Oct. 16 before a congressional hearing, Daniel Varga, M.D., chief clinical officer at Texas Health Resources conceded that mistakes were made and that Texas Health Presbyterian Hospital has since made changes to its Ebola screening process and to its EHR to increase the visibility and documentation of information.
As part of those changes, the hospital now asks questions about a patients travel history earlier in the triage process as they first enter the emergency department.
What they did is they reconfigured the outer triage personthe waiting room triage personwho now has to do the travel screening, in addition to the back room triage nurse, according to Dvorak. They have also made it into a hard-stop pop up alert [when theres a positive travel history and flu-like symptoms], whereas before it was simply document and communicate. And, theyve actually added a few more questions. In particular, they want to know if you handled dead animals or touched a person that was sick with Ebolathey specifically ask that.
Im not sure that the whole world thinks thats the right way to do it, but its certainly appropriate for them at this time, he says.
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