Texas Health Resources late Friday evening announced that there was no flaw in its electronic health records system that prevented a physician in the emergency department at Texas Health Presbyterian Hospital Dallas from learning that Ebola patient Thomas Duncan had arrived from Liberia.

Texas Health Presbyterian is part of Texas Health Resources, which uses EHRs from Epic. The announcement is a complete turnaround from a statement by the hospital Thursday evening updating the treatment of Duncan that also said a flaw in the workflow within the EHR resulted in the travel history not appearing in the physician EHR when Duncan first visited the emergency department, was examined and sent home.

Included in the Thursday statement, available here, was an explanation of the workflow flaw:

“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 a 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.”

Friday evening, the hospital issued another statement:

“We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow.

“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”

Emails to two Texas Health Resources spokespersons late Friday asking what changed so that the hospital now believes there was no fault in the workflow of the EHR, or if the attending physician simply missed the travel history, were not quickly answered.

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