Tags: medical | records | Ebola | Dallas

Electronic-Record Gap Let Dallas Ebola Victim First Leave ER

Friday, 03 October 2014 05:45 PM

A flaw in an electronic health records system is being blamed for the release of a man with Ebola into the Dallas area, because notes from nurses weren’t automatically sent on to doctors.

While the patient, Thomas Eric Duncan, told a nurse that he had been in Africa, that information wasn’t automatically included in electronic records seen by the doctor, according to a statement by Texas Health Presbyterian Hospital, where Duncan is being treated. The software is made by Epic Systems Corp., according to news releases and the hospital website.

“As designed, the travel history would not automatically appear in the physician’s standard work flow” within the electronic records system, the hospital said.

The documentation of the travel history was located in the nursing work flow portion of hospital notes, “designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order,” the hospital said.

There are now 50 people in Dallas being monitored daily for Ebola symptoms, down from 100, said health officials. Ten are considered high risk and will be physically checked by health workers twice a day. The rest are lower risk and will be examined once daily and check in by phone, said Texas health commissioner David Lakey. So far none has developed symptoms.

Health Records Company

Epic is one of the biggest providers of such systems in the U.S. Shawn Kiesau, a spokesman for the Verona, Wisconsin-based company, did not respond to requests for comment by e-mail and phone.

In July, Texas Health Resources was named by Hospital & Health Networks magazine as one of the nation’s “most wired” health-care systems. In March it earned national recognition for its electronic records system, according to a statement on its website.

Epic had yearly sales of $1.5 billion, and 290 customers, a company spokeswoman said last year. Hospitals have been pushed by U.S. laws to move from paper records to all-electronic systems as a way to modernize record keeping, improve efficiency, and avoid medical errors.

The hospital said it was making changes to the records system. “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 work flows,” according to the statement. “It also has been modified to specifically reference Ebola-endemic regions in Africa.”

Patient Questioning

Additionally, the hospital said that when Duncan was asked if he had been around anyone who had been ill, “he said that he had not.” Published reports have said that Duncan was exposed to people with Ebola during his time in Liberia.

When he came into the emergency room the first time on the evening of Sept. 25, Duncan had a temperature of 100.1 Fahrenheit, abdominal pain for two days, a sharp headache, and decreased urination, according to the hospital’s statement.

“These symptoms could be associated with many communicable diseases, as well as many other types of illness,” the hospital said. “When he was asked whether he had nausea, vomiting, or diarrhea, he said no. Additionally, Mr. Duncan’s symptoms were not severe at the time.”

As a result, he was released early the next morning. Duncan returned on Sept. 28 by ambulance, was placed in an isolation unit and health officials subsequently confirmed that he had the deadly Ebola virus, which has infected about 7,500 people in the West African countries of Liberia, Sierra Leone and Guinea, killing half.

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A flaw in an electronic health records system is being blamed for the release of a man with Ebola into the Dallas area, because notes from nurses weren't automatically sent on to doctors.While the patient, Thomas Eric Duncan, told a nurse that he had been in Africa, that...
medical, records, Ebola, Dallas
Friday, 03 October 2014 05:45 PM
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