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How to Avoid EHR Gaps Seen in the Ebola Crisis


An EHR work flow gap may be to blame for delayed treatment of a Liberian suffering from Ebola in the U.S. Here's how we can avoid such problems in the future.

When the Liberian citizen carrying the Ebola virus first presented himself at Texas Health Presbyterian Hospital last month, he was initially sent home with antibiotics and pain relievers, according to reports. This outcome gave him three more days without treatment and put others he came in close contact with at risk in contracting the deadly disease.

The big question of course is, “How could this have happened?” Here’s how.

It turns out that while the admitting nurse asked all of the right questions and even took the time to input the information into the hospital EHR, proper dissemination to physicians in charge never happened because the nurse's EHR work flow was separate and not integrated with the physician EHR work flow.

While this caused a public outcry of why keywords such as fever, vomiting, and a patient visiting from West Africa weren’t enough to create real-time people-to-people communication across the emergency room floor, it is important to consider the “chaotic” status of the hospital at that time in terms of staffing, noise-level, and other urgent crisis care needs rolling in the door.  The hospital and its staff counted on the technology to do the work for them, but previously unknown gaps suddenly became very apparent. 

Since then, the hospital has remedied its EHR work flow system, but where does that leave the rest of us? How do other healthcare facilities and physician practices overcome the fact that too many more health systems have similar separate functions and modules which do not share information to users on a timely basis? 

Here are three of my thoughts:

1. EHR systems must be communication-comprehensive.  Systems need to be automated to immediately share vital information about incoming patients with all users (nurses, technicians, and physicians), and to address enhanced public health and syndromic surveillance. To achieve this, the work flow component must have an alert system attached and the ability for users to find and gather data with a minimum number of clicks.

2.  Interoperability must be the basis of the system functionality.  Total integration is an indispensable requirement for any healthcare system. All of the EHRs and practice management systems used at every level within a healthcare system (from the individual practices to the larger hospital), must be able to “talk” to each other. This will improve operations and provide appropriate, responsive patient care and communication. When different systems are being used for the emergency department and inpatient and ambulatory care, the lack of interoperability creates the biggest handicap for fast and efficient response.

3. Communication must be sent throughout the medical team. The nurse in the Texas hospital ER used an Ebola check list, which included a question about travel history. The patient told the nurse that he had recently visited Liberia, which has been ravaged by the Ebola outbreak. But the information was not widely enough shared with the medical team treating Duncan.

EHR systems must not only have the ability to alert when data and keywords are entered, but to aggregate and utilize the data and analytics for fast response. This can only happen if EHR systems are integrated and programmed to properly analyze the big data to result in actionable responses on dynamically emerging disease patterns. EHRs should have a common "flag" to indicate a serious threat, such as Ebola. When such issues are flagged, an automatic alert should be sent to staff to inform them to contact local public health authorities as well as the CDC.

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