Mistakes in the handling of Ebola patient Thomas Duncan in September 2014 that led to his discharge in September 2014 have now been linked to "challenges" in the Epic Systems EHR used by the hospital, according to a report from an expert panel.
During Mr. Duncan's first visit to Texas Health Presbyterian Hospital's emergency department in Dallas, he was assessed separately by a nurse and then a physician. As part of the nursing assessment, he answered questions about his travel history, identifying that he had recently traveled from Africa. One of the EHR challenges emphasized by the board occurred when this was documented in the electronic record, but not communicated verbally to the rest of the care team, according to the panel's report.
They also cite that "the EHR configuration did not provide for automatic alerts on questions related to Mr. Duncan's travel history." Once the information was entered, no systems within the record would prompt a review of that critical information.
The panel also found that the record did not reflect clearly whether or not the physician was made aware of or reviewed information about Mr. Duncan's symptoms, which would have been an opportunity to change the outcome even after the travel history was overlooked.
"The lessons shared by THR after the Ebola events also speaks to an over-reliance on the
EHR for communication of important clinical information between the key members of the patient's clinical care team," the panel wrote. "As noted earlier, the Emergency Department clinical processes did not optimally address the early identification of Ebola Virus Disease or other emerging diseases during the first ED visit, nor did it optimally utilize the full capability of the EHR."
The panel concluded that in the future, it is imperative for institutions to place an emphasis on structures and processes that support decision-making and reconfiguration of EHRs in the face of urgent public health emergencies.
Read the full report here.