On Oct. 2, Texas Health Presbyterian Hospital Dallas released a statement pointing to a workflow issue in the hospital's EHR as a reason clinicians initially did not test Ebola patient Thomas Eric Duncan for the deadly virus.
"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," according to the hospital statement. "As designed, the travel history would not automatically appear in the physician's standard workflow," and the physician did not have reason to test Mr. Duncan for Ebola.
The hospital later backed off that explanation, issuing a statement asserting no flaw existed in the health system's Epic EHR, though maintaining the EHR had been updated to better flag potentially infected patients. Texas Health Presbyterian isn't alone — across the healthcare industry, providers are looking to ensure their EHR systems will be an asset rather than a liability if a potentially infected patient comes through their doors.
HealthEast Care System in St. Paul, Minn., has embedded a special alert in the system's Epic EHR to flag any patient at risk for Ebola. "Our area has the highest Liberian population in the U.S., so we had strong motivation to develop this type of screening tool," says Brian D. Patty, MD, the health system's vice president and CMIO. He says the trigger was relatively easy to develop and integrate into HealthEast's Epic EHR, taking his team a total of about six hours to build, test and deploy.
The trigger was first integrated into emergency department admission processes and in the initial nurse triage screen. The trigger went live Friday, Oct. 3, and that weekend alerted staff to three patients who had Ebola-like symptoms and who had traveled to endemic areas. Fortunately, none of the three were determined to have Ebola, but the tool proved effective and is currently being deployed to all points of care across the health system.
Dr. Patty notes Epic has since made available a recommended configuration for similar trigger build to all of its customers. Many providers are taking advantage of these types of tools offered by their EHR providers, such as Boston-based Partners HealthCare.
"Partners is planning to incorporate the communicable disease packages that Epic provides and suggests at multiple places in the care delivery process," Andrew Karson, MD, Partners' associate chief health information officer, told the Boston Business Journal. "At the clinical domain, those same flags should lead to isolation, specialty consultation and other clinical [reactions]."
Some other providers' EHRs will be updated automatically. Cloud-based vendor athenahealth updated its EHR platform shortly after news broke of the misdiagnosis in Dallas, providing clients with a Centers for Disease Control and Prevention-approved intake checklist to help identify potential Ebola patients.
The CDC and the ONC are currently working together to further foster collaboration between providers and vendors to ensure EHRs are identifying any potential Ebola cases. In addition to hosting conversations between stakeholders, the CDC will review the current clinical algorithm for Ebola and the ONC will lead discussions on how current systems can be configured to better detect potential cases.
At HealthEast, the new Ebola trigger tool is a stepping stone to ensuring the health system is ready for future endemics. "We are now building a tool that screens for any foreign travel in the last 30 days and captures the countries traveled to in discrete data fields," says Dr. Patty. "We will then develop — and will continue to develop — alerts based on CDC recommendations for each specific outbreak based on the areas in which it is endemic, [allowing] us to remain flexible in responding to future outbreaks."
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