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Hospital: EHR Flaw Obscured Ebola Patient's Travel Note

 |  By cclark@healthleadersmedia.com  
   October 03, 2014

Texas Health Presbyterian Hospital says it has identified and modified a flaw in the way the physician and nursing portions of its electronic health records system interact.

A critical flaw in the electronic health record system at Texas Health Presbyterian Hospital prevented emergency room physicians from knowing that Ebola patient Thomas Eric Duncan had been in Africa prior to becoming ill, the hospital revealed Thursday night.


Although a nurse's note in the EHR noted that Duncan had recently travelled from Africa, he was sent home after seeking medical help on Sept. 25, the hospital said in a media statement.


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"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 statement said.

"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," the statement said.

"As designed, the travel history would not automatically appear in the physician's standard workflow."

A former hospital executive confirmed Friday that Texas Health Presbyterian Hospital uses an EHR system made by Epic.

The statement said that since discovering the problem, Texas Health Presbyterian "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."


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"We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola."

Additionally, the hospital's statement said, "When Mr. Duncan was asked if he had been around anyone who had been ill, he said that he had not."

"Mr. Duncan was asked if he had traveled outside the United States in the last four weeks, and he said that he had been in Africa. The nurse entered that information in the nursing portion of the electronic medical record."

The hospital said it was releasing its statement "in the interests of transparency, and because we want other U.S. hospitals and providers to learn from our experience." The hospital said it had Duncan's permission to release the information.

Additionally, the hospital statement said that on his first presentation to the hospital on Sept. 25, he presented with a temperature of 101.1 F, abdominal pain for two days, a sharp headache, and decreased urination.

"These symptoms could be associated with many communicable diseases, as well as many other types of illnesses. 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 he first visited the hospital emergency department."

Duncan remained hospitalized in serious condition Thursday.

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