Texas Tech University Health Sciences Center
Electronic Health Records and Ebola - What can we learn?

Electronic Health Records and Ebola - What can we learn?

electronic-health-records-and-ebola-what-can-we-learn- image0More on the Ebola situation from Dallas, but from a different angle—the Electronic Health Record (EHR) portion of the drama. This is one of many aspects of the story that interests me.

Here is what happened. Officials at the Dallas hospital caring for the nation’s first Ebola patient issued a statement around October 1, which was critical of the EHR that their system uses. At issue was the interaction between the physician and nursing portion of the EHR and why critical travel information was not communicated between the people providing care. It took about two days for the hospital to retract that statement.

In reading blogs and news reports on the subject, people have divided into two camps on the EHR Ebola matter—those (who probably were not that keen on EHRs to begin with) say this would not have happened with the paper chart and that this is yet one more example of why EHRs are “bad.” Those on the other side say the EHR worked fine, but the hospital did not “build” its EHR correctly — they should have made travel history easier for the physician to find. I do not necessarily want to add to the second-guessing about what happened, but a good question to ask is, “What can we learn from the incident?”

Well, a few obvious things. First, we know that both paper records and EHRs can produce errors. We know that when recording data in either type of record, accuracy is critical, as is taking time to read what is in the record. We know that workflow must take into account ways in which data is stored and how it can be viewed. And, we know that communication is difficult even under the best of circumstances.

But, we did more than just learn. The EHR and Clinical IT teams from TTUHSC and UMC responded quickly to the situation and made the following changes to our travel history intake form:
  • First, we made the travel history component required on ALL INTAKE forms in all settings of care across ambulatory clinics, inpatient and outpatient hospital services, and in the Emergency Center (where by required, it means that you literally cannot exit the form without completing a travel history, along with some vital signs and smoking history, which have been required for some time).
  • We added flexibility to the time of travel to allow specifying travel within 7 days, 14 days, 21 days, or 30 days.
  • Finally, a more specific region, West Africa, was added as a choice for travel regions.

In addition, we created a rule to notify the user of all patients who have traveled to West Africa within the last 30 days. In other words, if you open the chart, you see the alert notifying you of travel. All users, every chart opening, for the entire encounter.

Our teams, with assistance and guidance from Texas Tech Physicians' Dr. Craig Bradley, learned quickly from a rapidly evolving situation and acted upon those lessons. An EHR is a tool. A wonderful tool, in my opinion. It can drive better data collection and even empower distribution and communication of that data.

But, let us not forget the value of a physician listening to a patient and a care team engaging in ongoing interpersonal communication between human beings. Those have been and will remain the cornerstone of great healthcare.