Ebola and Electronic Hospital Records

As part of my day job, I work with infectious disease specialists who are experiencing the shift to electronic record keeping. So this doesn’t surprise me at all (boldface mine):

“The lack of complete history taking, particularly travel history assessment, documentation and sharing, the ineffective communications among the clinical team and a seeming overreliance on the EHR [electronic health record] rather than focusing on the complete care of the patient, leads the Expert Panel to recommend a broad review of the quality of care. . . . IT [Information Technology] . . . and the culture of the THD [Texas Health Presbyterian Dallas] Emergency Department,” the report says…

The report criticized the staff in the emergency department for not verbally communicating information about Duncan’s recent travel to Liberia, where ebola was rampant, and which was entered into the electronic health record. The 15-page report also said the hospital’s electronic health record’s failure to have automatic alerts related to questions on travel history contributed to Duncan’s misdiagnosis on his first visit.

Anyone who has been involved, even tangentially, in developing a complex informatics system or pipeline knows there will be ‘edge cases’ that just weren’t anticipated–like treating a patient with a very lethal infectious disease from outside the U.S.

If you’re trying to figure out how to let people download porn faster, edge cases are not such a big deal (MOAR PORNS! NAO!). But having them crop up when faced with a contagious (thankfully, not as contagious as some) and very dangerous viral infection, that’s suboptimal.

I think the next few years, as the kinks are worked out, have to potential to be interesting, as in “may you live in interesting times.”

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1 Response to Ebola and Electronic Hospital Records

  1. Brea Plum says:

    I’ve been in the clinical research industry for 16 years and I am very disturbed the hosannas and amens greeting the advent of widespread EMR systems. I have worked with medical records in those systems and they follow the same principle as every other computer system ever devised: GIGO (garbage in, garbage out). EMR systems allow great flexibility in how/whether data is recorded, which is a necessity. But they are no different from paper records in that they are only as good as the data recorded in them, which means that that EMR charts are no more likely to be complete, thorough or clear than paper charts. And yes, you bring up another excellent point, information is thought to be instantly communicated via EMR when it is not, and so should be communicated verbally.

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