(Editor's Note: Texas Health Resources subsequently backed off its statement that a flaw in the electronic health-record system had led to miscommunication between nurses and doctors resulting in the patient being sent home after being evaluated in its emergency department.)
A procedural flaw in the electronic health-record system at Texas Health Presbyterian Hospital Dallas prevented a doctor there from seeing a nurse's note that eventual Ebola patient Thomas Duncan had been in Liberia, the hospital said late Thursday.
Duncan—who has not been named by the hospital but identified by family members and the Liberian government—first visited the hospital emergency room on the night of Sept. 25. Nurses recorded his travel history, but doctors did not see that information in the EHR workflow they viewed, the hospital said. Duncan was released, only to be readmitted several days later. The hospital's parent, Arlington-based Texas Health Resources, has an Epic EHR system deployed across its 14 hospitals.
“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 hospital said in a statement. “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.