Texas Health Resources backs off statement about EHR flaw in Ebola case

The system that owns the Dallas hospital treating the first case of Ebola diagnosed in the U.S. late Friday retreated from an earlier 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.

Officials at Texas Health Presbyterian Hospital Dallas initially said a communication breakdown was responsible for clinicians releasing Thomas Eric Duncan after he came to the ED on the evening of Sept. 25 showing symptoms of Ebola, only to be admitted and placed in isolation on Sept. 28 after his symptoms worsened.

In a statement issued Thursday, Texas Health Resources, the hospital's parent company, said some caregivers were aware of the patient's travel history, but cited a workflow issue with its EHR system in sharing the information. “Protocols were followed by both the physician and the nurses,” the statement read. “However, we have identified a flaw in the way the physician and nursing portions of our electronic health records interacted in this specific case.”

THR issued another statement Friday night backing off that explanation, however. “As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician's workflow,” the statement read. “There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”

Texas Health Presbyterian's EHR system is made by Epic Systems Corp., Verona, Wis. The company declined to comment on the events at the hospital.

Not long after Texas Health posted its first statement about an EHR problem, one Epic competitor, Athenahealth, a developer of EHRs for office-based physicians, announced it was modifying its system to include specific questions related to Ebola.

It added to the social history section of its patient record three global security questions based on an Ebola alert from the Centers for Disease Control and Prevention. They are: “Has the patient: Directly handled bats, rodents, or primates from endemic areas? Had contact with the blood, bodily fluids, or human remains of a patient known to have or suspected to have Ebola virus disease? Had residence in or traveled to an area where Ebola virus transmission is active.”

The questions were added to Athena's Web-based EHR Friday as part of changes to templates it offers to providers, and so, because Athena offers an online EHR system, became part of their clinical workflow then, according to a statement from Dr. Brian Anderson, senior manager for clinical content at Athena.

THR's initial announcement of the problem also provoked a quick response from the National Nurses United, which Friday issued a release in which Bonnie Castillo, director of NNU's Registered Nurse Response Network, said, “As we have been saying for many months, electronic health-record systems can, and do, fail. That's why we must continue to rely on the professional, clinical judgment and expertise of registered nurses and physicians to interact with patients, as well as uniform systems throughout the U.S. that is essential for responding to pandemics, or potential pandemics, like Ebola,” Castillo said.

Duncan continues to be treated at Texas Health Presbyterian. Health officials initially estimated as many as 100 people might have been exposed to the virus because of Duncan's initial release from the ED, but that number was cut to 50 late in the week and now only 10 are considered high risk, according to published reports.