Case Analysis: Impact of EHR Systems on Information Integrity

The Scenario is based on an article by Helen Gregg published in the Becker’s Hospital Review on the Recent Ebola outbreak (link to article).

When Ebola patient Thomas Eric Duncan first presented in the emergency department of Texas Health Presbyterian Hospital Dallas,

he told a nurse he had traveled to Africa and she recorded that information in the hospital’s EHR system — but that information was not displayed in the physician’s EHR view, and Mr. Duncan was released.

When he returned to the hospital three days later by ambulance, he became the first person to be diagnosed with Ebola on American soil.

Texas Health Dallas has since been criticized for not making the diagnosis on Mr. Duncan’s initial visit and placing him under quarantine, potentially exposing people he came into contact with between hospital visits to the deadly virus.

Case Analysis: Impact of EHR Systems on Information Integrity

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On Thursday, the hospital released a statement explaining the EHR workflow flaw that led to the missed diagnosis:

“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.

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

The hospital has since updated its EHR so that travel information is displayed in both workflows. “We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola,” according to the statement.

What to hand in:

A 1-3 page document specifying the following:

• Identify the risks associated with the scenario
• What could the hospital have done differently?

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