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Electronic Health Records Blamed for Improper Evaluation of Texas Ebola Patient

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Published on: October 3, 2014

If there is one thing this administration, headed by Obama, has demonstrated to everyone in the nation is the ability and effectiveness of the “blame game.” The “it’s always someone else’s or something else’s fault” mantra reverberates in the daily spittle that spews forth from the Conniver-in-Chief, his mouthpieces, and everyone associated with him. This “game” has become so effective that now the Dallas, Texas hospital where the first diagnosed Ebola patient in the US was admitted is blaming the electronic health record (EHR) workflow interaction on the misdiagnosis and the facility initially sending the patient home.

According to

When a sick Liberian man walked into Texas Presbyterian Hospital last month, “Protocols were followed by both the physician and the nurses,” the hospital said in a statement released Thursday night.

The man told a nurse he had come from West Africa, where an Ebola epidemic is raging.

“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.”

The hospital said its electronic health records include “separate physician and nursing workflows.”

The hospital said the Liberian man’s travel history was located in the nurses’ portion of the EHR, but – “As designed, the travel history would not automatically appear in the physicians’ standard workflow.”

“As a result of this discovery, Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows. It has also been modified to specifically reference Ebola-endemic regions in Africa.”

“We have made this change to increase 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,” the hospital said.

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As a former practicing professional registered nurse, this “discovery” caused much shaking of the head. Here’s why. Healthcare facilities, along with corporations responsible for developing these EHRs, have pushed so hard for the inclusion of EHRs in the system that doctors and nurses rely on them so heavily they forget the basic tenets of their training, including effective communication between the varying disciplines involved in a patient’s care. Of course, all of this came about for “efficiency” with medical record keeping, “saving time” in regards to completing paperwork and reducing the number of staff required to provide care and maintain records. Couple that with the 2009 stimulus law that required physicians and healthcare facilities to adopt EHRs by 2014 and the ingredients were mixed to eventually produce a disaster.

A year ago, reported on a study conducted for the American Medical Association that indicated doctors were frustrated by these electronic health records. Many found the EHR technology interfered with “face-to-face discussions with patients; required the physician to spend too much time performing clerical work; and degrades the accuracy of medical records by encouraging template-generated doctors’ notes.”

Not only this, EHRs, coupled with certain facility policies, procedures and protocols on documentation, encourage and promote “lazy” documentation and “lazy” assessments. It’s easier to check a box or a pat answer than it is to truly evaluate a patient using the five senses coupled with training and an “intuitive sense” that comes with years of practice. It’s much easier to click those keys while looking at a screen with predetermined questions and answers then apply “sterile” criteria to determine a course of action than it is to truly spend time assessing, evaluating, formulating and implementing a plan of care. If the answer doesn’t fit into some predetermined category on the screen, questions are further asked to try and make it fit or an assumption is made. Fancy machines are used to take blood pressure, pulse and respiration rates – performed by a patient care technician or assistant – then communicated to the nurse who records these vital statistics. Much is lost in translation.

Much is gained by the facility, however, if they can introduce mechanisms that decrease employee count thereby decreasing overhead. The newest models regarding patient care are usually implemented, sold as “better quality care models,” resulting in better bottom lines. Decreasing the number of “hands on” providers of care decreases the overhead, increasing the bottom line. But, at what cost? Healthcare is a lucrative business – to some, that’s all it is. However, healthcare is more than a business, which should be taken into account by all of those associated with it.

Many that I have worked with in facilities that were beginning to use this “latest and greatest” of technologies accused me of being “anti-technology,” describing me as a “dinosaur” amidst the evolution of medical care technology. They called nurses like me a “dying breed” that will be replaced with more “tech savvy” care providers who will be able to out-perform us “slow boats.” But, as I am always reminded of what an instructor in nursing school said in a lecture, I take comfort in my stance on the “latest and greatest” of technologies.

This wise, intelligent woman, who happened to be the dean of the school at the time, said, “While certain devices aid you in the care of your patients, it is important to remember it does not take the place of your use of thorough physical assessment and documentation skills. When it comes to the medical record, it is a legal document. It is better to rely on yourself, then thoroughly document your results. Memory will fade with time. By utilizing your training to the fullest and letting your documentation reflect that, you can say with confidence, ‘if that is what I documented, that is what I assessed at the time.'”

Which is a better description of skin? “Skin normal;” or, “skin warm and dry to touch; pink in color. Turgor brisk. No rash, redness, flaking, raised areas, lesions, lacerations, bruising, or petechiae noted. No open areas noted at present; skin intact. Complains of itching to arms for last 3 days.”

Another important tool in the care of patients is direct communication between nurse and physician. No EHR can take the place of any face-to-face interaction between health care professionals or between the health care professional and the patient. Important, vital information that might be missed in the review of the record by the physician should be directly verbally communicated to the physician and then, documented in the patient record – whether it is a hard copy paper record or a virtual EHR. There is no substitute for the collaboration, to include communication, between health care professionals in caring for a patient. Nothing can replace common sense, sound judgment, and working as a team to provide the highest quality care to a patient.

All of this boils down to upholding the standards of health care according to the law governing physicians and nurses, ethical and moral standards regarding care, and the absolute belief in the oath nurses and physicians take upon completing their training. While the hospital would like for us to believe it was a failure of the EHR, it actually was a failure on the part of the physicians and nurses. So, let’s put the focus where it belongs since the technology does not make the decisions and the choice to base decisions on technology still rests with people.

The hospital is now engaged in “CYA” of not only itself, its technology and policies, procedures and protocols, but its employees as well.

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