The Dallas hospital at the center of the Texas Ebola outbreak has changed its story.
Last Thursday, the hospital blamed a poorly designed electronic medical record for the failure to diagnose Duncan when he arrived at the hospital’s emergency room with symptoms consistent with Ebola, including a fever, stomach cramps and headache. According to the initial story, a badly designed electronic health record workflow made it difficult for doctors to see details of Duncan’s West African travel. Duncan was sent home. Very bad things happened as a result, as we all know by now.
On Friday, the hospital reversed itself without explanation.
The new statement:
Clarification: We would like to clarify a point made in the statement released earlier in the week. 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. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event. [ Full text ]
In other words: The EMR didn’t do it.
When the EMR story came out Thursday, critics jumped all over it. It did sort of make sense to some people, especially people who aren’t fans of electronic medical records. The idea that a piece of key information could get lost in the maze of screens and pop ups and clicks in a complex medical record sounded plausible.
A lot of other people weren’t buying it:
The swiftness of the hasty retreat led some critics to speculate that Texas Health’s statement Thursday provoked the wrath of EPIC, the hospital’s EMR vendor. Industry critics pointed out that many major EMR vendors, EPIC among them, often include strongly worded clauses in contracts that forbids customers from talking publicly about their products.
After this story was posted, EPIC contacted THCB with a response via email. Company spokesman Shawn Kieseau wrote:
We have no gag clauses in our contracts. We had no legal input or participation in our root cause analysis discussions with Texas Health staff on this issue. Texas Health’s correction is appropriate given the facts in this situation.
According to the new version, everybody involved had access to Duncan’s travel plans: both doctors and nurses.
So what happened? We still don’t know.
PATIENT ZERO CONTACTS DETAILED:
In a news appearance on Sunday, CDC Director Thomas Frieden said CDC contact tracing has identified 10 high risk contacts in the Dallas area, 7 of whom are healthcare workers. That’s not entirely surprising, given the pattern in Africa, where health care workers fighting the disease have paid a heavy price. The contacts will be monitored for 21 days for symptoms of the disease.
The agency is not releasing the names of the high risk contacts , but a back of the napkin list likely includes the two physicians who treated Duncan during his second visit to the ER, the ambulance crew who transported him to the hospital, emergency department nurses who had contact with him to handle his intake, draw his blood as well as anybody who had significant exposure to the patient.
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Anyone who has ever read one of Epic’s contracts knows they contain gag clauses.
John, I wouldn’t doubt it, but then the message they put out contained a lie.
Are you able to produce some of material from an epic contract that would help us better understand it?
Let’s face the facts. These devices are in need of oversight by the FDA to protect the public from their risks.
Not gonna happen. FDA doesn’t want this mess.
EHRs are good for simple cases like hangnails. And they enable upcoding and profiteering. I like how they made up the real truth.
Either they lied at first, or they are lying now.
The first remark was spontaneous by those looking at the raw data of what happened.
The second remark was carefully prepared undoubtedly with damage control experts and attorneys involved so the facts presented could be true while leaving out important facts that would tell a different story.
EHRs are going to be tested, proved valuable–or not–quite shortly. There are too many obvious challenges coming up: will it improve diagnostic acumen or dull it? …re d-68, Chikungunya, MERS, HxNx flu? Will it tolerate slews of hacker attacks and privacy abridgements? Interoperability failures will eat at its very soul: its purported care coordination utility. Important people will demand a separate and secure parallel medical record. E.g. politicians cannot abide by previous abortion or STD histories. It will incur new costs, not relieve old costs, in data management.
Will an informed cynical public allow it to become an entrenched health care fixture?…for all its medical records? I see splitting occurring with partial adoption and patient choice emerging. It’s just too easy to criticize.
everyone and i mean every honest person knows that the ehr was never about improving patient care, and has always been about control of information and therefore control of the health care dollar.
Wish the docs could get hold harmless clauses in their contracts. Cars and airplanes too!
And I will strike down upon thee with great vengeance and furious anger those who would attempt to poison and destroy my EMR. And you will know my name is the Judy Faulkner when I lay my vengeance upon thee.
That’s unlikely to stop the trial lawyers if the shit goes south in this case. They can easily see who has how much money, from a “Joint and Several Liability” tort perspective. I’m sure Scot Silverstein is already volunteering to be their star “expert witness.”
Oh man, they’ll hit the jackpot on this one.
I’m not, actually. However, from the tone of your post, you seem to have a problem with the justice system of this country, specifically, those injured by negligence seeking redress.
and if I am misinterpreting your post, please explain what you did mean.
If the doctor is going to be held accountable for whats in the ehr, then he should have say in how it functions. And he is not! he is told us it and and quit complaining.
“There was no flaw in the EHR”
Judy Faulkner has spoken.