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.