Ebola and the Information Flow Challenge

Screen Shot 2014-10-28 at 9.34.48 AMThe Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.

As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month: 

“The worst supply chain in our society is the health information supply chain. It’s just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network.”

At athenahealth, we’ve fielded a number of client requests asking what they can do to meet the challenges of Ebola. We responded by adding globally available content to our electronic medical record (EMR) that assess for Ebola symptoms, travel history, and risk for exposure as recommended by the Centers for Disease Control and Prevention (CDC). Alerts in the EMR will notify providers, based on their documentation, of the appropriate steps to take according to the algorithm established by the CDC. We were able to push these changes out instantly to the more than 23,000 providers on our cloud-based EMR on Friday October 10th as part of the intake stage. All triage assessments documented in the intake stage are automatically available for summary review by the provider. Additionally, based on provider request, these Ebola guidelines were pushed out as a triage questionnaire to patients through our patient portal’s Group Call functionality so that providers have any Ebola-relevant data before the patient even walks into the clinic.

Perhaps more importantly, we’ve pushed out information on Ebola to the more than 300,000 physicians and 1 million users of Epocrates. We’ve worked closely with the CDC to craft a quick-reference list, have been releasing frequent DocAlert mobile news messages targeted to various audiences, and while things are changing fast, we are working on a full disease monograph as well.

Ebola gets press attention, but what happened in Dallas happens every day with conditions every bit as lethal. The press just doesn’t notice because the diseases that kill all the time — even the ones people can catch — are somehow not news. The question should not be, “What should this particular EMR have done with respect to this particular patient?” but rather, “Why are there so many impediments to information flow and availability in health care?”

Todd Rothenhaus is chief medical officer at athenahealth. He blogs regularly at the cloudview blog, where this post first appeared. 

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3 replies »

  1. “Why are there so many impediments to information flow and availability in health care?””

    How is this problem solved? Does your medical device have a search function?If so, please demonstrate its use.

  2. We indeed told you so. The controllers of information flow, the impediments to care, the disruptors of cognitive processes, the time consumption machines, and the Goat in the Dallas ER should, at the least, go before the FDA to determine its safety.

    As for Asthenia, and its CEO Bush, there will always be a disease that shocks the care team and surprises the system. It is the doctors whose creative thought must flow to solve and discover the etiologies, the teatments, and the right care at the right time.

    In their current configurations and iterations, EHRs are tragedies and farces, according to several reports, and fail to faciliate the clinical work flow needs of the clinicians.


  3. The “Shame and Blame” culture remains alive and well.

    From my KHIT blog current post:

    “It has been quite fashionable in QI circles for some time now to cluck progressively “fix the process, not the blame.” Nonetheless, we still tend to reflexively reach for the culpability laser guns when hyperemotionally-charged incidents occur. The mainstream health IT blog comments sections these days are overrun with indignant “we-told-you-so” anti-EHR sentiment.”