10.07.2014

Human Factors: Electronic Medical Records and Ebola

One of the muddy reports coming from the first case of the Ebola virus diagnosed on US shores is why the patient was initially sent home -- to potentially expose hundreds of people -- when he first presented to the Emergency Department.

Reportedly the triage nurse screened him for recent travel and he told the nurse that he had just arrived from Liberia. After that something broke down -- either two EMR systems didn't talk to each other, or the doctor and charge nurse didn't read that part of the chart. Initially hospital officials said there was a flaw in the system, then they said there wasn't.

Slate notes that billions of dollars have been spent trying to get the US to adopt electronic medical records in the Emergency rooms and hospitals. That sort of makes it sounds like there is one computer program that everyone is using. There isn't.

Athenahealth CEO Jonathan Bush told HeathcareITnews. "The worst supply chain in our society is the health information supply chain," Bush told CNBC regarding the incident. "It's just a wonderfully poignant example, reminder of how disconnected our healthcare system is."

We currently use two computer charting programs in our ED and there is a third program -- supposedly to replace the other two -- coming in the next year or so. That system is EPIC which is the same system used at the Texas hospital. Epic can be customized by the hospital for different applications, but that customization costs. Given the penny-wise pound-foolish nature of the American hospital system, I am not optimistic

The American College of Emergency Physicians recently weighed in on the issue in a paper detailing the unintended consequences of using Emergency Medical Records systems that may not be optimized for emergency medicine and hospital systems seeking the lowest cost option.

That said, you can't blame the medical records if you don't talk to the patient. However, we are seeing increasing patient loads every hour with decreasing resources to do so. Computer records systems are supposed to make our jobs easier, but they actually add to the time and stress of each patient.

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