When the patient who just arrived from Liberia went to a Houston hospital with symptoms that should have suggested Ebola, he was given antibiotics and discharged, thus creating a serious threat of exposing others to the disease. He told the nurse that he had just arrived from Liberia, but the hospital says that the doctors were unaware of this fact when they discharged him from the ER.
The explanation given by the hospital: “Protocols were followed by both the physician and the nurses. 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. In our electronic health records, there are separate physician and nursing workflow. The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order.” The hospital has since retracted that statement, so there is some mystery as to why the physicians were not informed of this key piece of information.
Regardless of the Houston situation, the potential for Electronic Health Records (EHR) systems to cause serious errors in diagnosis and treatment is very real. In a case we recently handled, a hospitalized patient was gradually losing the ability to move his legs. This was documented very clearly in notes in the EHR made each day by the occupational therapists (OTs) and physical therapists (PTs) who were trying to get the patient on his feet so therapy could be done. The physician, a hospitalist, was unaware of this crucial information for four days. The reason: it is not the practice of the doctor to seek out and read the notes in the electronic record made by ancillary providers, such as OTs and PTs.
Experts we consulted said that many physicians do not scroll through the electronic record looking for such information, since they assume it would be brought to their attention if it were important. Yet the OTs and PTs were fulfilling their duty by noting the facts in the electronic chart and assuming the physicians would see that information.
The result was that a patient with a growing spinal epidural abscess was slowly becoming paralyzed because key information was not being taken into account by the physicians. As in the initial reports of what happened in Houston, key information was “lost” in the electronic records. The EHR errors in Seattle meant the patient ended up a paraplegic who will spend the rest of his life in a wheelchair. In Houston, it might have meant the beginning of an Ebola epidemic in a major U.S. City.
