I then related how the press reported, the very next day, that this was indeed the case.
Now...gee whiz...the hospital changes its tune. "No, it wasn't the EMR after all!"
See "Hospital reverses explanation for fumbling Ebola case" at http://www.dallasnews.com/news/metro/20141003-hospital-reverses-explanation-for-fumbling-ebola-case.ece. The reversal strains credibility and sounds like redirection, to my ear possibly due to inside attorney and/or EMR company attorney pressure.
The "new explanation" itself per the new article is that:
... A written statement Thursday said hospital officials identified and corrected “a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case.” That statement implied, without directly saying it, that the flaw left the doctor uninformed about Duncan’s travel history. In Friday’s statement, though, the hospital said, “The patient’s travel history was documented and available to the full care team in the electronic health record.” “There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event,” the statement said.
Again, sounds like redirection and making the doctor (and perhaps the ED doctor's group, if they were contractors) the sole scapegoat.
"Available to the full care team?" "Available" in a complex computer system with myriad screens is a very relative term. The issue seems not "how the physician and nursing portion interacted", it is "how the physician portion made the information readily apparent to the physicians and other team members, or not."
The problem here, I believe, still likely amounts to "information hard to find" and "suboptimal support of teamwork (situational awareness)", among others, per the AHRQ hazards taxonomy.
See, for instance, this. Either it is true, or not, regarding the travel history:
(click to enlarge)
I think an impartial investigation is needed to get to the truth.
What we have now is likely healthcare defense attorney and/or risk management "fog", a phenomenon I have both professional and (sadly) personal experience with.
One also wonders if the EHR vendor had a contractual defects non-disclosure ("gag") clause with the organization, and is now threatening suit, leading to the retraction. (See http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=koppel_kreda for more on that issue, and of corporate "hold harmless" clauses).
Unfortunately, a comprehensive investigation would be likely to only occur in a courtroom via Discovery if others become infected.
If any reader has knowledge of details, my email address is scotsilv AT aol DOT com.
-- SS
Addendum: A medical informatics colleague, Dr. William Goossen of the Netherlands, sent me a reminder about this article on the de-professionalizing aspect of health IT:
Harris BL. Becoming de-professionalized: One aspect of the staff nurse’s perspective on computer-mediated nursing care plans. Advances in nursing science. 1990: 13, 2, 3-74.Some content of this study - Nurses who participated in this study felt to some degree:
- De-professionalized: being controlled by the computer, not formally planning individualized care, losing skills to develop NCP's (Nursing Care Plans).
- De-autonomizing: - control by supervisors - linear operations of the computer and nurses felt to think like that - the system doesn't allow free texting, - nurses must follow the rules of the computer.
- De-individualizing: - 'one-size-fits-all' - routinized care - eliminating creativity.
- De-expertizing: - mindlessness and losing the skills learned in school, the computer does the work.
There is a human aspect to computerization in medicine that is often overlooked, especially by the health IT hyper-enthusiasts (see http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html).
Perhaps the ED staff at the Dallas hospital needs to be surveyed on these issues.
-- SS
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