Ebola Misdiagnosis: Experts Examine EHR Lessons

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Joe Stanganelli,
User Rank: Author
11/3/2014 | 12:03:58 AM

Re: There is no patch for human stupidity

@Alison:

re: Not all healthcare workers are alert and driven

Precisely! Healthcare -- especially nursing -- is one of those professions (like teaching) that seems to get a free pass on every incompetence, societally speaking, because of how obviously loving and wonderful all people in the profession would have to be.

Incompetence abounds in all professions -- and failsafe checks need to exist everywhere.

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Joe Stanganelli,
User Rank: Author
11/3/2014 | 12:00:57 AM

Re: There is no patch for human stupidity

@David: Even so, Ebola crisis aside, being out of the country can certainly be a risk factor indicator for a wide variety of diagnoses. This should be part of basic intake.

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tzubair,
User Rank: Ninja
10/25/2014 | 6:50:41 AM

Re : Ebola Misdiagnosis

Mechanization of tasks must not serve to make the health staff less vigilant. A careful patient's history is of prime value in reaching a correct diagnosis.. Everything else comes later. If you miss an important cue like migration status etc and cannot take proper action, or alarm the relevant authorities dealing with public health care, you have exposed public to a great health hazard. Which in other cases would count as criminal negligence.

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LisaS642,
User Rank: Apprentice
10/24/2014 | 4:33:44 PM

EHR Lessons about Teamwork

We have a large body of evidence about the amount of time documentation requires, particularly from RNs. It can be up to 45% of their time. Clinical teams comment that EHRs are further eroding communication and that in some systems the abiltiy to see notes from other clinicians is another layer of complexity.

There are mounds of studies that show the benefit of collaboration/teamwork in clinical care to improve safety and outcomes but we are moving farther away from that under MU. As an experienced advanced practice nurse I am worried about the direction we are taking in patient care where the processes and documentation take priority over precious time with patients.

The Dallas tragedy is a system (or lack thereof) problem....just as many medical errors are the result of ineffective design and lack of infrastructure. We need to take away the most important lesson from that experience. That is the basics matter. Team huddles when a red flag surfaces is one of several human-human communication methods that we need to embed in clinical care.

If we simply add another layer of written words and measures to monitor on top of the EHR problem we are indeed doomed to a dim future in hospital care.

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David F. Carr,
User Rank: Author
10/24/2014 | 4:27:38 PM

Ebola, the rumor epidemic

Frank Catalano, a very smart guy I met while covering education tech, has some interesting observations about the rumor epidemic that comes along with the disease.

From AIDS to Ebola: In rumor control, only the tech changes - @FrankCatalano via @GeekWire http://buff.ly/1oCXqj9

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Alison_Diana,
User Rank: Author
10/24/2014 | 2:22:13 PM

Re: There is no patch for human stupidity

Not all healthcare workers are alert and driven; there are thousands of people employed in this vertical and it would be impossible to find any workforce that's completely motivated all the time. Even the best people have off days, too, especially in an environment where the shifts are long and can be physically and emotionally draining. That's one reason EHRs have been touted as a way of improving health and outcomes: They provide several safety measures, checks and balances, to overcome tired, blase, or incompetent humans.

One problem I see with the government's EHR-related actions is its Ebola-focused approach. As discussed in Ebola: 10 Technology Approaches to the Deadly Disease a far more effective and efficient way of dealing with emergencies would be to add something to EHRs that allows them to be quickly customized, no matter whether hospitals have to cope with Ebola, anthrax, tornado victims, or a dirty bomb. EHR vendors cannot roll out a new tweak each tme the nation faces a health crisis! In the case of Ebola, we've been fortunate: There have been very few cases, appearing one at a time across extended periods. But other viruses crop up quickly, across multiple hospitals, and there's no way the more than 1000 EHR vendors can address them on a case-by-case basis.

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David F. Carr,
User Rank: Author
10/24/2014 | 11:00:45 AM

Re: There is no patch for human stupidity

My understanding is the question about where the patient had traveled was asked and answered, but the clinicians did not recognize the significance of it, or not enough to sound the red alert. Remember, we're talking about a time just a few weeks ago when Ebola was a scary crisis half a world away and no case had been diagnosed in the US. This was Patient Zero. Yes, health authorities were already starting to spread the word about what hospitals ought to be watching for, but the reality of it hadn't been brought home yet. And there are a LOT of things doctors and nurses are supposed to be watching out for, all the time.

To characterize people as lazy certainly strikes me as unfair, given the workload of an emergency department and all the data healthcare workers are supposed to be tracking. The promise of EHR, which eventually ought to be achieved in the long run, is to produce tools that help clinicians manage the cognitive overload and recognize the most important details in a medical record.

When the software advances to the point where it helps doctors and nurses make better decisions faster, EHR will finally be more than an electronic replacement for the file folder.

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Joe Stanganelli,
User Rank: Author
10/24/2014 | 7:25:39 AM

Re: There is no patch for human stupidity

Exactly. A PEBKAC error if ever I heard of one.

And why, oh why, is "Have you been out of the country in the past X days?" not a standard history-taking question? (House convinced me of the necessity of that question years ago.)

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asksqn,
User Rank: Ninja
10/23/2014 | 5:43:27 PM

There is no patch for human stupidity

To the casual onlooker/anyone not employed in a health profession, health workers are supposed to be diligent, efficient and detail oriented, however, the reality is that most are not. Many are lazy/lax and do only enough not to get fired. Unfortunately, documentation almost always falls by the wayside, and, in this particular incident, I can well believe that personnel were at fault moreso than use of EHR.

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