The fatal Ebola virus has killed thousands in Africa and has infected two health care workers and caused dozens to be quarantined in the U.S. since the beginning of the outbreak earlier this year. Although government officials have reported that the virus is contained in the U.S. and that there are no signs it is likely to become a severe danger to citizens, it is important that hospitals are prepared for the worst. Accurate diagnoses and the processes involved, such as documentation, need to be fast and efficient. Electronic health records make this possible.
The first US Ebola misdiagnosis: Was a poorly functioning EHR to blame?
Thomas Eric Duncan was the first case of Ebola in the U.S. and passed away in a Dallas, Texas, hospital. Duncan's travel history should have sent up a red flag to health care workers when he first arrived in the emergency room, but unfortunately, due to lack of communication, Duncan was misdiagnosed, and infected two health workers.
The hospital first blamed its EHR system for the misdiagnosis, claiming that it was inefficient and that Duncan's travel history did not appear in the physician's workflow due to faulty software. However, the organization quickly took back its initial report and admitted to poor screening procedures, for Duncan was not asked of his recent whereabouts during his initial evaluation when he first arrived on Sept. 25. Daniel Varga, M.D., chief clinical officer at Texas Health Resources, said if the hospital had known Duncan had recently returned from Liberia – one of the most infected areas of Africa where thousands have died from the virus – Ebola would have been a probable diagnosis from the start.
"Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola," said Varga in his testimony before the congressional committee, according to Healthcare IT News. "We are deeply sorry."
Since the misdiagnosis, Varga has reported that the hospital improved its screening procedures, ensuring that travel history is one of the key components to the initial evaluation. Although the EHR system was not responsible for Duncan's misdiagnosis, Varga acknowledged that it has the potential to enhance physicians' ability to diagnose Ebola and other serious medical conditions quickly and accurately and that the hospital's previous software was not as efficient as it could have been.
According to Healthcare IT News, the Texas hospital modified its system, including improvements to the placement and title of the screening tool and the addition of a pop-up that works to flag the patient as high-risk for Ebola if he or she answers yes to specific screening questions. If the patient is marked as high-risk, the system even comes with subsequent instructions for further action. The new software also flags patients who were recently exposed to known or suspected Ebola cases and a screening question for patients who have been to areas largely affected by Ebola, focusing on high-risk activities.
"We have modified our electronic health record in multiple ways to increase the visibility and documentation of information," said Varga, reassuring the anxious onlookers throughout the country after the misdiagnosis, according to Healthcare IT News.
How EHRs can make Ebola diagnoses more effective
An effective EHR has the ability to immediately respond to a certain bacterium or virus, according to Dr. Kenneth Mandl, Harvard professor in the Boston Children's Hospital Informatics Program, in an interview with InformationWeek. It is important that providers are able to easily modify the way in which data is entered and displayed, relying on public health information to guide them as they make these important diagnoses. Many hospitals, such as the one where Duncan was treated, have proven that EHRs can easily be modified to better guide physicians as they test patients for life-threatening viruses. If more health care organizations made sure this was done, the diagnosis process would be significantly faster and more accurate.
Many health care providers have also stressed that there needs to be a coding designation for Ebola, for there currently is not one under the ICD-9, leaving physicians to categorize the virus under several descriptions of "hemorrhagic fever," according to InformationWeek. Once ICD-10 is implemented, they will simply check off "Ebola," or A98.4, eliminating any doubt or confusion during the diagnosis.
According to HealthIT.gov, with the help of EHRs, 75 percent of doctors using EHRs reported that they receive lab results faster, 70 percent said they see improvements with data confidentiality and 79 percent reported that their practice or hospital functions more efficiently as a whole. These benefits are crucial during outbreaks like the current Ebola pandemic. To prevent the virus from impacting even more lives than it already has, health care organizations must ensure that they are taking every measure to work as efficiently as possible, which cannot be done without an effective EHR system.