Ebola and EPRs – a deadly combination?

This week saw the first British person die after contracting the deadly Ebola virus. It also saw the first US citizen die on US soil after he contracted the virus following a trip to West Africa.

But whilst most cases to date have been accepted as a terrible and unnecessary tragedy, albeit sparking fear across the world about the potential of a pandemic, the death of Thomas Duncan in the US has faced great controversy and questions around whom, if anyone, is to blame.

The debate began following the admission of Thomas to Texas Health Presbyterian Hospital in Dallas where he told his nurse he had been in Liberia several days before. This information was allegedly entered into the Epic electronic patient record (EPR) system, however for some reason it did not reach the appropriate clinicians. Thomas was then discharged from the hospital and returned two days later in a far worse condition and later died.

Initially, the fact the information about Thomas’s recent trip to Africa was not shared with the full care team was blamed on the EPR. This led to widespread criticism of EPRs more broadly and whether they are really fit for purpose. Shortly after, the hospital quickly retracted its statement saying that the travel history had been made available through the system, but still did not manage to explain how the mistake was made.

Interestingly, the issue around what did or did not cause this oversight appears to have now been dropped. When the EPR was to blame it was all over the headlines, now that the likelihood is that it was human error, it has gone very quiet.

This demonstrates just how skeptical people still are around the use of technology in healthcare. A potential (unproven) mistake occurs with an EPR and the whole issue of the use of technology in healthcare is called into disrepute, but when it is down to a potential error made by nurses and clinicians, the healthcare profession as a whole is not put on trial! The fact is that would be a huge generalisation and quite frankly unfair.

And realistically, even if the fault did lie with the EPR, there are so many flaws in the logic that says ‘The EPR is completely to blame’. Ashish Jha, a health policy professor at Harvard University’s School of Public Health in Boston points out: “When a patient walks in to the ER [emergency room] with a fever, the standard question is ‘Have you traveled?’ I don’t understand why [in the case of Thomas Duncan] that question wasn’t asked by the physician.”

EPRs were never designed to replace common sense or human intelligence, they were designed to add value by reducing errors, creating efficiencies and improving patient safety.

Perhaps more interesting is what has now been done to ensure that this does not happen again (irrespective of whether it was a fault of the system or not). The Epic software (and a number of others) has allegedly been reconfigured to bring patients’ travel history to the screen, moreover it has been modified to specifically reference ‘Ebola-endemic’ regions in Africa and therefore is more likely to recognise if a patient has potentially been exposed to the virus.

This is something that would be very difficult to do without such a system in place, so let’s accept that EPRs must be accountable for any errors that do occur but in this instance praise the system for doing its job and having the potential to save many more lives going forward.

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