'Flaw' in Electronic Health Record Blamed for Medical Error Involving Ebola Patient

originally posted by: sheepslayer247
a reply to: beezzer

Pure politics, Beez.

Bad form....bad form.

I'm all for taking Obamacare to task, but this is complete bull#!

Obamacare has nothing to do with the unwillingness of the politicians to stop all travel to the US from Africa and put this outbreak to a quick end.

Again.....bad form.

Different topic.

And I honestly don't see how exploring how this error occurred is bad form.

Unless it sheds light on a system you favor. . . . .

I work in the healthcare industry.

I know first-hand the regulatory nightmare that Obamacare has thrust upon the healthcare system.

I'm personally aware of the penalties that would be placed on a hospital if all the "t's" aren't crossed and all the "i's" aren't dotted.

Hell, I'm spending time at the office tomorrow just to get caught up on the paperwork!

So I can sympathize with the onerous weight of new regulations having an impact on real patient care.


If we can't look to see why problems develop, if we are too "PC" to shine the light on legislation, if we are too timid to expose flaws in signature laws by politicians, then we might as well just call ourselves a dictatorship and accept whatever is given to us.

a reply to: beezzer

Beezy, been a while, glad to see something finally caught you lol. First the upgrading and modernization of medical records has nothing to do with Obama. Accept that they are attempting to modernize and standardize records across the healthcare system. This is no easy task, not even for the military as brought out by other veterans here.

Before healthcare everyone was moving in this direction but at their own pace with competing standards and protocols. Think of it like some hospitals using apple and some PC's. I did not vote for Obama but man everything being his or healthcare fault is really getting old. My family needed it and it has been great. I would also say despite the best efforts of republicans the economy is much better than when he took office.

Now that that is over. My sister who is a doctor is pretty adamant about this subject. Records should be standard, using the same software and accessible anywhere in the country. It will cut down on mistakes she says and ensure we get the best care possible.

She says it is getting better since Obamacare but that the standarrds and protocol need to be changed faster and that people are even dying. The point being you should be able to go to a different hospital across town and access your records from the other one or be on vacation in another state and access them in the emergency room in another state. A doctor should see the same records in the same protocol no matter where he is. Simple.

This is a no Brainerd with just plain common sense.

The Bot

a reply to: beezzer

I have a loved one who was in charge of implementing the requirement for Electronic Health Records at their hospital. They started in 2006. They said it was a nightmare. They trained the hospital staff and doctors concerning electronic records creation. They had to assign one person(babysitter) who would actually go through the patient's file to make sure everyone signed off on the portion of the records they created. Employees didn't want the buck to stop with them if something was missed. Doctors were even avoiding signing off. They have found it difficult to get others to verbally share information because they fear HIPPA violations. They said it is the responsibility of the patient to inform each hospital personnel they speak with why they are there and information needed for an accurate diagnosis. They said information is often missed by the next person handling the patient.

So yes, responsibility avoidance is running rampant, and the system isn't helping.

a reply to: dlbott

Is this implementation making things easier or more difficult?

I find it more difficult, personally.

Again, it may be great in a think-tank, in a tabletop discussion.

"It looks good on paper."

But in real life?

The road to Hell is paved with good intentions.

a reply to: 2gd2btru

The system used to be treating the patient.

Nothing else.

Laws, legislation, rules, regulations, have made treatment a secondary aspect to healthcare.

Sadly.

It's an issue I fight with constantly.

I'm constantly saying, "Don't lose focus!" We're here for the patient!

Fortunately, I do work for an organization that does believe that.

a reply to: beezzer
They say many personnel get the impression that the most important part of their job is signing their documentation, as opposed to caring for the patient. Once they have signed their portion they feel released from any more responsibility. They said all the form requirements often dehumanize the patient. It isn't that they are not caring, but more they are so time pressured they don't have time to give the care they desire to give. Time pressures often create anxiety and feelings of job insecurity.

Look at the Dallas Ebola case, the nurse documented all the right answers to all the right questions. Her job was done. Her backside was covered, next. Somehow the written information on the computer screen made less of an impact on the next person that saw the patient and he was given antibiotics and released. That person documented their actions (CYA), next. Now they are trying to figure out who dropped the ball instead of how to better communicate for the sake of the patient.

a reply to: dlbott

A doctor should see the same records in the same protocol no matter where he is. Simple.

If memory serves, It was Bill Clinton who signed the EHR mandate into law. How it was implemented is where you find the fiasco. It was all driven by the insurance industry and know-nothing politicians. A bunch of idiots all clamoring, "No, you're wrong. Do it my way."

I was at a national conference eight or nine years ago. Standardization of the EHR between DoD components and the VA alone carried an estimated cost of 25 Billion (with a capitol "B") dollars. People are trying to get seriously rich off this mess.

Where's that damned reset button?

Well, I hate to say it but Texas Health Presby admitted it was not a computer error. They're not saying what really happened, though.

I knew they'd try and blame it on computer glitch to take some of the heat off the hospital staff but at least they're coming forward now and backtracking that statement. (Heard this on several local news stations)

I don't get it...

Did the guy not speak personally to a doctor/nurse and tell them he came from West Africa where Ebola is raging ? Would it not at that point be solely at the descretion of the doctor/nurse to decide what actions to take right away before writing up a prescription and sending him on his way ?

What the hell do electronic records have anything to do with it when he's at a direct in-office visit ?

Electronic records might be a problem after the fact, but during his visit with a doctor/nurse, it doesn't even play into it.

Sounds to me like the hospital is just simply trying to place the blame elsewhere to cover their own asses.

a reply to: CranialSponge

From the link in the OP. . .

The hospital said the Liberian man's travel history was located in the nurses' portion of the EHR, but -- "As designed, the travel history would not automatically appear in the physician’s standard workflow."

I agree that simply treating and speaking to the patient would be far simpler and more effective (for the patient) than having to document every detail and trust that the electronic health forms would have been read.

From what my eye doctor was telling me, not all of the software that is mandated is compatible....not all systems can talk to each other at this time......so I do blame ACA.
Seems like there was a time frame...some date in the future....when all systems must work together.

In the meantime........

Holy Crap. People are going to blame this on Obama Care? Computers are tools.

edit:

What about the software vendor?

a reply to: texasgirl
They zigged when they should have zagged. When Pt Zero came to the hospital the first time, every single person should have been pulled off the job immediately. Just think of the surfaces that the patient touched...the patients and family members in the ER's waiting room. I honestly don't see how the CDC thinks they have a handle on this.

As for electronic records, our hospital uses a program that is ancient, like, from 2008. They absolutely will not upgrade and tell doctors to buy an old iPad. I should think that Texas Presbyterian would have a better e-system. Why is the administration spinning, and so badly? I'm sure they are in the fetal position, fretting about potential lawsuits. And they should worry!

a reply to: CranialSponge

Sounds to me like the hospital is just simply trying to place the blame elsewhere to cover their own asses.

Exactly. They have been in CYA mode since it hit the news.

The computer did an improper interview at intake.

a reply to: 2gd2btru
This is a very sad situation indeed. The responsibility of the patient to inform each person that is a part of their health care is a recipe for disaster all the way down the line. I have experienced this too, and this is very difficult when you are sick and just want answers and having each one of them ask you why you are there and where does it hurt. Look at the darn chart!!! For something as serious as what happened on September 26th and all the bungled transmission of information is totally unacceptable. What prevented the nurse from communicating directly with the physician her knowledge that the patient could be infected with Ebola rather than leaving it on the electronic record and trust that he would see her note, if there was one?

I can see how it possibly played out...
Patient zero arrives at the busy emergency dept and because he is feeling ill takes a chair next to others and his girlfriend goes to the triage nurse when his number is called. Meanwhile he has been moaning and coughing and who knows what else on the other patients waiting their turn. The nurse takes his details and enters them on his electronic chart and notes the info that he is not an american citizen and just flew in from Liberia a few days earlier.
She finishes and tells her to take a seat until they are called in to see a physician. Meanwhile the girlfriend vacates the triage chair and the the nurse calls the next number...They continue to wait all the while the coughing and sneezing continues, he goes in to use the facilities and another patient follows in after he has left. His number is finally called after several hours of waiting. He proceeds into one of the examination rooms and lies on one of the beds with a thin curtain separating him from multiple patients in the same room.
The physician is run off his feet and opens the curtain and after briefly glancing at his chart asks him why he is there after using the sanitizer after the patient he saw before. The problem is he glanced over the chart to get a preliminary idea of what condition this patient might have.
He checks him over, touching various spots, checking his ears, throat etc and proceeds to write him a script to cure his ailment. Patient zero leaves with his script and the next patient occupies that bed, with only a change of sheets between them and the waste bucket untouched ...
This is only speculation as to what could have happened, how many people could have come in contact with any droplets or active virus during this time, who knows.

Speculation must be addressed, if Obamacare would not have been enacted, could this have been prevented?

Well the way I see it.

Before the current regime from mordor gave us the ACA.

We never had an ebola case.

After we got it.

Now we do.

originally posted by: neo96

Speculation must be addressed, if Obamacare would not have been enacted, could this have been prevented?

Well the way I see it.

Before the current regime from mordor gave us the ACA.

We never had an ebola case.

After we got it.

Now we do.

That's some might fine logic work...

a reply to: beezzer

I actually had similar issues with doctors and nurses before Obamacare along with failure to diagnosis infectious diseases that occur outside of the US. Heck, I had dysentery back in 1987 and, despite telling every doctor of where I had recently visited outside of the US, not a single one of the 5 born and bred American doctors were capable of diagnosing dysentery. It took a doctor from India to recognize the illness and make the diagnosis.

The hospital, to be quite honest, is more than likely attempting to shift the blame off the attending doctor and staff and onto some "other" simply because what doctors expect to be contracted here is far different from what one would expect to contract in a foreign country. Stomach ache = flu in the US, not Ebola.

originally posted by: beezzer
a reply to: CranialSponge

From the link in the OP. . .

The hospital said the Liberian man's travel history was located in the nurses' portion of the EHR, but -- "As designed, the travel history would not automatically appear in the physician’s standard workflow."

I agree that simply treating and speaking to the patient would be far simpler and more effective (for the patient) than having to document every detail and trust that the electronic health forms would have been read.

Yes, I understand that aspect...

But what I'm not getting is wouldn't the doctor sit down and examine/speak to the patient like most normal doctors do before they write out a precription ?

For example: How are you feeling ? What are your symptoms ? When did the symptoms start ? etc... even if the doctor had no idea about the patient just arriving from West Africa or his exposure to ebola, surely there must have been some conversation between the doctor and patient ?

Or did the doctor just grab the clipboard off of the door, walk in, have a quick glance at the guy, write up a prescription, and walk out the door without any form of communication ? If there was any communication going on, surely the patient would have made mention again that he just arrived from West Africa and was around people who were sick with ebola ?

That's the part that makes no sense to me and that's why I call this BS and say the hospital is just covering their butts for a doctor that didn't do his job properly.