As mentioned in the previous post, Centers of Excellence exist for Ebola care in the US. Given the reported issues with care outside of these facilities, it has been reported that Nurse Nina Pham was recently transported to one of these centers for care. Others who have been recently diagnosed will be treated within one of these facilities. Standards will also be communicated and taught to healthcare facilities. Even a Czar has been appointed by Presidentt Obama.
So what does this tell us about quality? When the stakes are high and there are significant risks, let expertise rule. Employ Centers of Excellence and develop standards and communicate these. Place a hard to manage situation with high potential for miscommunication under central governance.
Will this all contribute to better outcomes? We will need to wait and see.
Wednesday, October 22, 2014
Thursday, October 16, 2014
Are Electronic Health Records (EHRs) Partly to Blame in Ebola case?
When Thomas Eric Duncan was turned away from the Dallas hospital emergency room on September 20, was there a lack of alerts within the EHR which caused an oversight? This premise comes into play since an attending physician may not have been aware of the patient’s recent travel to Liberia. The travel was indeed documented in the hospital’s EHR. The physician deliberately would have known the record existed to retrieve it.
EHRs in most cases are customized to specific facilities. They may require 30 to 60 seconds to log in. They may portray an automated rendition of flawed paper workflows. These systems can require many ‘click throughs’ to document the situation. They can make the process of searching for and retrieving records more cumbersome than the processes they've replaced.
Recent regulatory pressures in the past few years have fueled the rapid adoption of EHRs. By the end of 2013, about 58 percent of all hospitals had implemented EHRs, four times that of hospitals in 2010.
Currently, EHRs do not incorporate health alerts from the Centers for Disease Control or other agencies. These systems generally miss the mark when it comes to sharing data with other providers – about 14 percent presently have this capability. Deficiencies in staff training are also noted.
Taking the system solely into account, there are usability factors such as arduous maneuvering to enter and retrieve data, under often severe time pressures, as in the case of an ER. In the attempt to be comprehensive in gathering data and soliciting information, the user is faced with a barrage of questions they must wade through.
A well developed, easy to use, and fully fit for purpose EHR would need to cut away at the periphery and keenly focus on the vital information demanded by a given scenario. Workflows and interactions more closely synchronized with how users actually perform work are needed. Alerts from outside agencies would be incorporated and information sharing and standards with partner healthcare providers would have seamless integration.
As seasoned quality professionals are well aware, an automated system is only a part of an overall, integrated whole. For it to work as intended, system users and stakeholders need to interact amongst themselves; they should converse with each other in matters requiring attention. General protocols also require adherence. For example, sending any patient home from an ER with a 103 degree fever may not be a good idea. It may warrant further investigation and patient care.
The challenges posed by a possible epidemic most likely required direct involvement of the CDC and the greater expertise in facility processes and controls. The CDC director, in retrospect, regrets not placing a team at the Texas hospital to monitor infection control. As the story unfolds, we are learning specific expertise and facilities provide the best care for Ebola patients and decrease the risks of spreading infectious disease. There are only four medical facilities in the US having specialized treatment centers and experience with deadly infectious diseases. The facilities are: Atlanta’s Emory University, Omaha Medical Center, St. Patrick’s Medical Center in Missoula, MT and a National Institute of Health facility. These facilities are said to exceed the standards required by the Ebola contagion.
The inability of the EHR to alert the attending physician is dwarfed significantly by omissions in human communication, awareness, and training. Existing challenges with this particular EHR have been unduly distorted in the face of the complex web of human interactions, skill, and judgement of health care providers and agencies facing an Ebola contagion. What has transpired with undeserved emphasis on the shortcomings of an EMR may spur improvements in EHRs overall in the future.
References
Are e-health records at fault for Ebola mistakes? Computerworld, 10/8/2014
http://www.computerworld.com/article/2823713/are-e-health-records-at-fault-for-ebola-mistakes.html?source=CTWNLE_nlt_pm_2014-10-08
Treatment Spotlight Back in Atlanta, WSJ, 10/16/2014
Dallas Warns More Cases Possible, WSJ, 10/16/14
EHRs in most cases are customized to specific facilities. They may require 30 to 60 seconds to log in. They may portray an automated rendition of flawed paper workflows. These systems can require many ‘click throughs’ to document the situation. They can make the process of searching for and retrieving records more cumbersome than the processes they've replaced.
Recent regulatory pressures in the past few years have fueled the rapid adoption of EHRs. By the end of 2013, about 58 percent of all hospitals had implemented EHRs, four times that of hospitals in 2010.
Currently, EHRs do not incorporate health alerts from the Centers for Disease Control or other agencies. These systems generally miss the mark when it comes to sharing data with other providers – about 14 percent presently have this capability. Deficiencies in staff training are also noted.
Taking the system solely into account, there are usability factors such as arduous maneuvering to enter and retrieve data, under often severe time pressures, as in the case of an ER. In the attempt to be comprehensive in gathering data and soliciting information, the user is faced with a barrage of questions they must wade through.
A well developed, easy to use, and fully fit for purpose EHR would need to cut away at the periphery and keenly focus on the vital information demanded by a given scenario. Workflows and interactions more closely synchronized with how users actually perform work are needed. Alerts from outside agencies would be incorporated and information sharing and standards with partner healthcare providers would have seamless integration.
As seasoned quality professionals are well aware, an automated system is only a part of an overall, integrated whole. For it to work as intended, system users and stakeholders need to interact amongst themselves; they should converse with each other in matters requiring attention. General protocols also require adherence. For example, sending any patient home from an ER with a 103 degree fever may not be a good idea. It may warrant further investigation and patient care.
The challenges posed by a possible epidemic most likely required direct involvement of the CDC and the greater expertise in facility processes and controls. The CDC director, in retrospect, regrets not placing a team at the Texas hospital to monitor infection control. As the story unfolds, we are learning specific expertise and facilities provide the best care for Ebola patients and decrease the risks of spreading infectious disease. There are only four medical facilities in the US having specialized treatment centers and experience with deadly infectious diseases. The facilities are: Atlanta’s Emory University, Omaha Medical Center, St. Patrick’s Medical Center in Missoula, MT and a National Institute of Health facility. These facilities are said to exceed the standards required by the Ebola contagion.
The inability of the EHR to alert the attending physician is dwarfed significantly by omissions in human communication, awareness, and training. Existing challenges with this particular EHR have been unduly distorted in the face of the complex web of human interactions, skill, and judgement of health care providers and agencies facing an Ebola contagion. What has transpired with undeserved emphasis on the shortcomings of an EMR may spur improvements in EHRs overall in the future.
References
Are e-health records at fault for Ebola mistakes? Computerworld, 10/8/2014
http://www.computerworld.com/article/2823713/are-e-health-records-at-fault-for-ebola-mistakes.html?source=CTWNLE_nlt_pm_2014-10-08
Treatment Spotlight Back in Atlanta, WSJ, 10/16/2014
Dallas Warns More Cases Possible, WSJ, 10/16/14
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