HIMSS Amends Blog Post On Role Health IT Played In Discharge Of Ebola Patient

Boy did health IT social media buzz today regarding the possible role of health IT in the recent unfortunate release of a patient infected with the Ebola virus. I certainly weighed in, in my Ebola, APIs & Workflow: We Need A More Process-Aware Health IT Ecosystem. But I was small potatoes. Major papers reported a “flaw” in EHR workflow was being blamed.

And I tweeted the following, shown in the morning CNN news shows.

As the major trade and professional association representing health information management and technology, it was to be expected that HIMSS should weigh in as well. But what was interesting was they weighed in twice, deleting and replacing their first blog post with a second edited version. Here’s a comparison of the first version (left column) to the second version (right column). Differences are in blue.

The post was probably just accidentally published before intended. I’ve done that before. Most of the changes are just rewordings of the same basic ideas. But some of the changes are more interesting. First of all there’s the change in title.

First title:

IT Did Its Job in Dallas – But What About the Human Factor?

Second title:

Health IT Is Only a Portion of the Solution – Addressing Human Factors Are Key

And the following, from the first post:

“We are all paying very close attention to the situation and the role health IT may have played in determining the proper Ebola diagnosis. As we understand the circumstances, the separation of nursing and physician notes in the electronic record may have contributed to a lack of cross-team knowledge sharing. Communication in a busy emergency room, and between clinicians in any patient care setting, is vital to providing quality care. And health IT is only one solution. As we understand the circumstances to-date, the separation of nursing and physician notes in the patient’s record may have contributed to a lack of cross-team knowledge sharing. This presents an opportunity to explore the role health IT can, or should, play in determining a clinical diagnosis….The IT system at Texas Health Dallas did the job it was designed to do. Can it be improved? Absolutely, and it appears that they are working on that.”

Was replaced by this, in the second post:

“As we understand the circumstances to-date, the separation of nursing and physician notes in the patient’s record may have contributed to a lack of cross-team knowledge sharing. This presents an opportunity to explore the role health IT can, or should, play in determining a clinical diagnosis….First and foremost, communication is vital to providing quality patient care – whether in a busy emergency room or in a doctor’s office. Clinicians must be able to share information with each other across clinical disciplines and with their patients. Health IT is only one solution to the goal of cross-team knowledge sharing.”

The rest of the changes were, as I said, minor. But feel free to examine them as well.

So. What do you think?


4 thoughts on “HIMSS Amends Blog Post On Role Health IT Played In Discharge Of Ebola Patient”

  1. EMRs have facilitated information retrieval, but they totally fail at communication.
    That’s why they weren’t used until mandated by Obamacare–they are dangerous to patients, as clearly shown by this utter fail.

    We didn’t not use them because we are technophobes–we didn’t use them because they suck.
    Except for billing–we are getting super duper bills out of ours.

    1. On the whole, I agree. However there really are different styles of EHR, some of which are better at facilitating communication and coordination between physicians and other members of the care team. Sometimes I talk about “singleware” vs “teamware”. Most current EHRS are the former, partly due to focus on Meaningful Use features instead of other more intangible but important qualities such as workflow and usability, and partly due to emphasis on structured data instead of structured workflow. But there’s a few diamonds in the rough out there.

      One hopes EHRS will improve in the workflow department, communicating and coordinating the tasks of patient care, once Meaningful Use has run its course.

      I sympathize and: Thank you for your trenchant insight!

      Chuck

  2. The problem is that the EHR has changed communication…for the worse. Have you read the book “Wrench in the System” by Harold Hambrose.?.It hits the nail on the head. When the Epic people were training me in the office and I would question why things were a certain way, I often heard…”I don’t know how it works in the clinic setting, I do the computer side.” I honestly wish that someone had studied the work flows of a healthcare team before they created the EHR. ..Here are some examples from the trenches…Before EHR, my nurses would come over and ask me a question. Now, they are required to send me a note with the question in it in order that it is documented. So, one day, she sent me a note asking if a patient needed to be seen that day…She assumed that I got it and read it amidst all the other info in my in basket..I did not and at 4 Pm, I saw it and said..”absolutely, that patient needs to be seen today.’ Another example, my colleague had a major head injury and the ER nurse was doing the intake, she asked her LMP (last menstrual period), she could not remember….the nurse said she had to have a date as it was a hard stop in the record. The nurse was almost frozen by the fact that the computer did not let her add more to the record without this piece of data. (So, then we have all learned “work arounds” – such as just make up a date- to deal with this which creates more problems) This sort of behavior cab contribute to a delay in ordering a head CT. I have often found it difficult to find the critical information embedded in excessive information in the electronic record. The short cuts to deal with the data entry have created their own problems. I have also seen incorrect information about patients that are repeated in the record when docs/nurses “cut and paste.” I could go on….but we have some serious flaws in this system that was designed as a billing tool to meet government regulations and was never designed with the end-users in mind.

    1. Thank you Beth,

      For your direct-from-the-front-lines, heartfelt comment. If I may:

      “The problem is that the EHR has changed communication… wish that someone had studied the work flows of a healthcare team before they created the EHR… difficult to find the critical information embedded in excessive information in the electronic record. The short cuts to deal with the data entry have created their own problems… we have some serious flaws in this system that was designed as a billing tool to meet government regulations and was never designed with the end-users in mind.”

      I believe above is consistent with a great deal of anecdotal evidence as well as a growing body of research on EHR usability and workflow.

      In my view, most EHRs today are essentially databases full of structured data about patients. This is all well in good. We need this data. But we also need something more: usable EHR workflows. I believe that workflow technology, such as I describe in this five-part series, combined with necessary structured clinical data, can greatly improve EHR workflow and usability. Unfortunately we’re prematurely cementing into place layers and layers of unusable frozen workflows that will takes years to unfreeze and improve. That said, I would like to end this comment, a reply to your excellent report, on a somewhat optimistic note. Between physicians, such as yourself, willing to speak up, and newer technologies, not around when EHRs were created, a new generation of process-aware clinical care systems will eventually displace the workflow-oblivious databases we confront today.

      Thank you again!

      Chuck

      PS I believe I just followed you on Twitter!

      @bethnearymd

      And I look forward to our interactions.

      –Chuck

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