If I Could Change One Thing About EHRs That Might Have Prevented Release Of The Dallas Ebola Patient

If I could change one thing about EHRs in general, it would be for them to be implemented on true workflow platforms, instead of the currently used structured document platforms. True EHR workflow systems have a workflow engine that does things for users automatically, saving them time and effort. Further, and possibly relevant to the Ebola vs. EHR case in Dallas, workflows can be created and customized by physicians, who know their workflows best. For example, a workflow definition could have been created that would have been triggered when the nurse entered the information the patient had traveled from Liberia. This workflow definition would have been executed by the workflow engine to do almost anything, from putting a work item into the physician worklist, to escalating to a text message to be sent to a supervisor if the work item was not completed within some short duration. Finally, this work item could have been posted to a generally visible status board, so all the members of the staff could know it was there. Patient data and task visibility is a big problem in many current EHRs, and workflow technology has a solution to this invisibility. Looking ahead, if we can model and execute clinical workflows, then we can transmit and monitor them as well. Eventually, public health entities will transmit candidate workflows to EHRs, to have useful effects at the point of care, but without the workflow disruption physicians find so troublesome. So, during the next Ebola-like crisis, public health departments will be able to broadcast actionable workflow to prevent the kind of mistake we may have witnessed in Dallas.

2 thoughts on “If I Could Change One Thing About EHRs That Might Have Prevented Release Of The Dallas Ebola Patient”

  1. Chuck,

    Agree with your assessment and conclusions. Also agree that someday we will be able to transmit model workflows and workflow components to organizations — and individuals.

    But we also need to look a bit deeper at a troubling aspect of health IT and any IT systems that are regularly used to capture, update, report and exchange information, be it in healthcare or not. And it’s not just restricted to health IT systems. But in health IT systems, lives are at stake.

    The function of an organization’s IT system – like the other components of its enabling infrastructure — is to facilitate the process and the work of the organization. But, we must always be watchful so as to spot those instances when we’re more concerned with “feeding the system” with data — so as to move the person, package, or product along in the system and on to the “next station” — becomes the primary objective, as opposed to excellently executing the process with the assistance of the installed infrastructure.

    All too often, the human element devolves to “feeding the system” and moving the object being managed along. This might have added to what happened in Dallas.

    I hope not.

    I hope that the patient, and the patient’s health, and the health of all the personnel that came into contact with that patient was the most important thing going on in the emergency room, not just feeding the damn machine.

    – Bob

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