Paranoia isn’t a good mental state for evaluating electronic health records.
The reaction in the United States to what is actually a very limited Ebola contagion here (as opposed to the epidemic in Africa) follows the phobia of a zombie attack survival guide. The Dallas hospital where an Ebola patient died and two nurses contracted Ebola is reportedly a ghost town. HIStalk said “doctors whose offices are near the hospital are having up to 60 percent of their appointments cancelled as patients refuse to get close to hospital property, treating it as though it were Chernobyl instead of the building that previously housed a contagiously sick patient as it does 365 days per year.” The Wall Street Journal reported that two publicly-traded Hazmat suit-makers’ shares shot up 250% and 163%, respectively, over the first two weeks of October.
Spurred by the Dallas hospital’s attempted scapegoating of its electronic health record (EHR) system, pundits and policy wonks have proposed Ebola healthcare information technology fixes. Have EHRs display a warning to treating physicians and nurses, says a common proposal, if a feverish patient says he’s been to Africa recently. This approach seems unnecessary. Quoting HIStalk again, in the aftermath of the recent events in Dallas, it’s probably safe to “assume that even the least-competent nurse in America would go on alert in that case even without an EHR prompt.” Additionally, it may exacerbate the already-existing problem of over-alerting, which a 2013 report submitted by the Urban Institute to the Office of the National Coordinator for Health IT identified as one of the healthcare IT usability issues most noted by clinicians. It’s a problem of crying wolf – doctors and nurses have trouble managing the litany of alerts that EHR and clinical decision support systems generate, especially false positives.
Another genre of proposals involves changing EHR workflows to make Ebola-related information, such as recent travel, more prominent to treating clinicians. As a lawyer, I can’t say whether changing EHR workflows is needed to facilitate diagnosing Ebola. Changing EHR workflows, however, shouldn’t be taken lightly. A primary finding of the 2013 Urban Institute report is that planning changes in clinician workflows – and changing EHR workflows will automatically change clinician workflows – is critical to successful EHR implementation and use.
The report identified the following key lessons for planning workflow redesigns:
- Sufficient time and resources need to be allocated for detailed workflow analysis, user training and planning.
- Redundancies, workarounds, and handoffs should be identified by systematically evaluating how patients and information flow through a healthcare organization.
- Office culture and functionality (such as interactions between physicians and other practice staff) must be understood.
- Revised workflows should be tested before being implemented.
- IT, nursing staff, and physicians must have good communication throughout the workflow implementation process.
- Planning activities should occur at the department level since work (and workflows) differ from department to department.?
Healthcare providers and healthcare IT vendors should work together to identify changes to healthcare IT systems to improve the diagnosis and treatment of Ebola. If changes are needed, healthcare providers and healthcare IT vendors should commit the time, resources and planning necessary to successfully implement the changes.