Electronic Health Record (EHR) Issues To Blame for Miscommunication in Dallas Ebola Case
Patient data resides in many systems, in multiple locations, which requires adept coordination and collaboration to deliver quality healthcare. However, sometimes pertinent data slips through the cracks – as demonstrated at Texas Health Presbyterian Hospital in Dallas.
Dr. Daniel Vargi of Texas Health Resources, explains the breakdown in communication in a recent CNN interview: “While we had all of the elements of information that were critical to understand a potential diagnosis of Ebola, the way we built them into our clinical process – not only the process of gathering the information but then communicating the information between caregivers – was not as front-of-mind as it should have been.”
This gap in information sharing needs to be bridged, especially to mitigate risk when dealing with significant diseases such as Ebola. It is critical that healthcare systems obtain a 360 degree view of patients, and achieve EHR interoperability.
Providers wrestle with EHR technology to enter patient information that is often never reconciled with patient history or existing data on countless other data sources including ancillary services, and other healthcare organization’s electronic medical record system (EMR). The HITECH Act (2009) initiated governmental incentives and penalties designed to nudge healthcare to adopt certified (EHR) technology for better patient outcomes. As of 2013, 59% of acute care hospitals (non-federal) (link in PDF) have adopted at least a basic EHR system with clinician noted.
However, this journey is far from over and is not without its detours. In a recent letter to the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology, Dr. James L. Madara, Executive Vice President, CEO, American Medical Association recommends, “to pause and fully assess what is working and what needs improvement before moving ahead to Stage 3 of the program.”
Among his many concerns, including patient safety, efficiency, and cost, Dr. Madara notes physicians are “unable to access data stored in a previous EHR system.” It is also true that patient data is often stored in many EHR/EMR systems within the same organization and data access across these systems is cumbersome at best. Another concern he raised is about how the EHR/EMR technology focuses on meeting MU requirements “instead of adopting revolutionary and innovative technology.” The closed and proprietary technology stacks used by EHR/EMR technology prevents interoperability and integration, which reflects this shortsighted view.
The delivery of effective healthcare needs a complete 360 degree view of the patient, from cradle to grave, that includes care delivered in every setting (e.g. hospital, home, accident site, diagnostic clinic, therapy clinic, rehabilitation, physician office). Current EHR technology alone is not sufficient to provide in order to fulfill this vision, in spite of the clinical focus and competent experience of many EMR system vendors. The main reason is that delivering a 360-degree view requires current EHR technology work with other systems for data interoperability and integration, which has not been thefocus. Dr. Madara points out that “EHR technology should not be viewed as the final answer for efficient and effective care delivery and population health management.” He adds that EHR systems could use third party systems for analytics and other specialized technologies to “connect physicians with timely and meaningful insights that are accessible, understandable, and actionable for everyday tasks.”
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