Ebola, Epic, the New York Times, and the Culture of Accountability

Oct. 5, 2014
In the era of hyperbolic news, electronic health record (EHR) workflow issues have been dragged into Ebola virus panic as one particular vendor is put under a microscope.

First, it was Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Now, it’s Ebola.  This is truly the year of the virus pandemic panic attack.

These kinds of stories are often a bit a little overhyped and I tend to ignore them if I can. It’s not that Ebola isn’t a concern. It is. It’s just “THE EBOLA VIRUS OUTBREAK” caps letters usage on the 24/7 news channels is a bit much. I call it CAPS LOCK news. If you shout something, people will eventually pay attention. In one short week, the virus’ arrival in the U.S. has been covered by the mainstream media more intensely than the Beatles coming here in 1964.  

As I once wrote, these are the kinds of problems that have your mother-in-law not eating tomatoes for a month because of an E. coli problem.

The story has become impossible to ignore. It’s now touched upon the health IT world, where something interesting is happening.  Epic Systems, the Verona, Wisc.-based vendor of electronic health record (EHR) systems, has been dragged into this mess.

As we reported earlier,  Texas Health Presbyterian Hospital, where the first American Ebola victim was admitted last week, is blaming issues from its Epic system as to why the patient, Thomas Eric Duncan, was prematurely released from the hospital. The hospital said that there is a flaw in the way the nursing and physician portions of the EHR interact. The travel history section is in the nursing workflow portion of the EHR, “designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order.”

This doesn’t come in contact with the physician’s workflow in the EHR. Thus, the physicians didn’t know Duncan, a Liberian, had come from Africa, where the Ebola virus has claimed more than 3,000 lives already. Changes to fix this have been made, Texas Health Presbyterian Hospital says.

It’s an interesting charge. Workflow issues are certainly a common complaint among healthcare providers on EHR systems. In fact, I’d say usability and workflow are the biggest complaints you hear from doctors on these systems. However, laying this goof up entirely on the EHR, as implied in this release, is a little convenient if you ask me.

What about the training of the staff? Duncan obviously told someone he came from Liberia. The Ebola virus has been in the news for a while now and the Centers for Disease Control (CDC) have been all over it, sending alert after alert. There were no alarm bells going off? It’s easy to blame a software program but what about human communication?  

We live in a culture of accountability. Everything has to be someone or something’s fault. You see it in politics, in sports, and in disease outbreaks. When this kind of thing happens it’s often a systematic failure.

For Epic Systems, the publicity comes at a bad time (not that there is ever a good time to be partially blamed for an Ebola outbreak). Earlier this week, a New York Times report (our old friends!) pointed the finger, primarily at Epic Systems for the industry’s lack of EHR interoperability.

The article brought up some fair points. In my opinion though, it was too biased against Epic. Obviously, Epic is a dominant player in this industry. The interoperability concerns, like those with usability, aren’t new or unwarranted. Other reports, one also released this week, quote many stakeholders –including Senate committee members—who also are pointing the finger at Epic for the interoperability problem. There are technical issues. There are cost issues.

Still, this is another “culture of accountability” type deal.  As Jeff Smith, VP of public policy at the College of Healthcare Information Management Executives (CHIME) tweeted this week during our Tweet Chat after I asked him had he seen the NYT report:

I completely agree. Interoperability is an industry-wide issue and Epic is a dominant vendor in the industry. They are not the entire industry. Look, I’m sure no one feels bad for Epic. The company is on a roll. They are doing well for themselves. Despite the bad publicity, they will keep on keeping on, as the saying goes.

But maybe, we ought to all tone down the hyperbole? CAPS LOCK news isn’t helping anyone.

Update: Texas Health released a clarifying statement on Friday night absolving the EHR of any blame in the release of the Ebola patient. 

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna

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