Amid a Building Crisis, Could Clinical Decision Support Tools Make a Difference in Managing the Ebola Outbreak?

Oct. 17, 2014
As developments move forward rapidly in the growing Ebola crisis in the U.S., could the leveraging of strong clinical decision support tools make a difference in patient care organizations?

On Friday, Oct. 17, as this blog was being composed, events in the Ebola situation in the U.S. were developing rapidly. Among them:

  • The White House announced Friday morning that President Barack Obama had asked Ron Klain, who had served as chief of staff to both Vice President Joe Biden and former Vice President Al Gore, to be his Ebola response coordinator, in the wake of recent developments. “He will report directly to the president’s homeland security adviser, Lisa Monaco, and the President’s national security adviser, Susan Rice as he ensures that efforts to protect the American people by detecting, isolating and treating Ebola patients in this country are properly integrated but don’t distract from the aggressive commitment to stopping Ebola at the source in West Africa,” a White House official wrote in an e-mail, as reported by the Washington Post. Leaders in Congress had been calling on President Obama to appoint a so-called “Ebola czar.”
  • On Thursday evening, Daniel Varga, M.D., the chief clinical officer of Texas Health Resources integrated health system, apologized publicly for the problems in the management of care delivery procedures related to the care of Thomas Eric Duncan, the first patient to die of Ebola on U.S. soil, while he was being treated at Texas Health Presbyterian Hospital. “Unfortunately, in our initial treatment of Mr., Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” Dr. Varga said, in a statement delivered to a congressional hearing. “We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.” Here is a link to Dr. Varga’s full testimony.
  • Texas Health Resources has also created a microsite to address Ebola concerns. Here is the link to that microsite.
  • Meanwhile, in Ohio, public health officials announced that they were increasing the state’s supply of personal protective equipment for healthcare providers in case such gear is needed for a suspected or confirmed case of Ebola. The announcement came in the wake of revelations that Amber Vinson, one of the nurses who had cared for Thomas Eric Duncan at Texas Health Presbyterian Hospital, had been confirmed as having Ebola after she had flown to Cleveland to participate in bridal gown fittings for her upcoming wedding. Symptomatic, she flew back from Cleveland to Dallas, and was later transferred to Emory University Hospital, where she is now being cared for.
  • Governor Rick Perry of Texas announced that Texas health officials were actively monitoring eight individuals who had been in close contact with Amber Vinson.
  • Describing the condition of nurse Nina Pham, the first nurse who had treated Mr. Duncan and who had subsequently been diagnosed with Ebola, Anthony Fauci, M.D., in a press conference outside the National Institutes of Health in Bethesda, Md., told reporters  Friday morning that, “At 11:54, Nina Pham, the 26-year-old nurse was transferred to the National Institutes of Health to be admitted to our special Clinical Studies Unit. She is here with us. Her condition is fair, she is stable, resting comfortably. In this unit, we have a grop of highly skilled physicians, nurses, and technicians. I'd particularly like to point out the extraordinary skill and training of the physicians and nurses taking care of her.” Dr. Fauci predicted that Pham would recover.

Meanwhile, amid swirling concern that was in some quarters approaching panic, one detailed element of the whole situation was evolving forward, albeit not much noticed by the mainstream media.

As HCI Senior Editor Gabriel Perna reported in an article on this website on Oct. 16, “Representatives from both the Centers for Disease Control (CDC) and the Office of the National Coordinator for Health IT (ONC) co-hosted a special webinar this week on the use of clinical decision support tools in the electronic medical record to screen potential Ebola patients.”

As Perna reported, “The idea, according to CDC’s deputy lead of the Ebola Medical Care Task Force, Dana Meaney Delman, M.D., was to explore ways in which the EMR could prompt healthcare professionals to identify those at risk for Ebola in a timely manner.”

Perna further noted that “The webinar comes as the Ebola virus has become an international topic of discussion, amid a full-on breakout in Libera, Sierra Leone, and Guinea and a smattering of cases elsewhere. In Texas, where the first case of Ebola in the U.S. was treated, representatives from the treating hospital, Texas Health Presbyterian Hospital, a Texas Health Resources facility, initially blamed workflow issues in its EMR as to why the patient, Thomas Eric Duncan, was prematurely released from the hospital. However, the hospital later recanted that statement and said the travel history workflow was available in both doctor and nurse workflows.”

So might clinical decision support play a role in the broader story around Ebola? What is worth noting is that EMR-facilitated intake procedures at hospitals across the U.S. will obviously have to be improved in order to avert some of the critical problems that afflicted the delivery of care around the Duncan case. Industry experts have noted that Texas Health Presbyterian, a community hospital, ended up being unprepared for the first Ebola case on U.S. soil.

What’s more, as Rachel Maddow reported on her program on the MSNBC network Thursday evening, the U.S. healthcare system overall is ill-prepared to face any uptick in Ebola cases. Maddow noted that there are only four hospitals in the U.S. will fully geared-up bio-contamination units: The University of Nebraska Medical Center, Emory University Hospital, the National Institutes of Health facility, and St. Patrick’s Hospital in Missoula, Mont. Those four hospitals have a total capacity of nine beds, five of which are now filled by the currently diagnosed Ebola patients. Yes, that’s right—nine beds across the entire U.S. healthcare system.

What is very clear amid all this is the need for extremely rigorous intake and care management protocols to be put into place; and yes, strong clinical decision support tools and strong clinical workflow optimization will be one element in all this.

One would hope that whatever leadership the CDC and ONC can show in this crisis could be of help, as every element of the healthcare system will be touched by, and important to a resolution of, the Ebola crisis.

In the meantime, a statement made this morning seems appropriate: Michael Anderson, M.D., a physician executive at the University Hospitals Case Medical Center in Cleveland told MSNBC host Jose Diaz-Belart, “This is scary, let's be honest; but from a public health standpoint and a medical standpoint,” he added, “we have to remain calm and follow appropriate guidelines. The number of people who have been exposed to these nurses has been small.”

Healthcare Informatics will continue to update readers on developments in this unfolding story related to healthcare IT and clinical informatics elements.

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