Is anyone else as concerned as I am about Texas Health Presbyterian Hospital Dallas' actions these past few days?
And I'm not just talking about the clearly troublesome misdiagnosis of Thomas Eric Duncan, who was sent home from the hospital's emergency department despite having the Ebola virus, and ultimately died from the disease.
I also am referring to the hospital's waffling of the mistake.
First, Texas Health Presbyterian admitted that it had a workflow problem with its electronic health record, claiming that while the nurse who conducted the intake duly included the fact that Duncan had been in Liberia and possibly exposed to the Ebola virus, a "flaw" in the EHR system failed to display that information to the treating physician, contributing to--if not causing--the missed diagnosis. The hospital even stated that it had corrected the problem.
Just one day later, the hospital retracted its statement, saying that "there was no flaw in the EHR" and that the full clinical team had access to Duncan's travel information. Evidently Epic, the EHR vendor that created the system, quickly jumped in and notified media outlets about the retraction. There has been speculation that Epic invoked a gag clause in its contract with the hospital in order to pressure it to make the retraction, although Epic officials told Politico that there is no gag clause in its contracts and that it "had no legal input or participation in our root cause analysis discussions with Texas Health staff on this issue."
There is so much wrong with this picture.
For one thing, Texas Health has provided no alternative explanation for why the misdiagnosis occurred. Without the "EHR flaw" defense, it has thrown itself and its physicians under the bus and set itself up for a multitude of malpractice and other lawsuits from Duncan's family, other patients and staff, not to mention scrutiny from OSHA, the Joint Commission and other investigative bodies. The hospital is basically admitting incompetence.
But if the problem really was a design flaw, and Texas Health can't alert other providers about it, then the industry has even bigger problems.
First, if a design flaw truly contributed to the adverse patient safety event, then the hospital should not accept total fault for the mistake when, in truth, this is a shared liability and responsibility.
But more importantly, if Texas Health did make the retraction due to the invoking of a gag clause, then what does that say about patient safety and EHRs? Will this have a chilling effect on other providers, afraid of the vendor Goliaths out there? If a hospital can't be honest and report a design flaw, then these flaws won't be corrected, except perhaps within the system that suffers it.
Providers have been complaining against poor EHR design for years, worried that they not only impede workflow but that they create new patient safety problems. And vendors have been resisting suggestions that they be required to report design flaws that could adversely impact patient safety. The HIMSS EHR Association in June 2013 developed a "voluntary" code of conduct, but it allows provider reporting of design flaws only in limited circumstances, and not to the public, the way Texas Health did. The U.S. Department of Health and Human Services also has not required vendors to report design problems that could affect patient safety, instead embracing voluntary reporting.
The Texas Health situation may be setting a dangerous precedent. This is a major world health crisis for which providers worldwide are trying to prepare. If truly the mistake Texas Health made in releasing Duncan was its mistake alone, so be it.
But if there really was a design flaw, then every provider--and every vendor--needs to know about it, evaluate whether it has the same problem, and correct it.