Testifying before the House Energy and Commerce subcommittee on oversight and investigations on Oct. 16, Texas Health Resources Chief Clinical Officer Daniel Varga spoke about electronic health record documentation and updates made to the hospital's system in the wake of treatment for Ebola (EVD) patient Thomas Eric Duncan, who died last week.
On Oct. 2, Texas Health Presbyterian Hospital Dallas (THD) issued a statement that an EHR flaw may have led hospital clinicians to misdiagnose and release Duncan upon his first visit to the hospital's emergency room. A day later, the hospital clarified that, in fact, an EHR flaw was not responsible for Duncan's misdiagnosis.
Varga, in his testimony, expanded on what went wrong.
"THD was and remains well prepared and equipped based upon the best available information to treat patients already identified as having EVD," Varga said. "Where we fell short initially was in our ability to detect and diagnose EVD, as evidenced by Mr. Duncan's first visit to the ED."
To that end, Vargas told federal legislators, the hospital has changed its screening process to more quickly and accurately capture a patient's travel history "at the first point of contact with ED staff."
"This process change makes the travel history available to all caregivers from the beginning of the patient's visit in the ED," he said.
Additionally, Vargas outlined several changes made to its EHR system to accommodate the hospital's new process. The changes included:
- Better placement and title for the screening tool.
- An expansion of the screening questions asked by caregivers, including questions about exposure to other known or potential EVD patients and high-risk activities for individuals who have traveled to EVD endemic areas (such as aiding sick patients).
- A pop-up alert now identifies to caregivers if a patient is at high-risk for EVD following those screening questions. For those patients deemed at risk, further instructions are provided for caregivers
"We have modified our electronic health record in multiple ways to increase the visibility and documentation of information related to travel history and infectious exposures related to EVD," Varga said.
In addition to the updates made, Varga said the hospital retrained clinicians on how to use the EHR in such a scenario.
"[A]n 'in-service' face-to-face training was provided, starting with the night shift and continued at the start of every shift for a number of days," Varga said.
President Obama, in response to the crisis stemming from Duncan's treatment--which includes two healthcare workers being diagnosed with the disease--has appointed an "Ebola czar" to help the Centers for Disease Control and Prevention oversee the federal government's response to EVD in the U.S.
To learn more:
- read Varga's testimony (.pdf)