EHR workflow flaw caused Texas Health Dallas to initially miss Ebola diagnosis

Update, Monday, 10:00 a.m. Texas Health Resources has backed off its original statement. Read the full story here.

When Ebola patient Thomas Eric Duncan first presented in the emergency department of Texas Health Presbyterian Hospital Dallas, he told a nurse he had traveled to Africa and she recorded that information in the hospital's EHR system — but that information was not displayed in the physician's EHR view, and Mr. Duncan was released.

When he returned to the hospital three days later by ambulance, he became the first person to be diagnosed with Ebola on American soil. Texas Health Dallas has since been criticized for not making the diagnosis on Mr. Duncan's initial visit and placing him under quarantine, potentially exposing people he came into contact with between hospital visits to the deadly virus.

On Thursday, the hospital released a statement explaining the EHR workflow flaw that led to the missed diagnosis:

"The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician's standard workflow."

The hospital has since updated its EHR so that travel information is displayed in both workflows. "We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola," according to the statement.

More articles on Ebola:

Up to 100 people in Dallas potentially exposed to Ebola
Ebola-fearing patients could strain ED capacity
Nurse survey: Hospitals are not ready for Ebola


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