With the Ebola outbreak, the efficiency of electronic health records (EHRs) in handling infectious diseases has been questioned. This October, representatives from the Centers for Disease Control (CDC) and the Office of the National Coordinator for Health IT (ONC) co-hosted a webinar to discuss the inclusion of clinical decision support tools within EHR for effective Ebola screening. In November, Texas Health Resources (THR) informatics team shared some lessons learned in this webinar and their rapid learning and reconfiguration of processes regarding EHR. The team advocates better EHR systems with more functionality for Ebola and other infectious disease, which demand more comprehensive clinical documentation.
As per the Healthcare Informatics report, the lesson learned in the emergency department (ED) by the THR was that they had all elements to make a diagnosis, but they were not in the right place throughout the care. The state of physician workflow and the manner in which nurses entered data into the EHR ran parallel to each other without the appropriate level of communication. THR implemented the following changes with respect to the lessons they had learned from the webinar.
- Redesign of Patient-screening Workflow – THR redesigned the workflow by including the patient screening with travel history, the core concept discussed in the webinar. In the redesigned workflow, the patient’s travel history is captured at the first point of contact with the ED staff and that data is to be made available for all caregivers. If the patient has traveled to countries with Ebola outbreak and the answer to any of the screening questions is positive, a pop-up identifies that patient as high-risk for Ebola with explicit instructions for next steps.
- Redesign of EHR screens – In addition to redesigning patient screening workflow, new EHR screens were designed to manage detection and initial treatment. The new screens mainly focus on detecting infectious diseases, warning staff, isolating the patient and initial treatment.
THR is not only focusing on making enough changes into EHR for Ebola, but is also utilizing this situation to make necessary improvements for handling other infectious diseases. It is assumed that other healthcare systems are making similar changes to their EHR for addressing infectious diseases more effectively.
EHR Documentation and Medical Transcription
Making necessary changes to EHR alone can’t bring the efficiency your need. In the case of an infectious disease, patients first present with a set of symptoms, clinical signs and test results. Physicians are not very clear about the story at the beginning, but it evolves as the data is uncovered which eventually lead to a diagnosis and a treatment plan. EHR is supposed to provide meaningful information from the disparate pieces of patient data at the right time to expedite this process. Thus, complete and accurate clinical documentation is quite important and more attention is required with new functionalities, especially while incorporating travel history into the workflow.
It has been found that miscommunication and omission of vital information exist within EHR and we are not yet sure to which extent new functionalities can help in reducing such errors. So, when trying new functionalities, physicians need to ensure that the data they are using is complete and accurate. The role of medical transcriptionists is quite evident in this aspect, though not perhaps in the traditional manner. Physicians can opt for backend speech recognition editing by medical transcriptionists to ensure data quality. They can also use Discrete Reportable Technology (DRT) in which physician dictations regarding infectious disease treatment are transcribed with the help of transcriptionists and populated into relevant EHR fields to make sure the data within EHR is accurate.