Ebola Crisis: Humans and Technology go hand in hand http://goo.gl/rXb34A

1. Ebola Crisis: Humans and Technology go
hand in hand
© CureMD Healthcare

2. Ebola Crisis
• Since the age of ignorance, humans have always tried
to create a perfect world around them in order to
cover up their shortcomings
• In an effort to realize this vision, they have developed
technology, expecting it to replace them in every
walk of life
• This has resulted in mishaps – often fatal in nature –
that teach them an important lesson: technology
facilitates humans in performing better, but cannot
function like them

3. Ebola Crisis
• What has happened at the Dallas hospital is a harsh
reminder of this lesson
• The misdiagnosis and subsequent death of the
Liberian man, Thomas Eric Duncan due to Ebola
highlights two important issues of our healthcare
system – error in patient diagnosis and the role of
Electronic Health Record (EHR) in making the correct
diagnosis

4. Ebola Crisis
• To say that technology is to be entirely blamed for
the unfortunate incident will be misinterpretation of
facts
• The statement released by Texas Health Presbyterian
Hospital pointed out communication lapse that
resulted in the discharge of Duncan with Ebola
symptoms. Whether this communication lapse was a
human error or caused by mishandling of EHR, will
be discussed in this blog

5. Ebola Crisis
Failed Communication
• Communication is a two-way process, in which there
is a sender and receiver of the message. Both ends
have to ensure that the message has been
communicated clearly
• In case of Duncan’s first visit to the hospital, there
was a communication gap due to which patient
information was not shared between the nurse and
ED physician

6. Ebola Crisis
• The hospital released a statement saying, “there was
no flaw in the electronic health record and the travel
history was available to the doctors”
• Based on the information available and the timeline
given by the hospital, it appeared to be a case of
human error on two levels
• First of all, there were visible red flags that the nurse
over looked; like the black man who traveled to
Africa, had flu-like symptoms and fever

7. Ebola Crisis
• If the nurse was aware of Ebola Symptoms, then she
should have recognized them right away and alerted
the ED physician
• Secondly, the nurse was familiar with the hospital
workflow and the EHR they used to create clinical
notes
• Knowing that her notes were not shared with the ED
physician, she should not have relied on the system
for communication of patient data

8. Ebola Crisis
Failure to make meaningful use of EHR
• Technology has not only changed our working
conditions, but has also increased our dependency
on it
• We expect it to perform like a human and give us
remarkable results. Similarly, in case of Eric Duncan,
the nurse and physician relied on EHR to make the
right diagnosis for the patient

9. Ebola Crisis
• This is not the first case of misdiagnosis in the
country.
• The Journal of the American Medical Association
(JAMA) published a survey in 2012 that reported,
“Cases of delayed, missed, and incorrect diagnosis
are common, with an incidence in the range of 10%
to 20%”
• However, the case attracted lot of media attention
because of EHR involvement in the misdiagnosis

10. Ebola Crisis
• How far the technology has been responsible for the
misdiagnosis is the right question to ask.
• Technology, no matter how sophisticated it is, can
never replace human ability to think critically and
make judgments
• Even the most perfect EHR cannot make the decision
for the physician
• Its job is to collect facts, maintain data, bring
efficiency in workflow and facilitate diagnostic
decisions

11. Ebola Crisis
• EHRs are still evolving. Currently they are in the
phase where they can facilitate physicians and
healthcare professionals to improve patient care; but
they haven’t reached their final shape
• Perhaps that will be the time when we can expect
EHR to make a judgment call based on the record
entered

12. Ebola Crisis
• Having the right EHR is essential for efficient
workflow. Failure to implement a system that is
compatible with the health facility’s workflow, only
results in mismanagement and miscommunication –
like in the case of Eric Duncan
• A hospital requires an interoperable system that
enables sharing of patient record between different
departments. Contradictory information on nurse
and ED physician notes (fever vs. no fever) resulted in
misdiagnosis of the patient

13. Ebola Crisis
• This could have been avoided, had the hospital
implemented a system that offered sharing of patient
data between the nurse and physician
• Having an EHR that does not meet the needs of the
hospital or practice will create obstacles in their
workflow
• Although there was no flaw in the software, but it
did not cater to the needs of the hospital

14. Ebola Crisis
The lesson that cannot be avoided
• There should be an independent and transparent
investigation into the misdiagnosis of Eric Duncan
case, which should be made public
• Based on the available information, it was evident
that communication lapse occurred because of
human error
• Surely, there is lot of rush and urgency in an
emergency department of a hospital and staff has
more than fair share of work to do

15. Ebola Crisis
• However, the physician could have asked questions
about patient’s vitals from the nurse before making
the diagnosis
• Therefore, healthcare professionals need to
understand that technology can be incorporated to
assist them in their workflow, but the clinical
decisions have to be made by themselves

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• http://blog.curemd.com/ebola-crisis-humans-and-
technology-go-hand-in-hand/

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