Ebola: Patient Notes on Travel History

by Peggy Salvatore

The story about Ebola has been dominating the news, and I didn’t feel any particular need to weigh in on it since there is plenty of information out there. Then a few little bits of information hit my inbox and I feel compelled to discuss the seriousness of it because the electronic patient record system has been implicated.

According to a story in HealthLeaders Media on the morning of October 3 by Cheryl Clark (who writes accurately and prolifically for HealthLeaders), Patient Duncan’s travel itinerary was tucked into a note in the nurse’s record which was not connected to the physician’s workflow. The way the unnamed electronic patient record software is set up, different caregivers can enter notes that are not cross-posted to other caregivers.

You can read the full article at: http://www.healthleadersmedia.com/page-3/TEC-309001/Hospital-EHR-Flaw-Obscured-Ebola-Patients-Travel-Note

If we stop and digest this for even half a New York minute, the flaw in this design is obvious and egregious.

That night, this tidbit hit my email alert by Joseph Goedert (also an accurate and prolific reporter) 10:25 p.m. October 3 in HealthData Management, “Friday evening, the hospital issued another statement:

“We  would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic patient record (EHR), including within the physician’s workflow.

“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event. [end of statement]

“Emails to two Texas Health Resources spokespersons late Friday asking what changed so that the hospital now believes there was no fault in the workflow of the EHR, or if the attending physician simply missed the travel history, were not quickly answered.”


You might imagine for a minute the panic at the up-until-then unnamed software vendor. Since then, I have seen the name, and I choose not to mention it here. But there are only a few biggies in hospital systems today, and it is one of them.

The truth is important. It really is.

Where You’ve Been Matters

At first, I was moved to put keyboard to screen when I read this story because I had an experience before the proliferation of electronic patient records that further supports the fact that our travel is a critical piece of information when we present with symptoms. About 20 years ago, I began to have serious gastrointestinal problems. I couldn’t keep anything inside me – solid or liquid. When it was clear that no matter how much I put into my body, I was losing it all immediately and starting to slip away, my primary doc sent me to a gastrointestinal doc. The gastro guy asked me a few questions and within 10 minutes knew exactly what I had and where I got it: after hearing the symptoms, he asked specific questions about my vacation the previous summer. He knew the lake, he knew the bug. He prescribed a heavy duty antibiotic and within 10 days I was recovered. He probably saved my life.

Doctors are human, too. They don’t all know everything; they can’t. That’s why we have specialists. And that is why all the information in an electronic patient record needs to be accessible to every provider who touches the patient. You never  know what little gems in there may really be the golden key in the hands of the right physician.

A thorough history shared with providers all along the caregiving continuum is not a luxury. It is essential to providing efficient and effective care, as quickly as possible, at all points along the healthcare spectrum. And travel histories, especially when a patient presents with a mysterious illness, is critical information. Travel histories are critical information today, especially with the proliferation of bizarre viruses and flu epidemics popping up all over the country and the globe. Where you’ve been matters.

That is the beauty of the potential of electronic patient records. The case of Patient Duncan in Dallas highlights the importance of designing the record systems so we can extract the value they could provide when done right.

Points to ponder:

1. Electronic patient records need to be comprehensive and include travel histories, especially when the patient presents with a mysterious disease.

2. All providers need access to all patient information across all sites of care.

3. As to the disparate reports, it is worth repeating that the truth matters or the record is pointless.


4 Responses to Ebola: Patient Notes on Travel History

  1. Jonena Relth says:

    Peggy, as always, you’re spot on.

    My ex-husband caught a “jungle virus” that nearly killed him 9 years ago. It was only because of our personal affiliation with a physician who treated patients in Vietnam and was an adviser to the CDC that he lived. Even with the CDC database, the docs in the US had no idea how to diagnose, nor treat jungle diseases.

    With our world shrinking due to overseas travel, having Complete and Accurate EHR data is vital today for the health of people around the world. This data added with the CDC, World Health Org. databases, etc., is the only way medical professionals will be able to keep up with current diseases and their control.

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  4. Denise Algire says:

    I spent several years as a practice management executive, I am also an RN. I have two comments, first the nurse would need to be sleeping under a rock to not know to bring the patient’s reported travel to the doctors attention. What happened to old fashioned nursing assessment?

    Second, with the advancements in technology and analytics– EHR should incorporate real-time alerts based on global health issues/CDC alerts. Particularly hospital systems.

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