Comment by ams6110 | Hacker News Reader

Comment by ams6110 | Hacker News Reader

Dallas hospital's debacle highlights the atrociousness of many electronic health records.

Yeah OK health records software mostly sucks. But let's think about it... how often does a patient present at the ER with "fever and abdominal pain" I am guessing dozens of times a day at a busy hospital. Is it really unexpected that the staff would triage this as anything other than a low-priority case to try to "treat and street" so they can deal with the serious immediately life-threatening trauma, heart attacks, strokes, etc. that are also constantly coming in.

He mentioned he had recently been in Africa yes, and yes in hindsight that was not given due attention. Maybe the software could have presented this better, but maybe everyone's mind was already on the next ten more urgent cases. If he instead said "I have had contact with Ebola patients" that would have been another kettle of fish, why didn't he say that? I don't think we can blame the hospital too much here.

> Maybe the software could have presented this better

I think there is plenty of room to improve the software in this area. Other EHRs might do this differently but the EHR that I have worked with previously basically had the "recent travel" field be a simple fill in the blank.

What if instead, the input from the field was matched with a database of locations? Once a location is selected, it could use online data of recent outbreaks and long term viruses/diseases of the region that was inputted.

Like you said, the medical staff wouldn't have ever thought "Ebola" as it has been 24 years since the last (and only) case of Ebola in the US. I am not even sure if Doctors would know the symptoms of Ebola to begin with, its just not something to be expected.

If that doctor was given a list of outbreaks and common viruses/diseases of the country the patient visited, it could have maybe allowed him to diagnose his symptoms by just seeing the word "Ebola" pop up.

Spent a year doing analysis of EMR data. Talk about a tar pit. Few industries are as backward and obstinate to change as healthcare. Every clerk and doc has their way to do something and is quite against change, which is painfully ironic, given the docs are some smart folks. For example: patient phone number, sounds simple? Some clerks enter a number, other leave blank (NULL), others enter ZZZ-ZZZ-ZZZZ for blank, others all 5's, or all 9's, or all 7's, or some other number that only they know means blank. And that's for something as trivial as a phone number, now imagine symptoms, measurements, etc. We've got a long way to go.

http://xkcd.com/1172/

I don't agree. He said he'd come from Liberia, and the CDC has issued numerous advisories about the epidemic risk, plus it's been near the top of the news for months. You'd have to be living under a rock not to know about the Ebola outbreak. Being up to speed and prepared for this sort of thing is why hospital administrators and clinicians are paid the big bucks.

Yes but this is our view as outsiders. When you see a dozen patients a day with "fever and abdominal pain" it's going to take something out of the ordinary to set off your alarm bells. Ebola has still affected only thousands of people in the world, and it's never been seen "in the wild" in the USA. It is legitimately almost the LAST thing a health care provider would suspect based on initial symptoms.

The first few cases are going to be misdiagnosed initially.

I think we have to look at this the same way the NTSB looks at airplane crashes. Not to assign blame, but to identify root causes, procedural/training problems, and changes to prevent the same failure from happening again.

Yes, but when someone says they recently came from Liberia, and he outbreak is centered in Liberia, that is something out of the ordinary. I don't expect people to have all knowledge about the management of the disease at their fingertips, but yes I do expect them to be aware of it as a potential danger, in the same way they need to be aware of things like Enterovirus D68 and the current measles outbreak, to name but two. That might simply mean asking the patient to wait while spending a few minutes looking up procedures and arranging for an unusual blood test to be performed (which was apparently done last instead of first: http://www.dallasnews.com/news/metro/20141003-ebola-case-blo...)

What is the point of the CDC sending out bulletins on things to watch out for if the people with the relevant clinical and administrative expertise don't pay attention to them? I'm sorry, I am not buying the idea that having greater domain knowledge is an excuse for being less aware of a major risk factor that has been a headline news story for months.

While it's true that Ebola has only affected a few thousand people so far, it's also true that it's led to the collapse of public health systems in several developing countries, and is threatening the ability of the countries themselves to function. It's fairly fast acting, fairly easily communicable, and kills 60-70% of patients. It seems to me that staying abreast of emergent public health issues is a significant part of what people are paid for. Again, not necessarily knowing in advance what to do about every situation, but the ability to recognize a potentially dangerous situation as something out of the ordinary.

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