Research Firm Says Don't Blame EMR for Ebola Mistakes

The implication that the EMR system at Texas Health Presbyterian Hospital in Dallas was somehow to blame for the care delay of Ebola patient Thomas Eric Duncan is flawed, according to Kalorama Information. The health care market research firm has covered the EMR industry annually since 2007, and says EMR has advantages in health threats and that paper systems would not be preferable. The firm surveyed the EMR industry earlier this year in its report, "EMR 2014: The Market for Electronic Medical Records."

"News reports in a frenzied media atmosphere appear to have blamed the hospital EMR vendor too early, without considering if other EMR systems, or paper records, would actually have responded better," says Bruce Carlson, publisher of Kalorama Information. 

EMR usability issues came to the forefront with early news reports based on Texas Health Presbyterian Hospital's implication that Duncan had initially been sent home due to a lack of transparency in its EMR system, provided by Epic Systems. The statement indicated that because the patient's vital travel history entered into the EMR by the nurse did not appear in an area that the emergency department physician could access, it wasn't known to the physician. The hospital later clarified that Duncan's travel history had been documented and available to the full care team in the EMR, including within the physician's workflow. So, the physician caring for Duncan had the ability to access the patient travel history if it needed to be called up.

According to Kalorama, usability and the need to page or click through to access information is a key complaint about EMRs, but news reports implied EMR buried information about the patient's travel history without considering if older paper records would do better. Carlson points out that in the days of paper files the average medical file was some 50-75 pages and notes that errors in communication between hospital departments, missing information, illegible handwriting, and buried details could all occur with paper files. 

"A contention that paper records would be preferable in these type of situations is not credible," says Carlson. "When it comes to late-breaking disease threats, emergency instructions or protocols issued by federal or state authorities can be more readily transmitted into an EMR system, certainly faster than the revision of a paper form."

"EMR systems can contain special precaution notes that health care workers can fill out to flag certain conditions," Carlson says.  In response to the Ebola, some are in fact showing their flexibility.

"For example, athenahealth has updated its Web-based EMR system to include specific questions related to Ebola," says Carlson. "You can't change a paper record form, print thousands of copies, and get it to scores of hospitals into immediate use that fast."    

Media reports also focused on the vendor, Epic Systems of Verona, Wisconsin. However most EMR systems do use multiple menus and windows for users to obtain information. Kalorama has noted in the past that Epic Systems is controversial in the industry in that critics contend they lack interoperability with other EMR systems, that each EMR is essentially a closed system that does not allow sharing of patient data with other EMR systems. (Epic defends their operability. In testimony before ONC's Health IT Policy Committee on August 15th, Epic President Carl Dvorak said that Epic has standard HL7 traditional interfaces.) This is partly due at least to the fact that Epic installations allow for a good deal of customization after the EMR has gone live. Therefore, much of a hospital's electronic workflow may depend on the hospital's "build," their version of a software program.  

"EMR 2014: The Market for Electronic Medical Records" is a complete global analysis of the EMR market. The report includes the important trends that will affect companies offering software, hardware, and services related to EMR, estimating the size of the market for the EMR hospital and EMR physician markets and reviewing usage trends among hospitals and physicians. It also forecasts the market to 2018. Included in the report are statistics influencing the industry, demographics, life expectancy, and company strategies. Market share is provided for top players in the industry. Revenues are reported based on worldwide figures with a focused view on US competitors and trends.

Source: Kalorama Information