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Should EMR Ebola Alerts Be Mandated?

Thomas Eric Duncan died yesterday from Ebola and I would like to express my deepest sympathy to his family and loved ones. I also feel for the 48 people being monitored for symptoms after their possible exposure. In view of the high mortality of Ebola, his death may not have been preventable, but U.S. healthcare showed a poor face for its first Ebola diagnosis on American soil.

All Certified Legal Nurse Consultants and all nurses working in hospital jobs know that a patient’s history is 95% of the diagnosis. In Duncan’s case, the Emergency Department (ED) nurse entered the patient’s travel history into the electronic medical record (EMR) but may not have verbally notified the ED team. The ED physicians, as physicians are prone to do, apparently did not review the patient’s travel history entry. We all know what happened next – the patient was sent home and 48 people are now under observation for Ebola symptoms.

The EMR can automatically generate alerts to help avoid situations just like this. Given the dangers of undiagnosed Ebola I propose that all healthcare facilities mandate EMR alerts for suspicious Ebola travel histories. In view of the lethal implications, these EMR alerts should unequivocally be the standard of care.

Once EMR alerts are instituted, the next concern will be ensuring that ALL healthcare providers (physicians included) heed the alerts.

I’m Just Sayin’

P.S. Comment and share your opinion regarding whether EMR alerts should be mandated for patients with a positive Ebola travel history.

7 thoughts on “Should EMR Ebola Alerts Be Mandated?

  1. I think EMR alerts would be a good standard of care. If this was in effect during Mr. Duncan’s diagnosis, a lot of people would hopefully have acted on this alert so others may not have been exposed. This needs to be put into standards immediately so maybe it would deter a widespread outbreak here in the U.S. like Africa has experienced.

  2. I agree with a national alert system, something that flows directly to the CDC besides the MDs. I also think if an MD gets a big alert like Ebola that it could go directly to administration and CEOs.
    There is such a term as “alert fatigue.” MDs get a lot of alerts in the EMRs but either tune them out or start ignoring them…

    1. I completely agree with the alert idea. My concern is with protective equipment: at ground zero healthcare providers are wearing level three suits. At Capital Health where I work we as healthcare providers we only have access to level one attire. I would also like to see more visibility from the CDC: as there is a global need for education and training in all affected areas!

  3. Although I whole-heartedly agree with Vickie on the EMR alert for travel being the standard of care for Ebola watch, there are many small rural hospitals, such as the one I work at, that still do not have EMRs in their ED, or even hospital wide. That should not preclude them from having a travel-alert system however… The triage nurse in our ED is required to fill out a paper travel questionnaire. I am not sure what the next step is if the answer to ALL of the questions for travel and exposure to someone who has traveled to Africa is yes. We have not been inserviced on that any further than to ask the questions… but at that point, the patient has already sat in the ED lobby, spoken to the registration clerk, and been in face to face contact with the triage nurse!! I would suggest that, like flu prevention, if a patient presents to the ED with a fever, body aches, etc., that before entering the department, they don a mask. We provided masks at the entry to the ED during flu season, why not do the same for questionable Ebola exposure?

  4. I think there should be national reviews of all personal protective equipment
    at all heathcare facilities. The CDC should implement stricter standards
    when caring for patients of suspected Ebola infection. There should be training
    in place before hospitals receive suspected Ebola patients.

  5. Absolutely, EMR Ebola alerts ought to be mandated. And verbal reports as well as any form of communication that would alert ALL team members who will come in contact with the patient. And let’s not forget about other hospital workers, especially dietary and HOUSEKEEPING. These workers are at risk also and they can easily spread the virus EVERYWHERE!

    Nurses and others need accurate information from WHO, the CDC and NIH etc. If these agency personnel and spokespersons do not know the answers to specific questions, they should openly admit it! Giving false, and/or inaccurate ‘guesswork’ answers is anything but reassuring! And, it’s downright dangerous on a global scale.

    Our U.S. President and his newly appointed “Ebola Czar,” while well meaning, have absolutely no clue as to how serious this is. They need nurses and doctors on such a team. The world needs to hear from people who have both the scientific background in microbiology, virology, communicability/contagion, Community/Public health as well as the experience of working with patients requiring such rigorous isolation measures. Mere business organizational paradigms are not the answer here.

    Needless to say, adequate PPE materials AND TRAINING in the use and disposal of such equipment is paramount.

    While the world community must continue humanitarian aide to the countries in West Africa which are experiencing the brunt of the epidemic thus far, there is no need to allow free travel from these nations to the rest of the world unless and until the epidemic is under control and waning. As we have seen, people can lie in airport screening interviews.

    Health care workers who volunteer to travel to the epicenter of the epidemic ought to have the best of the best, state of the art equipment AND evidence based protocols to deal with this crisis. And, they should expect that before they return home, they would spend 3-4 weeks in a “step down” environment where they can be both monitored and enjoy some most needed R&R in an area that is pleasant but isolated.

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*The opinions and statements made by Vickie Milazzo, the founder of Medical-Legal Consulting Institute, Inc. are based on her experiences and expertise, should not be applied beyond the specific context provided, and do not guaranty or project actual results. Vickie Milazzo is no longer involved in the operations or management of the business, but is involved as an independent education consultant.

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