The doctor didn’t see the Liberia connection either because he (it was a man in this instance) was in a hurry, or was conditioned to only look at one main web page, or had one training session six months ago and needed a refresher on the system’s features and functions.
It would seem obvious that the World Health Organization would maintain a list of disease outbreaks from around the world that could be published as a web service. Every vendor of electronic health systems could readily consume the service to alert health care providers of conditions to check for patients who have travelled overseas or even to another State or county. The Centers for Disease Control could maintain a web service for US outbreaks and the California Department of Public Health could offer a web service for regional concerns (remember West Nile virus??).
So the failure to consider Ebola in a Texas hospital had nothing to do with technology. It could have been a difference of opinion between doctors and triage nurses as to what information was important to know about a patient; or it may have been a case of a doctor who had an unrealistic patient workload, or who needed a refresher on how to use the records system; or a doctor who received a one-shot training course and couldn’t possibly remember everything; or it may have been that process improvement sessions were not conducted to collect best practices among the doctors and nurses.
Whatever the combination of reasons as to why the nurse and doctor were not on the same page, it had nothing to do with technology used to capture and display critical health information. All of the real possibilities for the oversight were the result of actions taken by committees—groups of people—on how to conduct business. But technology does not make decisions on how to conduct the business, technology is used to enforce the rules made by those committees. There is an insidious consequence to blaming technology rather than holding decision making committees responsible. That dangerous consequence is that future groups of people will not work as hard to: understand their responsibilities, to think through their business process, to train the participants in the new environment, and to provide ongoing support to ensure that learning can occur on a continuous basis so that people can make effective use of the technology-enabled business process.
We need to pay more attention to process, clarity and confidence around what patient intake and record review requires, and practice, how to ensure that doctors have the resources – including time – necessary to fulfill those processes. Until we are able improve process and practice, let’s hope that we don’t shift the blame from technology to the tools used to build the technology; we would be moving further away from the real issues if we were to transfer blame from the technology used to the pencil used to take notes during the requirements gathering session.