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Ebola and the Information Flow Challenge

by Todd Rothenhaus, MD, Chief Medical Officer

The Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.

As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month: "The worst supply chain in our society is the health information supply chain. It's just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network."

At athenahealth, we’ve fielded a number of client requests asking what they can do to meet the challenges of Ebola. We responded by adding globally available content to our electronic medical record (EMR) that assess for Ebola symptoms, travel history, and risk for exposure as recommended by the Centers for Disease Control and Prevention (CDC). Alerts in the EMR will notify providers, based on their documentation, of the appropriate steps to take according to the algorithm established by the CDC. We were able to push these changes out instantly to the more than 23,000 providers on our cloud-based EMR on Friday October 10th as part of the intake stage. All triage assessments documented in the intake stage are automatically available for summary review by the provider. Additionally, based on provider request, these Ebola guidelines were pushed out as a triage questionnaire to patients through our patient portal’s Group Call functionality so that providers have any Ebola-relevant data before the patient even walks into the clinic.

Perhaps more importantly, we’ve pushed out information on Ebola to the more than 300,000 physicians and 1 million users of Epocrates. We’ve worked closely with the CDC to craft a quick-reference list, have been releasing frequent DocAlert mobile news messages targeted to various audiences, and while things are changing fast, we are working on a full disease monograph as well.

Ebola gets press attention, but what happened in Dallas happens every day with conditions every bit as lethal. The press just doesn’t notice because the diseases that kill all the time — even the ones people can catch — are somehow not news. The question should not be, “What should this particular EMR have done with respect to this particular patient?" but rather, “Why are there so many impediments to information flow and availability in health care?"

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