The United States Ebola Case May Have Cast Doubt On The Use of Electronic Health Records - Part 1

Friday, October 10, 2014
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

The evolving world of electronic technology saturates every type of industry imaginable. Organizational communication and the resources utilized have come full circle; from paper and pens to iPads and keyboards. Healthcare is not excluded from this advancement.

Conversion to electronic health records (EHRs) has been a hot topic in the healthcare world for years. At its inception, the intent of EHRs was to streamline procedures and improve the quality of patient care. Some healthcare professionals agree that these goals have been accomplished, while others are hesitant, arguing that the digitization of patients' medical records is a dangerous risk to the future of medicine. The recent diagnosis of the first Ebola patient on September 28, 2014, in the United States has created a unique argument for those against the adoption of EHRs.

EHR's Relationship to the First U.S. Case of Ebola.

On September 25, 2014, a patient arrived at a Dallas, Texas, hospital complaining of common flu symptoms including a high temperature, abdominal pains, decreased urination, and sharp headaches. First seen by a triage nurse and an intake nurse, the symptoms were documented into an EHR digital filing system. According to The Huffington Post, one of the nurses documented the patient's travel history which indicated he had recently returned from Liberia, West Africa. Liberia, and several countries in the region, are currently experiencing a devastating epidemic of Ebola, a contagious disease linked to more than 3,000 deaths. This travel information should have been a major red flag to the physician assigned to the ailing patient. However, according to the Dallas hospital, the physician never saw the patient's travel information noted in the EHR file. Subsequently, the patient was released and sent home. To read more from The Huffington Post article, click here.

Three days later on September 28, 2014, the patient returned, this time by emergency ambulance. The symptoms had worsened and the patient was in severe condition. Testing concluded that patient was positive with the deadly Ebola virus.

The patient, who was highly contagious, had been in contact with numerous people between his first emergency room visit and his second. The patient was placed under secure isolation, and all those he is believed to have come into contact with were quarantined as well.

For an update on the current state of Ebola in the United States, click here.

The Alleged EHR Flaw with Deadly Potential.

Because of how quickly the virus spreads, the Dallas hospital has been criticized for sending the patient home without proper and cautionary testing. The hospital and staff received backlash for the lack of communication after it was revealed that the patient had been sent home. The hospital attributed the error to a flaw in the hospital's EHR filing system. The system is described as running on two different workflows: one for nurses and one for physicians. When the patient provided his recent travel history to the nurse, that information was allegedly only retained in the nursing workflow of the patient's medical records within the EHR and did not duplicate over into the physician's workflow. The hospital claimed that due to this design flaw, the crucial travel history was not communicated in the physician's workflow.

In a statement, the hospital was adamant that both the doctors and nurses followed all instructed protocol when treating a patient suspected to be carrying a communicable disease. The mishap is attributed to the major design flaw of the EHR filing system. As a result, the hospital has relocated the travel history documentation portion to a part of the EHR system that is linked to both workflows. The system has also been modified to specifically reference Ebola-endemic regions of Africa. These changes are expected to aid the Dallas Hospital in the early identification of other patients at risk of communicable diseases.

The Politics and Legalities of EHRs.

According to The New York Times, United States government has given $6.5 billion in incentives to healthcare providers and facilities using EHR systems. However, a large number of healthcare providers still argue that the systems have the potential for more misunderstandings and confusion. Some view the method as too time-consuming, unfamiliar, and vulnerable to crashes. Proponents of EHR systems argue that challenges are to be expected with any new technology, but believe the benefits of EHRs outweigh the easily corrected challenges by improving safety, quality, and convenience, ultimately leading to better outcomes overall.

The potential magnitude of challenges implementing EHR systems could bar any positive benefits from being felt. According to a recent study ordered by the government, if and when EHRs are fully adopted nationwide, they could be linked to at least 60,000 adverse events a year, as seen in the Ebola patient crisis.

To harbor health threats from occurring due to EHR flaws, The Institute of Medicine, a division of the National Academies of Science, recommended that the government create an independent agency to deal with patient safety issues that may arise due to EHR use. The institute also called for an end to the "hold harmless" clause that protects software manufacturers from lawsuits but limits the freedom of doctors and hospitals to publicly raise questions about errors or defects. Neither suggestion has been implemented to date.

When lawsuits arise due to issues EHR software, healthcare professionals are not fully protected from liability. There are many legal pitfalls healthcare professionals should be aware of before adopting EHR programs into their business models. Keep a look out for our next blog that will detail the legalities associated with utilizing an EHR system.

To read more from The New York Times on EHR pros and cons, click here.


What is your opinion of using EHRs? Do you think the benefits outweigh the potential challenges? Do you believe that flaws such as noted in the Ebola patient case will be common if EHRs are nationally adopted? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, pharmacists, pharmacies, optometrists, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, NPDB actions, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at


Chan, Amanda L. "Travel Information Wasn't Communicated In Dallas Ebola Case Due To Electronic Health Record Flaw." The Huffington Post. (October 2, 2014). From:

Freduenheim, Milt. "The Ups and Downs of Electronic Medical Records." The New York Times. (October 8, 2012). From:

Berman, Mark. Dennis, Brady. Sun, Lena H. "First Ebola patient in U.S. dies as officials announce new airport screening measures." The Washington Post. October 8, 2014. From:

About the Author:  Lenis L. Archer is as attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

Tag Words:
electronic health records (EHRs's), electronic medical records (EMR's), patient files, patient records, Institute of Medicine, health care records, health care files, doctor offices, office files, office records, patient travel information, Ebola, Ebola patient, Ebola virus, intake nurse, triage nurse, nurse files, physician files, hospital files, hospital records, patient protocols, hospital protocols, patient filing protocols, workflow, EHR workflow, EHR system, patient documentation, health law, healthcare, hospital, doctor, nurse, physician, patient

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Lenis L. Archer 10/10/2014

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