[sbis_l] A culpa foi do PEP !!!

Pessoal,

Vejam que discussão interessante sobre o recente caso do paciente contaminado com vírus Ebola e que passou por vários hospitais nos EUA.

Um dos hospitais, onde o paciente foi atendido, “culpou” o PEP por não ter sido coletada dados de viagem na anamnese do paciente. (http://www.advisory.com/daily-briefing/2014/10/03/dallas-hospital-says-ehr-flaw-led-to-ebola-patient-discharge.)

Esta discussão ocorreu no Mobile Health WG do HL7, onde sugere-se o uso de dispositivos móveis para contornar este problema.

Eu, obviamente, discordo tanto da culpa quanto da solução. Como Professor de Semiologia, ressalto a máxima de que a clínica é soberana, onde uma anamnese e um exame físico bem realizados são fundamentais para um bom diagnóstico.

E isso, não depende de nenhum SIS ou qualquer outro recurso tecnológico.

Mas, está aberta a discussão, e alguns argumentos são controversos.

Abraços,

Marivan

_________________________________

Dr. Marivan Santiago Abrahão

Universidade São Camilo

Faculdade de Medicina

Disciplina de Semiologia

From: "Charles Jaffe, MD (HL7)" <cjaffe@hl7.org>

Subject: RE: Opportunity for mobile Health?

Date: 4 de outubro de 2014 11:54:10 BRT

For the record, Presbyterian Health has retracted its earlier statement blaming the EMR and now says physicians as well as nurses were aware of the travel history. Chuck

http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-troops-west-africa.html?smid=nytcore-ipad-share&smprod=nytcore-ipad

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From: owner-mobilehealth@lists.hl7.org on behalf of Jeff Brandt
Sent: Sat 10/4/2014 7:25 AM
To: Revati

I see the EHR design changing in the next few years.  We will move to a Web services design where data is distributed and mobile clients are the UI interface.  The majority of the intelligence will be in the Cloud via a PaaS such as AWS or Salesforce.  API will expose the data and developers will easily be able to customize the needed solution or change the workflow on demand without impacting any of the staff.  

The problem we are facing it the overspending of monolithic antiquated systems.   This too will change,  companies like Epic and the many others will come to realize that the cost of supporting these BOX systems is very expensive.  I am not placing all the blame them, the ACA has place the market in a strange position, "carriage before the house" so to speak. We will be soon entering a phase where we get to slow a bit, refractor and design, hopefully.

IMHO

Jeff 

From: Revati <revatishah@gmail.com>

Subject: Re: Opportunity for mobile Health?

Date: 3 de outubro de 2014 22:43:14 BRT

Wouldn't it have been great if the EHR had the intelligence built into them that comprehended the context from the nurses notes, patient demographics, combined with the current local and global epidemiological data and presented a checklist (Atul Gawande), to prompt the physician to ask the right questions? 

On Friday, October 3, 2014, Jeff Brandt <jlbcsi@gmail.com> wrote:

Jim,  a nurse just told me the same thing.   

Jeff

Begin forwarded message:

From: "McClay, James C" <jmcclay@unmc.edu>

Subject: RE: Opportunity for mobile Health?

Date: 3 de outubro de 2014 18:38:01 BRT

Dear HL7,

 

IMHO

 

According to the Advisory Board the hospital is blaming the EHR http://www.advisory.com/daily-briefing/2014/10/03/dallas-hospital-says-ehr-flaw-led-to-ebola-patient-discharge.

 

I have been in this exact position before, I was fortunate the patient did not have Ebola.

 

I’m an Emergency Physician. My responsibility is to stabilize the patient, perform a thorough history and physical, consider all the relevant facts, develop a preliminary diagnosis and determine a safe care plan. While the medical record and department policies are there to help me perform my job they can’t think for me.

 

The fact that they missed this one has nothing to do with the nurse, the EMR or their policies. It was a failure by the physician to consider the travel history as relevant and ask the patient. No matter how good your EMR or how careful your policies, you can’t overcome “stupid.” (there, I said it.)

 

Jim

 

James McClay, MS, MD, FACEP
Associate Professor, Emergency Medicine

Chair, Biomedical Informatics Graduate Program
University of Nebraska Medical Center
402-559-3587, jmcclay@unmc.edu
_______________________________
The information in this e-mail is privileged and confidential, intended only for the use of the addressee(s) above. If you have received this e-mail by mistake, please delete it and immediately contact the sender.

 

From: owner-mobilehealth@lists.hl7.org [mailto:owner-mobilehealth@lists.hl7.org] On Behalf Of Jewell,Gaby
Sent: Friday, October 03, 2014 3:14 PM
To: Charles Jaffe, MD (HL7); Gora Datta; HL7 Mobile Health List Serv
Subject: RE: Opportunity for mobile Health?

 

Thank you!  If this is truly how the EHR operates, the staff should know these limitations.  Possessing EHR technology does not alleviate the burden of communication.

 

Gaby Jewell | Sr Strategist | Cerner Corporation | office: 816.201.3290 | fax: 816.571.3290 | gjewell@cerner.com | www.cerner.com

 

From: owner-mobilehealth@lists.hl7.org [mailto:owner-mobilehealth@lists.hl7.org] On Behalf Of Charles Jaffe, MD (HL7)
Sent: Friday, October 03, 2014 12:58 PM
To: Gora Datta; HL7 Mobile Health List Serv
Subject: RE: Opportunity for mobile Health?

 

May I suggest that the newspaper got it wrong. It wasn't an EHR issue, it was a policy issue. You cannot blame the technology for the bad policy.

 

The triage nurse who took the history, simply entered the information into the ADT information. The critical travel history should have been verbally conveyed to the ER physician, not simply entered into the  digital record.

 

There are a long list of people, processes, and policies to blame, but the technology should be at the very bottom of that list.

 

Chuck

 

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From: owner-mobilehealth@lists.hl7.org on behalf of Gora Datta
Sent: Fri 10/3/2014 9:30 AM
To: HL7 Mobile Health List Serv
Subject: Opportunity for mobile Health?

Folks:

 

Earlier in our call today, we were discussing the Ebola-Texas case and the initial travel data capture that took place at the hospital.

Looks like it wasn’t paper process issue but an “EHR” issue as noted in this article: http://www.healthcareitnews.com/news/ehr-flaw-core-us-ebola-outbreak?mkt_tok=3RkMMJWWfF9wsRonvqrMZKXonjHpfsX56egsUKWylMI%2F0ER3fOvrPUfGjI4ARMZrI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

 

Thanks.

 

Gora

(Gora Datta)

US: +1 301.678 9636