Decision Support Tools May Have Helped With Dallas Ebola Case

Thirteen years ago, in the midst of widespread publicity about anthrax-laden letters poisoning people, emergency room physicians sent a postal worker home with a diagnosis of the flu. He later died from anthrax inhalation.

Fast forward to 2014, with the Ebola outbreak in Liberia dominating healthcare coverage, a man who had just returned from the stricken nation visited an emergency room with symptoms but was not tested for Ebola. He was sent home with antibiotics.

Two days later, he was diagnosed with Ebola. In the intervening days, he potentially exposed family members and many more to the deadly virus. At the hospital where the misdiagnosis occurred, officials acknowledged the doctors had the information about the patient’s recent travel in Liberia but didn’t act on it..

How can this continue to happen? In 2010, the Institute of Medicine (IOM) examined the threat of bioterrorism and infectious disease outbreaks and said the most “crucial step in disease detection is the first one – recognizing that an ill patient has a potentially unusual disease…” But it recognized the potential for misdiagnoses of diseases physicians rarely see – such as Ebola and anthrax poisoning – especially in busy emergency departments where information can get lost or overlooked.

The IOM recommended the use of clinical decision support tools to ensure doctors quickly and accurately detect and diagnose unusual diseases. Four years later, some hospitals have these tools and use them. But most do not, even though they’re readily available, affordable and proven effective.

The entire Veterans Affairs medical system and hundreds of hospitals have clinical decision support tools, which allow international travel history searches and entries of patients’ symptoms.  This information is compared against a database of diseases prevalent in the countries where the patients traveled.   At many hospitals, a system, called VisualDx, is available as an online resource and an app, so physicians can literally have diagnostic support on the mobile devices they have in their pockets.

States, such as South Carolina, have placed the system in every emergency department and push public health alerts and clinical guidelines into the system.  Real benefits ensue, such as the early diagnosis of a child with meningococcemia.

Ironically, the federal government recently cut funding for biopreparedness, which will reduce access to these programs.  However, the Ebola threat will likely force hospitals to see diagnostic accuracy as a “must have” and invest in clinical decision support on their own.  In doing so, they would give their physicians the tools to recognize any infectious disease, not just Ebola.

Art Papier, M.D., is a University of Rochester associate professor. He was among those who advised the IOM on the use of clinical decision support tools. This article originally appeared on The Health Care Blog.