Electronic Health Records: A Splenectomy Story

Spleen- 1. A vascular ductless organ in the left upper abdomen of humans that helps to destroy old red blood cells, form lymphocytes, and store blood. 2. Anger or bad temper.

Dictionary definition

August 10, 2011 - This is the story as told by a trio of physicians at Partners HealthCare System and Harvard Medical School.

A 53 year old woman presented with pneumococcal sepsis with disseminated intravascular coagulation. She barely survived but lost multiple digits. Ten years before, she underwent splenectomy after a motor vehicle accident. There was no EHR data indicating she had received pneumococcal vaccination after the accident, a recommended treatment following splenectomy. After she recovered she filed suite against the primary care physician, a doctor in our integrated health system. We settled the case and began to work to prevent similar omissions in the future.

Which leads to this verse.

When it comes to the recording data in electronic record,
You can never be too careful in noting what there is stored.

Unfortunately, as an organ the spleen gets no respect,
Even so, its presence or absence should be checked.

Some even claim the spleen is vestigial.
Unnecessary to function of an individual.

But doctors know if the spleen is gone,
Pneumococcal organisms may quickly spawn.

That is precisely why splenectomy must be noted,
And in the EHR attention to is absence be devoted.

Yet at Partners Health System her splenectomy was not listed.
To the Electronic Record it was as if her spleen still existed.

The significance of her prior splenectomy was missed.
And research indicated even if it had been on the list.

In other patients 60% of patients received no vaccination.
To protect against the ravages of pneumoccoal prostration.

Which goes to show you the sins of EHR omission.
Depend on data entered and noted by a physician.

Tejal K. Gandi, MD, Gianna Zuccotti, MD, and Thomas Lee, MD, "Incomplete Care - On the Trail of Flaws in the System, " New England Journal of Medicine, August 11, 2011