Transcript Oral Presentation II - Research

Development of a Computerized
Physician Order Entry (CPOE)
System
Mark Rafalko
Michael Landau
Wallace Title
Problem Statement
 In 1999 between 44,000-98,000 people died due to
medical errors1
 Drug error rate before 2000 was around 10-20%3
 Large portion were human errors during prescription
ordering
 Drug-drug conflicts
 Drug-food conflicts
 Drug-allergy conflicts
 Other forms of error:
 Missing information, incorrect information, wrong dose, illegible,
and non-formulary
 Can we reduce the number of medical errors using a
computerized system?
 How do we design it so that people will use it?
Project Assessment
 Already CPOE systems being used in ~5% of hospitals
nationwide
 WizOrder @ Vanderbilt Hospital
 Improved to 0.02% error rate at Vanderbilt2
 Where have current systems failed?
 Not intuitive
 Require > 3 months of training
 System-wide replacements
 Don’t conform to user’s preferences
Project Assessment
 Things application will verify:
 Identity of patient
 Dosage
 Frequency
 Patient conflicts
 Allergies
 Food
 Conflicts with other medications
Project Goals
1)
Develop a web-based CPOE system that is an
improvement upon currently existing systems in terms
of capabilities and pragmatism
2)
Significantly decrease number of medical errors
3)
Make the application intuitive and user-friendly
4)
Significantly decrease the burden incorporated with a
training period
Solution
 Hospital workflow analysis
 Contacts at Vanderbilt Hospital
 Use to design efficient application
 Account for all documentation
 Make application personal and customizable
 Favorites
 Personal schedule/workflow
 Design for efficient error checking
Completed Work
 eMEDS
 Run by project advisors Patrick Harris and David Roth
 Patrick has a liberal arts and marketing background
 David has a masters in BME from Vanderbilt
 Build on current html based system
 Workflow analysis
 Efficiency
 Research current systems
 Analyze potential rooms for improvement
 Formulate ideas
 Custom screen
 Favorites
Completed Work Continued
• Received input from physicians and nurses who have a
hands-on experience with CPOE systems
 What did they like? What didn’t they like?
 What improvements would they like to see in the system?
 We have personally met with our project advisor, Patrick
Harris, to collaborate current ideas and devise future
goals
Current Work
 Creating use cases
 Describe functionality of web pages
 Aid in design process
 Aim for February 7th completion
 Page prototyping
 Continuing to brainstorm ideas
 Incorporating database
 Drug information from the pharmaceutical medical packaging
suppliers (PMS)
 Medical records of patients from the
Admissions/Discharge/Transfers (ADT) database
 For any missing information we will research and fill in the blanks
for important medications and the respective drug information
Current Work Continued
Use Cases: System Actions and Responses
Prescription Ordering Use Case
Preconditions:
 User has logged in.
 User is capable of ordering prescriptions.
Normal Flow:
 User selects drug, dosage and frequency
Alternative Course:
 Canceling, clearing, multiple drugs
Exceptions:
 User doesn’t complete form Error notice
Assumptions
 User is authorized to log into system
 User is authorized to order prescriptions
 Prescribed drug is available in the pharmacy
Prototype
Patient Name
Add Fav
Drug
Dose
Freq
Clear
Add Fav
Drug
Dose
Freq
Clear
Add Fav
Drug
Dose
Submit
Freq
Clear
Clear
Current Work Continued
Use Cases: System Actions and Responses
Prescription Validation Use Case
Preconditions:
 User has logged in.
 User is capable of ordering prescriptions.
 User has successfully completed prescription ordering page.
Normal Flow:
 User checks verification box next to drug info.
 User signs e-signature. User selects the submit button
Alternative Course:
 Canceling, “back” button
 Drug error on previous form  user must make verifications
Assumptions
 User is authorized to log into system
 User is authorized to order prescriptions
 Prescribed drug is available in the pharmacy
Prototype
Patient Name
Drug
Dose
Freq
Drug
Dose
Freq
1.
Drug
Dose
F
2.
Drug
Dose
F
Submit
Clear
Verify
Verify
Future Work
 Create Prototype application
 Design the appearance and functionality of the
system
 Designed for maximum intuition, efficiency, and user-friendliness
 Add units conversion tab
 Testing
 Test the prototype application to see if it satisfies its
design requirements
 Let physicians/nurses test the prototype to verify that
it is an improvement on current systems
 Upcoming meeting with project advisor
Future Work
 Make the CPOE prototype pda compatible
 Link each user’s personal CPOE systems to collaborate
with each other’s decisions
 Link the user’s CPOE systems with the pharmacy
 Keep track of medication delivery from pharmacy
 Availability to sort medication times more pragmatically
PMS (Pharmacy,
Management, System)
ADT (Admissions,
CPOE
Discharge, Transfer
system)
References
1.
2.
3.
To Err is Human: Building a Safer Health System. Institute of Medicine, John
Lindo. Janet M. Corrigan, and Mella Donaldson, eds, National Academy Press,
(1999).
Snyder, Bill. VUMC Honored for Reducing Medical Errors. The Reporter.
Vanderbilt University Medical Center: December 20, 2002.
Kenneth Elie Bizovi, Brandon Beckley, Michelle McDade, Annette Adams, Andrew
Zechnich and Jerris Hedges. The Effect of Computer-assisted Prescription
Writing on Emergency Department Prescription Errors. Academic Emergency
Medicine Volume 8, Number 5 499, 2001.