Transcript Oral Presentation III - 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
 7,000 deaths in 2000 were attributed to prescription errors2
 ~5% of the 3 billion prescriptions filled annually are incorrect
 Drug error rate before 2000 was around 10-20%3
 Human errors during prescription ordering
1. Drug-drug conflicts
2. Drug-food conflicts
3. Drug-allergy conflicts
 Other types of error
1.
2.
3.
4.


Missing or incorrect information
Wrong or incorrect dose
Illegibly written prescription
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 Hospital4
 Improved to 0.02% error rate at Vanderbilt in 2002
 ~4 million doses given annually at Vanderbilt Hospital
 Where have current systems failed?
 Not intuitive
 Require > 3 months of training
 System-wide replacements
 Don’t conform to user’s preferences
Project Assessment
 Verification Features
1. Identity of patient
2. Dosage
3. Frequency
4. Patient conflicts
•
•
•
Allergies
Food
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 during
prescription ordering
3)
Make the application intuitive and user-friendly
–
Significantly decrease 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
 Program-server interaction
 Application speed
 Embedded features make performing tasks quick and simple
Completed Work
 eMEDS
 Run by project advisors Patrick Harris and David Roth


Patrick has a liberal arts background in business and math
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
 Use Cases
 Outline functionality and flow of each page that will be used
Current Work
Static Prototyping
 Adaptation of current eMEDS system and layout into the
functionality of our pages
 Use cases describe how each page prototype will work
 Static - page design purposes
 Not yet linked to the software as a whole
 Current pages under construction
 Calendar
 Daily, Weekly, Monthly
 Prescription Ordering
 Prescription Validation
 Unit Conversion
 Event Logging
Prototype Idea
Patient Name
Add Fav
Drug
Dose
Freq
Clear
Add Fav
Drug
Dose
Freq
Clear
Add Fav
Drug
Dose
Submit
Freq
Clear
Clear
Prototype Idea
Patient Name
Drug
Dose
Freq
Drug
Dose
Freq
1.
Drug
Dose
F
2.
Drug
Dose
F
Submit
Clear
Verify
Verify
Future Work
 Finish Static Prototype
 Set the appearance and functionality of the system
 Testing
 Does the application satisfy design requirements?
 Physician prototype testing
 Taking Prototype Dynamic
 Integrating page functions
 Connecting to database
Potential 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.
4.
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).
“Prescription Errors Rising.”
http://www.consumeraffairs.com/news/pharmacy_errors.html. Visited Feb. 16,
2008.
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.
Snyder, Bill. VUMC Honored for Reducing Medical Errors. The Reporter.
Vanderbilt University Medical Center: December 20, 2002.