Transcript Oral Presentation IV - Research

Development of a Computerized
Physician Order Entry (CPOE) System
Group 22
Mark Rafalko
Michael Landau
Wallace Title
PharmaSys, Inc.
 Full-service life sciences consulting firm in Cary, NC
 Founded in 1998
 Specialize in validation and compliance for FDA regulated
industries
eMEDS
 Development of medical informatics software for hospitals and care
organizations
 Currently developing informatics technologies in Pungo District
Hospital in Belhaven, NC
Project Advisors
Patrick Harris
 Patrick has a liberal arts background in business and math
 Head of eMEDS program
David Roth
 David has a masters in BME from Vanderbilt
 Currently lead software developer
Problem Statement
Problem Statistics
 44,000-98,000 people died due to medical errors in 19991
 7,000 deaths were attributed to prescription errors in 20002
 ~5% of the 3 billion prescriptions filled annually are incorrect
 Drug error rate before 2000 was around 10-20%3
Prescription Error
 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
CPOE Function
 Collects patient information from ADT
 Order and validate prescriptions with the CPOE
 Orders are filled by the PMS
PMS (Pharmacy,
Management, System)
ADT (Admissions,
CPOE
Discharge, Transfer
system)
Deliverables
1.
2.
Hospital workflow flowcharts
Competitor research
1.
2.
3.
Product requirements
1.
4.
Joint application sessions with project advisors
Use-cases
1.
5.
Interviews
Online seminars
Functionality requirements
Prototype
1.
2.
3.
Prescription Ordering Page
Prescription Validation Page
Personal Calendar
Project Assessment
Current Products
 CPOE systems being used in ~5% of hospitals nationwide
 WizOrder - Vanderbilt Hospital4
 0.02% error rate recorded at Vanderbilt in 2002
 ~4 million doses given annually at Vanderbilt Hospital
Current System Drawbacks
 Not intuitive
 Require > 3 months of training
 System-wide replacements
 Don’t conform to user’s preferences
Project Assessment
Verification Features (Drug Ordering Page)
1. Identity of patient
2. Dosage
3. Frequency
4. Patient conflicts
• Allergies
• Food
• Other Medications
FDA Approval
 Title 11
 Applies to electronic signatures
 The user (physician) logging in with his ID and password will count
as his electronic signature
 Other FDA regulations do not currently apply to the CPOE system
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 to significantly
decrease training period
Solution
Hospital Workflow Analysis
 Design efficient application
 Account for all documentation
 Contacts at Vanderbilt Hospital
Personal and Customizable
 Preferred selections
 Personal schedule/workflow
Efficient Error Checking
 Program-server interaction
Application Speed
 Embedded features make performing tasks quick and simple
 Just as fast as writing a script
Completed Work
eMEDS
 Our software builds on this current HTML based system
Workflow analysis
Research current systems
 Analyze potential rooms for improvement
Use Cases
 Outline functionality and flow of application pages
Current Work
Static Prototype
 Use cases describe prototype functionality
 Not yet linked to the eMEDS software as a whole
 Design Layout
 Current pages under construction
 Calendar
 Daily, Weekly, Monthly
 Prescription Ordering
 Prescription Validation
 Event Logging
Prototype: Drug Ordering
Prototype: Drug Validation
Future Work
Finish Static Prototype
 Set the appearance and functionality of the system
 Finish calendar function
Testing
 Does the application satisfy design requirements?
 Physician prototype testing
Taking Prototype Dynamic
 Integrating page functions
 Connecting to eMEDS software
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
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.