Development of a Computerized Physician Order Entry (CPOE)

System

Mark RafalkoMichael 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?

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

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

• 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

Completed Work Continued

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 ContinuedUse Cases: System Actions and Responses

Prescription Ordering Use CasePreconditions:

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

PrototypePatient Name

Drug

Drug

Dose

Dose

Freq

Freq

Add Fav

Add Fav

Clear

Clear

Clear

Drug Dose Freq

Submit

Add Fav

Clear

Current Work ContinuedUse Cases: System Actions and Responses

Prescription Validation Use CasePreconditions:

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

PrototypePatient Name

Drug

Drug

Dose

Dose

Freq

Freq

ClearSubmit

Verify

Verify

1. Drug Dose F

2. Drug Dose F

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)

CPOE

ADT (Admissions, Discharge, Transfer

system)

References

1. 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).

2. Snyder, Bill. VUMC Honored for Reducing Medical Errors. The Reporter. Vanderbilt University Medical Center: December 20, 2002.

3. 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.