development of a computerized physician order entry (cpoe) system group 22

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Development of a Computerized Physician Order Entry (CPOE) System Group 22 Mark Rafalko Michael Landau Wallace Title

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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 e MEDS - PowerPoint PPT Presentation

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Page 1: Development of a Computerized Physician Order Entry (CPOE) System Group 22

Development of a Computerized Physician Order Entry (CPOE) System

Group 22

Mark RafalkoMichael Landau

Wallace Title

Page 2: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

PharmaSys, Inc.

Page 3: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Project Advisors

Page 4: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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 conflicts2. Drug-food conflicts3. Drug-allergy conflicts

Other types of error1. Missing or incorrect information2. Wrong or incorrect dose3. Illegibly written prescription4. Non-formulary

Page 5: Development of a Computerized Physician Order Entry (CPOE) System Group 22

Collects patient information from ADT Order and validate prescriptions with the CPOE Orders are filled by the PMS

PMS (Pharmacy, Management, System)

CPOE

ADT (Admissions, Discharge, Transfer

system)

CPOE Function

Page 6: Development of a Computerized Physician Order Entry (CPOE) System Group 22

1. Hospital workflow flowcharts

2. Competitor research1. Interviews

2. Online seminars

3. Product requirements1. Joint application sessions with project advisors

4. Use-cases1. Functionality requirements

5. Prototype1. Prescription Ordering Page

2. Prescription Validation Page

3. Personal Calendar

Deliverables

Page 7: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 8: Development of a Computerized Physician Order Entry (CPOE) System Group 22

Project Assessment

Verification Features (Drug Ordering Page)

1. Identity of patient

2. Dosage

3. Frequency

4. Patient conflicts• Allergies• Food• Other Medications

Page 9: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

FDA Approval

Page 10: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 11: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 12: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 13: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 14: Development of a Computerized Physician Order Entry (CPOE) System Group 22

Prototype: Drug Ordering

Page 15: Development of a Computerized Physician Order Entry (CPOE) System Group 22

Prototype: Drug Validation

Page 16: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 17: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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

Page 18: Development of a Computerized Physician Order Entry (CPOE) System Group 22

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. “Prescription Errors Rising.” http://www.consumeraffairs.com/news/pharmacy_errors.html. Visited Feb. 16, 2008.

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.

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