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

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 ordering1. 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

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 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

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 IdeaPatient Name

Drug

Drug

Dose

Dose

Freq

Freq

Add Fav

Add Fav

Clear

Clear

Clear

Drug Dose Freq

Submit

Add Fav

Clear

Prototype IdeaPatient Name

Drug

Drug

Dose

Dose

Freq

Freq

ClearSubmit

Verify

Verify

1. Drug Dose F

2. Drug Dose F

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)

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. “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.