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.