Development of a Computerized Physician Order Entry (CPOE) System

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

2. 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?

3. Project Assessment • 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

4. Project Assessment • Things application will verify: • Identity of patient • Dosage • Frequency • Patient conflicts • Allergies • Food • Conflicts with other medications

5. Project Goals • Develop a web-based CPOE system that is an improvement upon currently existing systems in terms of capabilities and pragmatism • Significantly decrease number of medical errors • Make the application intuitive and user-friendly • Significantly decrease the burden incorporated with a training period

6. 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

7. 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

8. Completed Work Continued • 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

9. 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

10. Current Work Continued Use Cases: System Actions and Responses Prescription Ordering Use Case Preconditions: • 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

11. Clear Clear Clear Clear Submit Prototype Patient Name Add Fav Drug Dose Freq Add Fav Drug Dose Freq Add Fav Drug Dose Freq

12. Current Work ContinuedUse Cases: System Actions and Responses Prescription Validation Use Case Preconditions: • 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

13. Clear Submit Prototype Patient Name Verify Drug Dose Freq Verify Drug Dose Freq 1. Drug Dose F 2. Drug Dose F

15. 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

16. 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) ADT (Admissions, Discharge, Transfer system) CPOE

17. References • 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). • Snyder, Bill. VUMC Honored for Reducing Medical Errors. The Reporter. Vanderbilt University Medical Center: December 20, 2002. • 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.