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Development of a Computerized Physician Order Entry (CPOE) System

Development of a Computerized Physician Order Entry (CPOE) System. Mark Rafalko Michael Landau Wallace Title. Problem Statement. In 1999 between 44,000-98,000 people died due to medical errors 1 7,000 deaths in 2000 were attributed to prescription errors 2

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Development of a Computerized Physician Order Entry (CPOE) System

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  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 • 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 ordering • Drug-drug conflicts • Drug-food conflicts • Drug-allergy conflicts • Other types of error • Missing or incorrect information • Wrong or incorrect dose • Illegibly written prescription • 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 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

  4. Project Assessment • Verification Features • Identity of patient • Dosage • Frequency • Patient conflicts • Allergies • Food • 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 during prescription ordering • Make the application intuitive and user-friendly • Significantly decrease 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 • Program-server interaction • Application speed • Embedded features make performing tasks quick and simple

  7. 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

  8. 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

  9. Clear Clear Clear Clear Submit Prototype Idea Patient Name Add Fav Drug Dose Freq Add Fav Drug Dose Freq Add Fav Drug Dose Freq

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

  11. 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

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

  13. 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). • “Prescription Errors Rising.” http://www.consumeraffairs.com/news/pharmacy_errors.html. Visited Feb. 16, 2008. • 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. • Snyder, Bill. VUMC Honored for Reducing Medical Errors. The Reporter. Vanderbilt University Medical Center: December 20, 2002.

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