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 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?

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

Project Assessment Verification Features Identity of patient Dosage Frequency Patient conflicts Allergies Food Other Medications

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

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 Workflow analysis Research current systems 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 Idea Patient Name Drug Dose Freq Drug Dose Freq Drug Dose Add Fav Drug Dose Freq Clear Add Fav Drug Dose Freq Clear Add Fav Drug Dose Freq Clear Submit Clear

Prototype Idea Patient Name Verify Drug Dose Freq Verify Drug Dose Submit Clear

Future Work Finish Static Prototype Testing Taking Prototype Dynamic 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

ADT (Admissions, Discharge, Transfer system) 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 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.