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 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?

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

Project Assessment Things application will verify: We are treating correct patient Dosage Frequency Patient conflicts Allergies Food Conflicts with other medications

Project Goals Develop a web-based CPOE system that is a stand alone product Significantly decrease number of medical errors 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

Completed Work eMEDS Workflow analysis Research current systems 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 What did people like? Where can we improve? Formulate ideas Custom screen Favorites

Current Work Create use cases Continuing to brainstorm new ideas Describe functionality of web pages Aid in design process Aim for end of February completion Continuing to brainstorm new ideas Finalizing workflow analysis 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

Future Work Prototype page creation Testing

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.