Development of a Computerized Physician Order Entry (CPOE) System Group 22

1. Development of a Computerized Physician Order Entry (CPOE) SystemGroup 22 Mark Rafalko Michael Landau Wallace Title

2. PharmaSys, Inc. • Full-service life sciences consulting firm in Cary, NC • Founded in 1998 • Specialize in validation and compliance for FDA regulated industries eMEDS • Development of medical informatics software for hospitals and care organizations • Currently developing informatics technologies in Pungo District Hospital in Belhaven, NC

3. Project Advisors Patrick Harris • Patrick has a liberal arts background in business and math • Head of eMEDS program David Roth • David has a masters in BME from Vanderbilt • Currently lead software developer

4. Problem Statement Problem Statistics • 44,000-98,000 people died due to medical errors in 19991 • 7,000 deaths were attributed to prescription errors in 20002 • ~5% of the 3 billion prescriptions filled annually are incorrect • Drug error rate before 2000 was around 10-20%3 Prescription Error • 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

5. PMS (Pharmacy, Management, System) ADT (Admissions, Discharge, Transfer system) CPOE CPOE Function • Collects patient information from ADT • Order and validate prescriptions with the CPOE • Orders are filled by the PMS

6. Deliverables • Hospital workflow flowcharts • Competitor research • Interviews • Online seminars • Product requirements • Joint application sessions with project advisors • Use-cases • Functionality requirements • Prototype • Prescription Ordering Page • Prescription Validation Page • Personal Calendar

7. Project Assessment Current Products • CPOE systems being used in ~5% of hospitals nationwide • WizOrder - Vanderbilt Hospital4 • 0.02% error rate recorded at Vanderbilt in 2002 • ~4 million doses given annually at Vanderbilt Hospital Current System Drawbacks • Not intuitive • Require > 3 months of training • System-wide replacements • Don’t conform to user’s preferences

8. Project Assessment Verification Features (Drug Ordering Page) • Identity of patient • Dosage • Frequency • Patient conflicts • Allergies • Food • Other Medications

9. FDA Approval • Title 11 • Applies to electronic signatures • The user (physician) logging in with his ID and password will count as his electronic signature • Other FDA regulations do not currently apply to the CPOE system

10. 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 to significantly decrease training period

11. Solution Hospital Workflow Analysis • Design efficient application • Account for all documentation • Contacts at Vanderbilt Hospital Personal and Customizable • Preferred selections • Personal schedule/workflow Efficient Error Checking • Program-server interaction Application Speed • Embedded features make performing tasks quick and simple • Just as fast as writing a script

12. Completed Work eMEDS • Our software builds on this current HTML based system Workflow analysis Research current systems • Analyze potential rooms for improvement Use Cases • Outline functionality and flow of application pages

13. Current Work Static Prototype • Use cases describe prototype functionality • Not yet linked to the eMEDS software as a whole • Design Layout • Current pages under construction • Calendar • Daily, Weekly, Monthly • Prescription Ordering • Prescription Validation • Event Logging

14. Prototype: Drug Ordering

15. Prototype: Drug Validation

16. Future Work Finish Static Prototype • Set the appearance and functionality of the system • Finish calendar function Testing • Does the application satisfy design requirements? • Physician prototype testing Taking Prototype Dynamic • Integrating page functions • Connecting to eMEDS software

17. 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

18. 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.