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
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 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

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. 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

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

13. 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

14. 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)

15. 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.” Visited Feb. 16,
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.