Capstone Presentation By Samir Keshk Agenda The Problem Why The - PowerPoint PPT Presentation

Capstone Presentation By Samir Keshk

Agenda  The Problem  Why The Project Was Chosen  Significance of the Problem  Benefits of EHRs  Goals and Objectives  The Solution  Planning Stage  Demo  Challenges  Limitations  Future Functionality  Conclusion  Questions?

Why I Choose This Project With Samir

Significance of The Problem: Deaths  To Err is Human: 98,000 deaths per year due to medical errors (IOM 2000)  Modern studies estimate approximately 210,000 preventable adverse events per year that result in to the death  Factoring in any errors that may have gone undetected, estimated to be 440,000 preventable adverse events per year instead (James 2013)

Significance of The Problem: Costs  Estimated that adverse drug effects can be as much $4685 dollars per patient with an increase in length of stay at the hospital by an additional 4.6 days (Weingart, Wilson et al. 2000)  Total $5.6 million per year

Significance of The Problem: Errors of Omission  Most difficult to detect  Reasons for missing care 85% lack of staff resources  56% lack of material resources  38% lack of communication  More staff = Less errors of omission  Higher educated staff = Less errors of omission  (Kalisch, Landstrom et al. 2009)

Significance of The Problem: Outside of The United States  Obstetric Emergency Ward in an Egyptian hospital  10,000 women were observed for ten months for patterns in medication errors  Total of 1976 medication errors found ○ 1 st - Administration Errors ○ 2 nd - Errors of omission ○ 3 rd - Unauthorized and Prescription Errors  (Kandil, Sayyed et al. 2012)

Significance of The Problem: Error Management Outside the US  Intervention added to pediatric intensive care unit (PICU) in Egypt  Pre-study  1107 prescription errors out of 1417 medication orders (78.1% error rate)  Post-study  Error rate dropped to 35.2%  (Alagha, Badary et al. 2011)

Significance of The Problem: Error Management Outside the US  Other countries working towards better error management  European Foundation for the Advancement of Healthcare Practitioners (EFAHP)  Institute of Safe Medication Practices (ISMP) Canada  India - Pharmacovigilance centers started up since 2005  (Patel and Balkrishnan 2010)

Benefits of EHRs: Error Reduction  CPOE - 55% reduction in serious medication errors in hospitals  Up to 83% error reduction with additional CDS tools (Menachemi and Collum 2011)  Pharmacy Dispensing Systems – up to 63% error reduction  Bar Code Medication Adminsitration – up to 84 % reduction with dispensing system (Agrawal 2009)

Benefits of EHRs: Costs  With EHR: cost $731, or 9.66% less on average per patient admission compared to hospitals that did not have an EHR (Kazley, Simpson et al. 2014)  Less errors = less extra costs  $4685 dollars per patient  Stay at the hospital additional 4.6 days  Save $5.6 million per year  (Weingart, Wilson et al. 2000)

Benefits of EHRs: Interoperability  Share patient information quickly  Old method = faxing  Aggregate data from multiple sources  Public health studies

Goals and Objectives  Goals (Long Term)  Reduce Errors of Omissions  Adopt an EHR  Objectives (Short Term)  Make staff more accountable

Planning Stage: Features Required  Schedule Tasks for a Patient  Track when a nurse completed a task  Alert nurses/providers when task not completed at scheduled time  Performance reports/graphs

Planning Stage: Scope of The Project  Web application vs Mobile App  Programming language to use  Java  Web languages  Self-hosted site vs Renting/Buying a site

Planning Stage: Technical Requirements  Web application  HTML/CSS/JavaScript/PHP  XAMPP Server  Apache  MySQL  PHP  Bootstrap  HTML/CSS/Javascript Framework

Challenges  Scheduling tasks for patient  Automatically check tasks for lateness  Getting alerting system to work

Limitations  “Cheat the system”  Alerting System in Egypt

Future Functionality  Improve Reporting Functionality  Reports on units  Re-engineer nurse assignments and task responsibility  Vacation/Sick Days and taking over shifts  More admin features  Develop to work on mobile devices

Questions?

References Agrawal, A. (2009). "Medication errors: prevention using information technology systems." Br J Clin Pharmacol 67 (6): 681-686.  Alagha, H. Z., et al. (2011). "Reducing prescribing errors in the paediatric intensive care unit: an experience from Egypt." Acta Paediatr  100 (10): e169-174. Berger, M. W. (2012). “In Nursing, Accountability Fosters Quality” HealthLeaders Media (July 2012)  Donaldson, M. S. (2008). An Overview of To Err is Human: Re-emphasizing the Message of Patient Safety. Patient Safety and Quality:  An Evidence-Based Handbook for Nurses. R. G. Hughes. Rockville (MD). Eldin, A. S., et al. (2013). “Evaluation of Electronic Health Records Adoption in Egypt.” International Journal of Engineering 3 (1): 1131-  1134 Hillestad, R., et al. (2005). “Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and  Costs.” Health Affairs 24 (5): 1103-1117 IOM (Institue of Medicine) (2000). To Err Is Human: Building a Safer Health System. Washington, DC, The National Academies Press.  James, J. T. (2013). "A new, evidence-based estimate of patient harms associated with hospital care." Journal of Patient Saftey 9 (3):  122-128. Kalisch, B. J., et al. (2009). "Missed nursing care: errors of omission." Nurs Outlook 57 (1): 3-9.  Kalisch, B. J. and B. Xie (2014). "Errors of Omission: Missed Nursing Care." West J Nurs Res 36 (7): 875-890.  Kandil, M., et al. (2012). "Medication errors in the obstetrics emergency ward in a low resource setting." J Matern Fetal Neonatal Med  25 (8): 1379-1382. Kazley, A. S., et al. (2014). "Association of electronic health records with cost savings in a national sample." Am J Manag Care 20 (6):  e183-190. Khajouei, R., et al. (2011). "Clinicians satisfaction with CPOE ease of use and effect on clinicians' workflow, efficiency and medication  safety." Int J Med Inform 80 (5): 297-309. Kukafka, R., et al. (2007). "Redesigning electronic health record systems to support public health." J Biomed Inform 40 (4): 398-409  Menachemi, N. and T. H. Collum (2011). "Benefits and drawbacks of electronic health record systems." Risk Manag Healthc Policy 4 :  47-55. Patel, I. and R. Balkrishnan (2010). "Medication Error Management around the Globe: An Overview." Indian J Pharm Sci 72 (5): 539-  545. Schilling, B. (2011). “The Federal Government Has Put Billions into Promoting Electronic Health Record Use: How Is It Going?” Quality  Matters (June/July 2011) Walker, J., et al. (2005). "The value of health care information exchange and interoperability." Health Aff (Millwood) Suppl Web  Exclusives : W5-10-W15-18. Weingart, S. N., et al. (2000). "Epidemiology of medical error." BMJ 320 (7237): 774-777.  Wilson, D. G., et al. (1998). "Medication errors in paediatric practice: insights from a continuous quality improvement approach." Eur J  Pediatr 157 (9): 769-774.