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

• mission

 (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

○ 1st - Administration Errors ○ 2nd - Errors of omission ○ 3rd - 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.