ProjectProposal-Jason Shangkuan
From CS160 User Interfaces Fa06
Problem:
Reducing the incidence of medical errors and increasing the robustness of safety practices are continuing issues encountered by the medical industry. One common error amongst doctors that seems easily avoidable is prescription writing. A theoretical based study done by Richard Marken “A Model-based Approach to Prioritizing Medical Safety Practices” on prescription writing errors stated that the error rate for prescribing the wrong drug and incorrect dosage were 39% and 57%, respectively.
The source of errors in writing prescriptions originates from many sources including misdiagnosis of symptoms, patient history, and the surrounding environment. The first factor of misdiagnosing problems is not controllable and relies mostly on the experience and knowledge of the doctor writing the prescription. The other two issues of errors related to patient history and the environment are problems that doctors and pharmacies constantly struggle with, but are seemingly easy issues to control and manage.
Mistakes related to a patient’s history results from not properly understanding a patient’s drug allergies, previous illnesses, and known health issues. As a result of overlooking a part of a patient’s history, writing the wrong drug prescription can be detrimental. In a CBS news article “Because the Doctor Isn’t Always Right”, the article describes how only 6% of hospital deaths are autopsied, and of that 6%, 40% were due to misdiagnosis. Another study by http://www.wrongdiagnosis.com/mistakes/types.htm states that 10% of misdiagnosis is due to medication errors.
In addition to not factoring patient history, the surrounding environment is another factor to prescription errors. The list for environmental factors is infinite, but major ones can be workload of the doctor, workload of the pharmacy, patient communication, and ambient variables. The overall environment factor can also affect the errors that arise in prescription errors due to overlooking a patient’s medical history.
In such situations when prescription errors arise from a patient’s history or the environment when the doctor writes a prescription or a pharmacist fulfills it, an automated solution to verify the prescription with patient history and what is filled out at the pharmacy would be useful in mitigating these issues.
Analysis of Problem:
Although medical statistics demonstrate that prescription error due related to patient’s history or the environment exist, it is important to understand the reasons behind these errors as described in the following:
1) Patient History The most common mistake related to prescription errors is not checking that the patient's drug allergies or history to make sure the patient will not react to the prescription. However, if the patient has never taken the drug before or has never demonstrated reactions or similar symptoms in the past, the prescription error is unpreventable. In addition, some pharmacies have implemented systems to check a patient's history. Although this is a good safety check, it definitely has inherent flaws. For example, the patient has to fill out a new history with each pharmacy that has this system since the database is not universal. If the mistake is found at the pharmacy then the patient has to go back to the doctor's office in order to get another prescription wasting time and urgency to fulfill the prescription.
A digital approach has also already been taken in hospitals according to the article by Philip Cohen and David McGee "Tangible multimodal interfaces for safety-critical applications". The article states that many hospitals tried to adopt computer systems for managing patient records and using wireless tablets for doctors to track patient charts. However, the systems failed and were removed because as Dr. Dudley Danoff states "I'm not opposed to change ... but it's got to be new and better," and continues to mention "This was new but certainly not better" than paper. The tablets pc’s used were not effective because of the size, weight, battery life, complicated menus, and difficult interfaces. Understanding how to use and explain the pc interface to patients and doctors was a bottleneck in the efficiency and effectiveness of using digital methods for health care.
2) Environmental factors When doctors and pharmacists become overloaded with work, they become more susceptible to making mistakes. A very simple but common mistake is to write or fill a similar sounding drug name or misread/miswrite the dosage on a prescription. Examples of common name mistakes from http://www.usalaw.com/a-mp-similar-drug-names.html are listed in the following: - Ambien .....Amen - Amiodarone......Amrinone - Cardene SR......Cardizem SR - Clonidine......Klonipin - Feldene......Seldane - Flutamide......Flumadine - Imipenem......Omnipen - Lodine......Codeine - MS Contin......Oxycontin - Oruvail......Clinoril - Prilosec......Prozac - Retrovir......Ritonavir Although it is difficult to prevent misinterpreting the drug name, a system is still needed to check the drug name with the patient’s history to alert the doctor or pharmacist against such a mistake.
Proposed Solution: In order to prevent errors associated with patient history or environmental factors, it is important to catch the problems at the source when the prescription is first written. In addition, in order to address the digital gap, the ability use paper and interface with a digital medium is a likely solution to help doctors adopt. Utilizing the Anoto paper and digital pen the proposed solution is structured in the following:
Paper design for prescription: The prescription pad will have each area designated for a certain item. The pen’s ability to track where it is in the page will be utilized to identify which item it is recording and the association. The pad areas will record certain information common in today’s Rx pads: patient name, drug, quantity (refill), and doctor signature. A check box for authorization following the signature will be added to authorize the prescription and notify the pen to send prescription to the pharmacy to be filled.
How it works: The pen will utilize knowledge of where it is on the paper to make designation of the described items in the previous section. In order to be most effective, the sequence for writing items and checking will be as follows: 1. Name and address: Once the name and address are written, the pen will query the doctor’s patient database and check if the patient name exists. If the patient name is not in the database, the pen will flash red twice, which will alert the doctor that a file needs to be created for the patient. If the name does exist, there will be another check to verify the address, and then the pen will buzz. If the address does not match, the doctor will be alerted again that the patient history is either non-existent or needs to be updated.
2. Drug information: The drug information area will include name of drug and quantity for refills, which the pen will record. The information is checked against the patient history to check for drug allergies or reactions.
3. Signature and authorization: The doctor will sign the prescription, which the pen will record for documentation, and the doctor can authorize by checking a check box. When the check box is filled, a timestamp is generated so that the prescription cannot be rewritten. The prescription is then sent to pharmacy to be filled.
The patient then brings the hard-copy of the prescription as verification.
Sketch of Solution
