2. PROBLEM STATEMENT – Medication prescription
Medical
error
$37.6 billion
annually
Worldwide
Ethiopia
less research
Research
Saftey
feautures
age to medication
medication to medication
dosage to age
brand to age
Interactions
Avoidable
Avoidable
mistakes
$17 billion
Prescrition
platforms
than Public
hospitals
Private
hospitals
Ideal deal
Wholesome
User-friendly
Cost-effective
Platform
3. Dimensions of the problem
1
Illigeable
writing
Inaccurate
Prescriptions
2 4
Drug-Drug
interactions
3
Look-
alike/Sound-alike
5
Allergy and
Sensitivity
6
Incorrect Dosage
Calculation
5. The case of ALERT Hospital
• Established by the Sudan Interior Mission (SIM) in 1934.
• Pioneer and the third-largest hospital in the nation by
patient flow.
• ALERT serves over 1,500 patients daily and caters to more
than 450,000 patients annually.
• Has EMR which fails very often.
• Lacks information system for electronic medication
prescription.
6. 1. User-friendly interfaces and standardized prescription templates.
2. Accurate and wholesome attributes.
3. Introducing E-signature.
4. Integrated reliable drug database.
5. Allergy and contraindication alerts.
6. Integrated with the patient's electronic health record (EHR).
7. Will offer decision support tools.
Mozcription – What it offers?
7. 1. System
Development
Design
Development
Testing
3. Integration with EMR
Electronic health record
2. Customization and
Configuration
Hospitals
Clinics
Pharmacies
4. Stakeholder
Collaboration
Healthcare provider
Pharmacists
IT professionals
Regulatory authorities
Mozcription – What’s the scope?
5. Training and Support
Training sessions and
support services
6. Compliance and
Security
Regulations
Standards
Privacy requirements
9. What Who Budget Work (est. hours) Timeline Status
Low High
Project Planning Mozart 168:00 h Jan 1 – Jan 8 Completed
Infrastructure
Assessment
Senishaw &
Mozart
240:00 h Jan 8 – Jan 18 Completed
System Requirements
Gathering
Senishaw &
Mozart 120:00 h Jan 16 – Jan 21 Completed
User Interface Design
Senishaw &
Mozart
528:00 h Jan 22 – Feb 13 Started – not completed
Database Integration
Senishaw &
Mozart
336:00 h Feb 13 – Feb 27 Started – not completed
System Development
Senishaw &
Mozart
792:00 h Feb 27 – May 7 Not started
Integration with EHR
Senishaw &
Mozart
336:00 h May 8 – May 22 Not started
Gannt chart- Who, When and what to be done?
10. What Who Budget Work (est.
hours)
Timeline Status
Low High
Testing and Quality
Assurance
Senishaw
& Mozart
480:00 h May 23 – Jun 13 Not started
Training and
Capacity Building
Senishaw
& Mozart
600:00 h Jun 16 – Jul 10 Not started
Pilot Implementation
Senishaw
& Mozart
984:00 h Jul 11 – Aug 22 Not started
Evaluation and
Feedback
Senishaw
& Mozart
312:00 h Aug 23 – Sept 6 Not started
Final System
Deployment
Senishaw
& Mozart
336:00 h Sept 7 – Sept 21 Not started
Ongoing Support
and Maintenance
Senishaw
& Mozart
………..
Every 6 months
and as needed Not started
17. User Interface Layer
Web or Mobile Application
• User-friendly interface.
• Features - auto-suggestions and dropdown menus
18. Application Layer
Prescription Management
• Including patient details, medication name, dosage,
frequency, route of administration, and duration of
treatment.
• Validate the prescription data to ensure accuracy and
completeness.
19. Application Layer
Decision Support System
• Decision support system that provides alerts and
warnings for potential drug interactions, allergies, and
incorrect dosages.
20. Data Layer
• Database: Store prescription data, patient profiles,
medication data, drug interaction information, and
allergy records in a secure and structured database.
• Drug Database: Maintain a comprehensive and up-to-
date drug database that includes information on drug
names, dosages, strengths, routes of administration, and
potential interactions
21. Integration Layer
External APIs: Integrate with external systems such as
electronic health record (EHR) systems, drug
databases, and drug interaction databases to access
relevant patient information, medication data, and
clinical decision support resources.
22. Security Layer
Encryption: Implement encryption mechanisms to
secure sensitive patient and prescription data.
Authentication and Authorization: Ensure secure user
authentication and role-based access control to prevent
unauthorized access to prescription data.
23. Reporting and
Analytics
Generate reports and analytics on medication errors,
drug interactions, and prescribing patterns to identify
areas for improvement and support decision-making
processes.
24. Development
Considerations
Usability Testing: Conduct usability testing with
prescribers to ensure that the user interface is intuitive,
reduces errors, and promotes efficient prescription
creation.
Continuous Updates: Regularly update the drug
database, clinical rules, and decision support system to
incorporate new medications, dosages, interactions,
and safety guidelines.
25. Fig 1.0. The System Architecture of the proposed E-prescription System
In India, investigations found that the MPE rate in hospitalized patients was as high as 35.7%.
In a study conducted in Nekemete specialized hospitals in western Ethiopia, a total of 813 medication prescription errors were recorded by the year 2012.
In a study done in Tikur Anbessa Specialized hospital, Of 882 prescription episodes. 359 MEs were detected.
omission errors, wrong abbreviation, wrong dose, wrong frequency ,
When a prescriber's handwriting is unclear, pharmacists or nurses may misinterpret the intended medication, dosage, or instructions.
Prescriptions that lack essential information - errors in drug name, dosage, frequency, or route. Incomplete prescriptions
similar names or packaging – Lamictal-anti-epliptic" and "Lamisil-fungal infection”
Not usually considered – unless critically ill
Fatal allergies
Infant, toodlers, adults, geratrics
Acc to the FDA of US, date, prescriber details (name, contact information, signature), medication name (preferably generic), dosage, route of administration, frequency, duration, special instructions, and refill options.
4. including indications, contraindications, dosing guidelines, and potential drug interactions
6. which is crucial to access relevant patient information.
7. such as drug interaction checks, dose calculators, and reminders for appropriate monitoring or follow-up
electronic prescribing system software, including the user interface, prescription template, drug database integration, decision support tools, allergy/contraindication alerts, electronic signature functionality, and prescription tracking capabilities.
to accommodate specific requirements of different healthcare settings-allow for the inclusion of local drug formularies, regulatory guidelines, and regional medication practices.
3. The integration will ensure seamless communication and data exchange between different stakeholders.
4. patient representatives. Feedback and input from these stakeholders will be essential in shaping the system's functionality and ensuring its usability and effectiveness.
5. educate healthcare providers and pharmacy staff on the effective use of the electronic prescribing system. This will ensure a smooth transition from traditional paper-based prescribing methods to the new electronic system.
7. conducted to test the system in a real-world environment, gather feedback, and identify areas for improvement. The system's performance, usability, and impact on patient safety and medication management will be evaluated during this phase.
8. will consider the scalability of the system to accommodate future growth and technological advancements. It will allow for future enhancements, such as incorporating advanced decision support algorithms, interoperability with emerging healthcare technologies, and integration with emerging standards.
The date on which the prescription is written is essential for documentation and tracking purposes. It helps identify the currency of the prescription and ensures that it is up-to-date.
The prescription will include the prescriber's full name, professional title, contact information, and signature. This information allows for easy identification of the healthcare provider responsible for the prescription and facilitates communication if necessary.
The prescription will clearly state the name of the medication being prescribed. It will use the generic name whenever possible to avoid confusion due to brand name variations. If a specific brand or formulation is required, it should be specified.
The prescribed dosage specifies the amount of medication to be administered at each dose. It will be stated clearly and accurately, using the appropriate units of measurement (e.g., milligrams, micrograms, international units). The dosage may vary depending on factors such as the patient's age, weight, renal function, and specific medical condition.
The route of administration indicates how the medication should be taken or administered. Common routes include oral (by mouth), topical (applied to the skin), intravenous (through a vein), intramuscular (into a muscle), subcutaneous (under the skin), or inhalation (breathed in). The route of administration is essential for ensuring that the medication is given correctly.
once a day, twice a day, every four hours, or as needed. It is important to be specific to avoid ambiguity and ensure proper dosing.
The duration indicates the length of time for which the medication should be taken. It may be specified as a specific number of days, weeks, or months, or it may be left open-ended. The duration helps guide the patient and ensures appropriate follow-up.
Special instructions provide additional information about how to take or administer the medication. This may include instructions regarding food intake (e.g., take with food), timing (e.g., take in the morning), or any specific precautions or considerations. Special instructions are crucial for patient compliance and safety.
If the medication is intended for long-term use or requires multiple doses, the prescription will include the option for refills. The number of authorized refills should be clearly indicated to prevent confusion and ensure appropriate medication supply.
The prescription sheet will have a section to document any known allergies or contraindications that the patient has. This information alerts pharmacists and other healthcare providers to potential medication interactions or adverse reactions
SQL(Structured query language) – Database Development-Structured query language (SQL) is a programming language for storing and processing information in a relational database.
Visual – System Development
for prescribers to create electronic prescriptions with clear and legible information. (small training)
to minimize errors in medication selection.
Contains - electronic prescription entry, medication selection, and dosage calculation. The UI layer also includes alerts, notifications, and decision support features to assist prescribers in making informed medication decisions.
can be accessible through mobile devices and web browsers to facilitate usage by healthcare professionals on the go.
It includes modules for prescription validation, allergy checks, drug interaction checking, dosage calculation, and medication history retrieval. The application layer communicates with the UI layer to process user inputs and display relevant information.
The system will leverage a comprehensive drug database and utilize clinical rules to identify and flag potential issues.
database layer stores and manages the IS data. It includes tables for patient information, medication data, drug interactions, allergies, and user accounts. The database layer supports data retrieval, storage, and updating operations required by the EPMM software
API playground will have alternates for several kinds of codes like R, Python, PHP, Ruby and the like to export to external platform for several reasons like monitoring via POWER BI or the like.
Integration with EMR systems allows access to patient demographics, medical history, and allergy information. Integration with PIS systems enable real-time medication orders, dispensing, and inventory management.
It includes user authentication, access control,
A use case diagram is a way to summarize details of a system and the users within that system. It is generally shown as a graphic depiction of interactions among different elements in a system. Use case diagrams will specify the events in a system and how those events flow, however, use case diagram does not describe how those events are implemented.
Provide a model for the flow of events when it comes to user interactions
Log-in- The system only allows authorized users including the administrator, doctor, and pharmacist to access. The administrator who is the user with higher privilege to add, remove and edit features such as drugs, diseases to the system including the creation and addition of users. He is the user responsible for maintaining the entire system – ensure it is up and running at all times. Also are the doctor and pharmacist, who make and dispense prescription respectively.
Admin page- functions to add, remove and edit the doctor, pharmacist, patient, drug and disease are available. The interface is only accessible to the administrator after he must have logged in with his original and registered credentials. After the login credentials of the administrator have been authenticated, the system opens up with several tabs - these tabs allow the administrator to make changes in the database relating to the doctors, pharmacists, disease and drug. This tab is inaccessible to the doctors and pharmacist.
Doc page- the doctor who is logged onto the system has the ability to make prescription by clicking the “Compose RX” tab. He can also search for patients, view a patients’ record, the drug detail and can send the prescription to the pharmacy.
Pharma page- He can view pending prescriptions, search for a patient, and also view the drug detail. Then afterwards would deal the prescription by clicking process
Drug details- Both the doctor and pharmacist when logged onto the system can view the drug detail before making a prescription by the former and before dispensing also by the latter. This detail contains the pharmaceutical class of the drug, generic description, indications, and adverse reactions.
