Roman Konovalov, Aroma
Software
Dr. Rafiq R. A. Abou-Shaaban,
Ajman University
|
Seven years ago, in 1999,
the Institute of Medicine in the United
States published its report" To Err Is Human:
Building a Safer Health System". The report
claims that medical errors [1] cause between
44,000 and 98,000 death s in the USA every
year. Using the more conservative figure,
medical errors rank as the eighth leading
cause of death, killing more Americans than
motor vehicle accidents, breast cancer,
or AIDS. In addition to this extraordinary
human toll, medical errors result in annual
direct costs of $17 to $29 billion in the
United States. Finally, fear of becoming
a victim of medical errors, may lead patients
to delay obtaining potentially beneficial
medical care, which may allow their illnesses
to worsen [2].
A big part of Medical Errors
are related to the mistakes made by a doctor
during the Drug Therapy. Doctor might miss
particular contra-indicated drugs while
making prescription for the patient, make
mistakes because of sound-alike or look-alike
medications, or prescribe the wrong dose
for a child or even misinterpret the Lab
Result because of drug therapy.
As it is the job of healthcare
professionals to provide healthcare services
to people, they should work in an adequately
equipped medical environment, that provide
them with information about patient's current
therapy and disease state as well as drug
information software to provide alerts and
precautions to reduce medication errors.
Currently, healthcare professionals
use very different sources of drug information
to learn about medications and their interactions.
Some hospitals use Micromedex or First DataBank,
the international drug databases that contain
a huge number of drugs available worldwide.
But because of the price, these products
are not available for small clinics and
private doctors. Some doctors download free
drug database for US or UK markets on their
PDAs from the web. Certain part of healthcare
professionals uses drug catalogs published
by HCP Healthcare Publications or similar
companies. Of course, the Internet is also
a source of drug information for doctors.
It's also possible to download a list of
drugs registered in the country from the
Ministry of Health web site, but it's a
simple plain list with product's brand name
and price information.
In spite of the fact that
there is a certain number of sources that
might help healthcare professionals to get
information about the drugs, there is no
product exists on the market that would
contain full details about the medications
that are presented in UAE or the entire
Middle East. And even more, only small number
of currently available sources of drug information
can be integrated into the existing hospital's
Electronic Patient Record.
In the late 2005, software
company Business Information System started
the project to create the expert system
that would contain drug database as well
as logic to check drug-drug interactions,
dose check, sound-alike or look-alike drugs
and many other things. The system got code
name DRUGS and was intended to be used as
a part of hospital's Electronic Patient
Record.
In the beginning of year 2006
another software development company based
in UAE, Aroma Software, started the similar
project to create Drug Database that would
contain all drugs available in the United
Arab Emirates. The information about each
drug would contain the details like Generic
Name, prescription recommendations, precautions,
contra-indicated drugs and diseases and
so on. The product would also contain the
logic to check drug-drug interactions, dose
check and precautions. The project got a
code name Snowhorse. It was intended to
be used first as stand-alone application
and then as a component that might be integrated
into hospital's Electronic Patient Record.
In early July 2006 both companies
had made a decision to merge their efforts
and create common program that would implement
the ideas of both companies in helping healthcare
professionals to deliver safer drug therapy
to their patients. The new joint project
got a name Greenrain. As a first step, the
product will be marketed in United Arab
Emirates, then in GCC countries and finally
in other countries in the Middle East.
|
|
First of all, the product
will help doctors to reduced medication
errors. At the time doctor make a prescription,
the program performs the following checks:
- Drugs
currently used have the same Generic Name
as currently prescribed drugs - this check
will prevent any duplication in therapy
and avoid Adverse Drug Events.
- Contra-indicated
drugs with currently used to find drugs
in the prescription that conflict with
currently used drugs.
- Contra-indicated
diseases of the patient to find drugs
in the prescription that conflict with
the diagnosed diseases.
- Drugs
with the same therapeutic use - this will
help doctors to avoid duplication in therapy.
If currently prescribed drug is in the
same therapeutic use as currently used
drug, then Greenrain makes a check for
sound-alike and look-alike drugs.
- All
the checks above are made against the
other drugs in the same prescription.
- Dose
check to find the situations when currently
prescribed drug has wrong dosage taking
in consideration Renal and Hepatic Impairment
possibility.
- Finally,
the program provides doctors with drug
information to make it easy for them to
learn the details about particular drugs,
its indications, contraindications, precautions
etc.
The second, Greenrain helps
doctors to avoid misinterpretation of Lab
Results due to Drug Therapy. At the time
when new Lab Results are saved in hospital
system, they are checked against currently
used drugs and currently prescribed drugs
to see if there are any drugs currently
taken by the patient that might affect the
Lab Results.
The third, the program checks
precautions of each currently prescribed
drug regarding the Pregnancy, Habit, Influence
of food or drinks, Drug Availability, Discontinuation,
Prolonged use, Start and stop conditions
and so on.
The fourth, Greenrain support
drug substation by checking if currently
prescribed drug can be replaced by another
drug based on Generic Name. Any particular
drug might be replaced by another one with
the same efficacy by with less side effects,
or to insure that patient gets cheaper drug
with the same efficacy to promote patient
compliance.
All the checks mentioned above
are possible because of the drug database
that is included into the program. The drug
database contains information about all
drugs approved and licensed by Ministry
of Health of United Arab Emirates and it
will be regularly updated as new information
is available.
The program will be released
in two major versions. Doctor version that
contains full drug search facility and basic
functionality for creating prescriptions
and managing patient details, and Hospital
version that might be smoothly integrated
into hospital's Electronic Patient Record.
The Greenrain will significantly
help to improve the quality of Healthcare
Services in the region. The benefits the
program brings might be considered from
two different perspectives.
From the medical point of
view, the safety of the patient will be
increases because of the fact that number
of Medication Errors will be reduced through
the checks explained above. The program
provides doctors with information and alerts
to warn about possible issues with the particular
drug or Lab Results. By providing the mechanism
to warn doctor about possible problems,
the mortality and morbidity of the population
due to Adverse Drug Events will be decreased.
From financial perspective,
the number of patient visits will be reduced,
as well as patient's stay in the hospital
will become shorter. This will allow hospitals
to save additional budget that is currently
spent on the treatment of Medication Errors
consequences.
|