| To advance the causes of reducing medical errors and improving the quality of patient care, healthcare is currently going through a period of vast reforms. CPOE (Computerized Physician Order Entry) is one such reform. An important example of CPOE is drug prescription, both of individual drugs and complex regimens, e.g., chemotherapy. By reducing medication errors, CPOE can both increase the quality of patient care and decrease cost. Several types of problems may arise during the design and implementation of CPOE systems. The most obvious of these problems are due to insufficient attention being paid to the nature of existing manual clinical workflows. Much more damaging are subtle problems related to insufficient attention being paid to the nature of the clinical workplace---in particular, the frequent lack of resources, e.g., system administrators and programmers, for ongoing system maintenance and evolution after the system is deployed.;In this thesis, we will describe the development of an on-line chemotherapy prescription system in which many aspects of system maintenance and evolution can be performed by the system's users. The user-guided operational model underlying this system overcomes many of the problems arising from limited system maintenance and evolution resources in the target workplace. This thesis will also include several discussions of various lessons learned during the development of this system that are applicable to the development of medical informatics systems in general. |
