The document describes a distributed system called SQUD (System Quality Use of Drugs) that was created to help with accurate drug dosage calculations. SQUD allows pharmacy administrators to generate drug protocols and clinicians to access calculators from mobile devices and computers. It has a web-based architecture that stores protocols on a server and has been deployed on a test website. Future work aims to expand drug problems addressed, improve security and integration with health systems, and collect usage data on expensive drugs.

1. A Distributed System for
Accurate Use of Drugs
• Bhaskar Rudroju
• Dr. Michael Schukat
• Peter Kidd
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

2. Outline
• Introduction
• Research background
• Capabilities of ICT
• SQUD Design & Architecture
• Progress
• Future work
• Conclusion
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

3. Introduction
• The recent advances in Information and communication
technologies (ICT) are acting as catalyst for significant
development in the sector of health care.
• Internet enabled healthcare applications
• Electronic Healthcare Records
• Telemedicine
• Inter-organisational collaborations
• Data management
• High performance computing
• Consumer health informatics
• m-Health
• Internet based services (e-Pharmacy, e-Care)
• Security
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

4. Research Background
• Problems facing in hospitals
• Hospital Wide Medication Management (HMM)
• Personalised Medication Management (PMM)
• Hospital Wide Medication Management
• Use of important and costly drugs, e.g. Immunoglobinun
• Lack of resources e.g. computers, Internet connection, server
problems.
• Personalised Medication Management
• Individualised patient care
• Right drug, right dose, every time
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

5. Research Background (Cont..)
• Medication errors
• Giving the wrong drug
• Giving the wrong dose
• Skipping the dose
• Giving the drug by wrong route
• Giving the drug at wrong rate
• Giving the drug at wrong time.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

6. Importance for Drug Dosage
Levels
• Over dose.
• Under dose.
• Low therapeutic index
drugs.
• Finding out optimal level.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

7. Complexity involved in
Calculating Dosage Levels
• Complex
• The calculation of dosage levels are complex, for e.g. Finding the
creatinine clearance the formula is
((140-age)*ideal body weight)/serum creatinine.
((140+age*ideal body weight))/serum creatinine.
• Multi-step
• Calculate IBW, adjusted body weight, CrCl, dosage regimen.
• Error prone
• Even a single misplace of decimal point can lead to a major error.
• Multiple Times a day
• E.g. antibiotics
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

8. Capabilities of ICT
• The information & communication technologies ICT
capabilities can be classified into 6 categories.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

9. Applying ICT to Drug Dosage
Problems
Person Process System
Wrong
Dose
Performance Communication
ICT
Capabilities
Standardisation Smart Phones
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

10. SQUD
• SQUD stands for System Quality Use of Drugs
• Formed by
• IT Department of National University of Ireland, Galway and
• Pharmacy Department of Galway University Hospital.
• Aim/Objectives
• Research on Quality use of drugs in hospital environment.
• Initiated with developing applications for calculating the drug
dosage levels for renal impairment medication.
• These calculators must accessible from patient’s bedside and from
hospital PC’s.
• Capable of sending instant messages to pharmacy staff.
• Transparent validation.
• Reliable.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

11. System Design of SQUD
1. Design drug dosage calculator for clinicians
2. Design framework for pharmacy administrator to generate
drug dosage regimens
3. Implement the calculator on multiple platforms like PDA’s,
mobile phones and on computers
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

12. System Architecture
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

13. System Architecture (Cont..)
1. The pharmacy administrator can login into the application
anywhere via Internet and can create, validate, update and
delete the drug protocols.
2. The created drug protocols will be saved in the webserver.
3. Clinicians can login into the application anywhere via the
Internet and can access the calculator or view the patient or
download the installation file for the mobile phones.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

14. System Architecture (Cont..)
4. The downloaded installation files can be installed on the
clinician mobile phones and access the application.
5. Clinicians can access the application on the smart phones by
downloading the application on their devices.
6. Smart phones which are enabled with Wi-Fi or GPRS can login
into the application via Internet.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

15. Progress
• The web application is deployed in an Ireland server, the
application can be accessed by the url: www.squd.eu
• Clinicians are registering into the application and accessing it.
• The framework can be accessed/used by
• Java enabled mobile phones.
• Smart phones with internet connection
• Stationary hospital PCs
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

16. www.squd.eu Admin page

17. www.squd.eu Clinician page
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

18. Mobile Version
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

19. Future Work
• Broaden / extending the technology
• to assist other dosing related problems such as those found
in new-born babies, cancer patients, ICU patients, etc.
• “drug-regime editor”
• Security / authenticity
• Deployment on other mobile device types (e.g. Android etc.)
• Improved system integration (HIS connectivity, adaptive
workflow integration)
• Start looking into HMM aspects
• to collect usage data on high priority (expensive) drugs like
intravenous immunoglobulin.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

20. Conclusion
• The research has shown that there is an increasing need for
robust medication management systems for clinical use.
• The present prototype provides this functionality over a
wide range of user platforms, while providing a reliable
mechanism to generate, verify and distribute dosage
calculations.
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin

21. Questions?
Thank you for your attention
16th Annual Conference and Scientific Symposium
Healthcare Informatics Society of Ireland
Date 17 -11-11, Dublin