In Reply: Our primary intent was to expand
discussions about CPOE systems to more balanced analyses. CPOE systems will
be central components of health care systems and a more judicious view of
their potential weaknesses can only strengthen them.
As several letters noted, the CPOE system we studied was old and has
since been replaced. However, it represents a widely used system that was
continually updated and improved, even during its tenure at the hospital;
it was not a historical artifact from the 1990s. Regardless, the question
of whether our new system (or any other) has addressed the concerns raised
in our article requires empirical investigation. As part of our ongoing work,
we are now studying this newer system in actual practice rather than in the
design laboratory. Our article focused on the problems of systems integration,
clinical and organizational workflow, unanticipated responses (side effects)
to enhancements, and human-machine interfaces. It is thus unlikely that new
systems have addressed all of the issues identified in our article, as claimed
by Drs Keillor and Morgenstern. Without evidence, there is no basis for the
assertion that new CPOE systems have eliminated such problems.
Koppel R, Metlay JP, Cohen A, Localio AR, Strom BL. Computerized Physician Order Entry Systems and Medication Errors—Reply. JAMA. 2005;294(2):178–181. doi:10.1001/jama.294.2.180
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