Faculty Opinions recommendation of Role of computerized physician order entry systems in facilitating medication errors.

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Abstract
This paper is a landmark in healthcare information technology research because it provides a rare but qualified dissenting voice to the zealous drive for technological solutions to complex medical problems. It provides a real assessment of computer order entry's 'fit' into the medical workplace, highlighting inconsistencies. The authors demonstrate how computer order entry can contribute to safety failures, and their research provides a viable model for future research by mixing quantitative and qualitative methodologies. Against a backdrop of increasing enthusiasm for the role of technology in healthcare safety, the authors studied an established computer physician order entry (CPOE) system in a major medical center. The authors translated methodologies from the social sciences to provide rich data, using interviews, focus groups, shadowing and surveys. What they found makes sense from a human factors perspective, but is largely ignored when information technology is injected into hospital care: fragmentation of data not only made CPOE difficult to use, it led to lapses in care and dosing failures, and the interface was difficult for clinicians to use. This is a problem with many forms of healthcare technology, including infusion pumps (please see ref {1}, on which I am an author; this study evaluated practitioners' ability to perform simple infusion device programming and showed that even experts were inefficient, mostly related to confusion with the device interface.). Frequency data suggest that failures were very common and that difficulties using the system were a rule rather than an exception. The authors insightfully note that clinicians had found "workarounds" to compensate for the system deficiencies. Having used this particular system and also being the subject of an electronic medical record transformation, I think that the poor fit of information systems to the medical workplace is not only common, but very difficult to overcome. Most importantly, it receives insufficient attention. Given the rapid pace of integration of healthcare IT, this study is a powerful argument to step back and study how to make these systems work better and also to appreciate their potential to cause harm.

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