Viewpoint Paper j Computerized Physician Order Entry: Helpful or Harmful?

A b s t r a c t Computerized physician order entry (CPOE) is touted as a major improvement in patient safety, primarily as a result of the Institute of Medicine’s 1999 report on medical errors and the subsequent formation of the ‘‘Leapfrog Group’ ’ of companies to preferentially direct their employees ’ health care to those institutions that install such systems (as part of directives that ‘‘Leapfrog’ ’ feels will improve patient care). Although the literature suggests that such systems have the potential to improve patient outcomes through decrease of adverse drug events, actual improvements in medical outcomes have not been documented. Installation of such systems could actually increase the number of adverse drug events and result in higher overall medical costs, particularly in the first few years of their adoption. j J Am Med Inform Assoc. 2004;11:100–103. DOI 10.1197/jamia.M1411. In the last five years, hospitals, including our own, have begun to use computerized systems that require physicians and other health care providers to electronically enter patient care orders.1 Before this time, only a handful of hospitals used such systems. These computer programs contain algorithms that alert health care providers to potentially harmful thera-peutic decisions before orders are processed. The installation of these systems is costly (millions of dollars) and requires major behavioral changes, not only by physicians, but also by the entire health care organization.2 In January 2003, Cedars-Sinai Health System in Los Angeles removed its recently installed computerized physician order entry (CPOE) system from use after almost unanimous protest from the medical staff. Why are hospitals and other health care organizations pursuing this avenue at this time? Does the literature support the premise that these systems are beneficial for patient care? Do such systems decrease total health care costs? The answers to these questions are still evolving. In this forum, we address these questions and describe some of the pertinent medical literature on this subject