eHealth Safety Issues - Focus on CPOE

Much of the literature on eHealth safety focuses on Computerized Physician Order Entry (CPOE) systems and their potential for reducing medical errors, particularly with respect to medications. However... the literature is split on the efficacy of CPOE systems and some evidence points to the potential for CPOE systems to contribute to errors. The following papers give pause for thought for those who want to barrel ahead with eHealth implementations.

J. Ash, M. Berg, E. Coiera, Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors, JAMIA Mar/Apr 2004

Y. Han, J. Carcillo, S. Venkataraman, R. Clark, R. Scott Watson, T Nguyen, H. Bayir, R. Orr, Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System, Pediatrics Dec 2005

R. Koppel, J. Metlay, A. Cohen, B. Abaluck, A.R. Localio, S. Kimmel, B. Strom, Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, JAMA Mar. 9 2005

R. Berger, J.P. Kichak, Computerized Physician Order Entry: Helpful or Harmful? JAMIA, Mar./Apr. 2004

G. Kuperman, R. Gibson, Computer Physican Order Entry: Benefits, Costs and Issues, Annals of Internal Medicine, July 2003

A few thoughts after reading these articles:

1. CPOE is undoubtedly a good thing... if implemented well.
   
2. CPOE is not a magic bullet. Simple implementation of a CPOE system will not automatically result in reduced errors. In fact it may increase errors.
   
3. All CPOE systems are not created equal. Some commercial products are better than others... which also means that some commercial products are worse than others.
4. Software implemented badly, no matter how good it is, will result in a bad system that can hurt people.