JAMA article on CPOE

JAMA — Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, March 9, 2005, Koppel et al. 293 (10): 1197

Context Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.

Results We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients? medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.

Conclusions In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Well, now, that seems terrific, doesn’t it? I’m not a Luddite, and believe that, in general, computerization and data pushing can make medicine safer and more efficient. However, It’s a long-term project, not “OK, here’s your system, where’s the check”?

I’m told that our parent organization has already paid an astounding sum to buy an integrated, hospital-wide EMR, which would include CPOE. (Here comes 2 more weeks of EMR ads on Google again. Oh, well). They’re rolling it out in one of the smaller hospitals in the chain, with the intent to ‘work out the bugs’ there, but I’m a big believer in bugs being everywhere.

We’re going to get very dependent on our new computer overlords, and the one thing that’s assurred is that the computers will go down, usually when the tech people are asleep / away.

Color me skeptical.

via Medpundit

Update: Symtym is thinking along the same lines (I think).


  1. A good computer system that you’re familiar with could save time, money, and mistakes. Unfortnatly, for all the tech advances that exist within medicine (a stent for every artery), and outside medicine (the very act of typing this), our field is horribly behind. I don’t see the report regecting EMRs and other computer aides – there are problems with the current EMRs – but they need to get much better. And eventually they will.

    Medical documenting and paperwork is like government system: they’re all bad, we just need to find the least bad.

  2. I had a somewhat less pessimistic take (http://doctorandy.blogspot.com/2005/03/does-computerized-order-entry-increase.html).

    The article has two huge flaws, IMHO:

    1. It doesn’t measure actual errors or harm to patients, it is completely based on talking with housestaff.

    2. There is no control group (i.e.a group of housestaff using handwritten orders).

    I see computer systems as likely to substantially cut medication errors, and studies have supported that.

    One advantage of computer systems is that they can be improved. Gruntdoc, I share your concern about what to do when the system goes down.

    Dr. Andy

  3. I used the word “Luddite” in my MCAT essay. I think it’s why I did so well on my overall scores. ;)

  4. Anonymous says:

    Wonder if this will work like the new posting of “good hospitals” who “comply with all the “evidence based” guidlines. Our administration is so worked up that we are being “encouraged’ to give everyone with chest pain, beta blockers so we don’t miss any MI’s and don’t worry about the number of temporary pacemakers required to fix the complications as no one is following those.
    Medicine by the least trained. Don’t get me wrong I think we should strive to give aspirin and beta blockers to the appropriate patients by concern is the dangers of trying for perfection without looking at the downside.
    North of Texas Doc

  5. Does anyone have a opinion on the the dogmatic nature of the JCAHO folks about abbreviations and a prn indication for everything known to man.

    Example A surveyor sited our hospital because the MD did not wite ducolax prn with an indication. I think they have gone to far


  1. JAMA article on CPOE

    GruntDoc JAMA — Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, March 9, 2005, Koppel et al.

  2. JAMA article on CPOE

    GruntDoc JAMA — Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, March 9, 2005, Koppel et al.