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In reply

In his letter, Dr Graber points out that new technology may result in unexpected and deleterious consequences. We agree. Moreover, CPOE can be difficult to implement, as demonstrated by the Cedars Sinai experience.¹ However, there is scant evidence to date that CPOE with CDSS results in increased error rates, and there are much data to the contrary.²

An advantage of modern clinical epidemiology is the ability to systematically count errors rather than rely on anecdotal evidence. We could find little empirical data demonstrating that CPOE causes errors. The best example was from one of our own studies, which demonstrated that the rate of potassium-related errors rose substantially after a screen change that made it easy to order overly high doses of potassium. Although the potassium-related medication error rate increased, the overall medication error rate was still more than 80% lower than the baseline rate prior to CPOE. Once . . . [Full Text of this Article]

Rainu Kaushal, MD, MPH
Boston, Mass

Kaveh G. Shojania, MD
San Francisco, Calif

David W. Bates, MD, MSc
Boston

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