Physicians, Information Technology, and Health Care Systems: A Journey, Not a Destination

Abstract

Two papers in this issue of JAMIA discuss computerized physician order entry (CPOE) and a third one discusses patient clinical information systems (PCISs), which often include CPOE. The first paper, by Ash and colleagues, simply reports the rate at which U.S. hospitals and their care providers are adopting physician order entry systems.1 The other two challenge the current push toward rapid adoption of CPOE and PCIS in the health care industry—Berger and Kichak,2 by challenging the evidence base for the push, and Ash et al.,3 by calling attention to many failure points that occur when rigid computer system designs meet the reality of really complex clinical systems. Before commenting on these papers, we should confess our long-term infatuation with computers and a 30-year conviction that computers could be the “chicken soup” for many illnesses of the health care system. We proved that computer reminders systems are chicken soup for preventive care in a series of studies starting in 1976.4–7 Then, during the early 1980s, we spent our nights and weekends and as much time as we could scrape from our workday writing, testing, implementing, and studying software for what would become the Medical Gopher ,8 the first PC-based order entry system used, and studied, in outpatient care.9–11 More years were required to tune and adapt this system, born in an outpatient setting, for an inpatient service. Then we performed the first, and what may be the only, randomized trial of CPOE in the hospital and proved that our Medical Gopher order entry system is chicken soup to hospital inefficiency. It reduced the cost of care and improved the workflow among CPOE users by 13% compared with the control group who used the traditional paper orders. An example of its benefit …

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