Process-supporting information technology (IT) has been heralded as
an important building block in attempts to improve the quality and safety
of health care. Two areas in particular have drawn both attention and funding.
The first is clinical decision support; that is, information systems designed
to improve clinicians’ decision making. The second is computerized physician
order entry (CPOE) as a means for reducing medication errors. The literature
in these fields has been characterized by frequent reports of success, often
accompanied by predictions of a bright new (and near) future; however, the
future seems never to arrive. Behind the cheers and high hopes that dominate
conference proceedings, vendor information, and large parts of the scientific
literature, the reality is that systems that are in use in multiple locations,
that have satisfied users, and that effectively and efficiently contribute
to the quality and safety of care are few and far between.1
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