Healthcare information technologies hold great promise. Technologies such as electronic medical records, computerized order entry for prescriptions and diagnostic tests, and clinical decision-support tools may improve quality, reduce medical errors and prevent deaths.

Medical errors are one of the nation's leading causes of death and injury. A report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. Many of these errors are medication errors. It has been shown that computerized physician order entry with decision support substantially decreases the frequency of serious inpatient medication errors. Electronic prescribing is safer than paper prescribing because it eliminates problems with handwriting legibility and, when combined with decision-
support tools, automatically alerts physicians to possible interactions or allergies.

Certain other inpatient information technologies may be beneficial as well. These include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions.

All of the benefits of technology notwithstanding, there are some reasons physicians must be cautious in adopting technology. In a June article published in the Journal of the American Medical Informatics Association, "Types of Unintended Consequences Related to Computerized Provider Order Entry," the authors write that physicians should be aware that "clinical unintended adverse consequences may result from computerized provider order entry (in order of decreasing frequency):

1) More/new work for clinicians,

2) Unfavorable workflow issues,

3) Never-ending system demands,

4) Problems related to paper persistence,

5) Adverse changes in communication patterns and practices,

6) Negative emotions,

7) Generation of new kinds of errors,

8) Unexpected changes in the power structure, and

9) Overdependence on the technology."

The article highlights the fact that computer systems may create new kinds of errors if not accompanied by well-designed, well-implemented cross-checking methods. Researchers will surely continue to study real-world computer system implementations so as to understand their helpfulness and harms. At the same time, administrators and physicians should seek ways to alleviate these harms.

Different types of medical errors are likely to require different solutions and preventive measures. Recommendations include steps to increase communication and improve interactions between healthcare professionals and patients, as well as steps patients should take to protect themselves. Healthcare provider groups should actively monitor their progress in improving medication safety by using computer systems that detect medication-related problems and audit prescriptions filled in community pharmacies.

Further, innovations in electronic health records and the secure exchange of medical information can help transform healthcare in America by improving quality, reducing costs, improving administrative efficiencies, reducing paperwork, and increasing access to affordable healthcare.

All of this is to say that technology--applied appropriately--may be one of our strongest allies in our quest to do our best for patients.