Computers and productivity: is it time for a reality check?

Many clinicians and administrators in academic medical centers have eagerly embraced the idea of a comprehensive computer-based patient record (CPR), and either are contemplating implementing such a system or have already begun implementing one. Most believe that CPR systems will lead to greater productivity and clinical efficiency, and ultimately to better patient outcomes at lower cost. But there is a gamble in all of this. It is possible that in some settings a CPR system's potential will not be realized because of poor implementation, poor organization, or excessive and unanticipated costs. Given the high stakes associated with CPR implementations, it is important that medical centers move more cautiously, always asking the question "What if these systems do not work?" The author of this article considers worst-case scenarios of CPR deployment as well as evidence from industry and government that undermines claims that CPR deployment will inevitably confer greater productivity and efficiency. He challenges readers to think hard about the cost-benefit ratios of both CPR systems and paper-based systems, and to commit to an institutional "bill of rights" before forging ahead with CPR deployment.