Information technology promises many benefits but is not without limitations and pitfalls. Physicians must learn about these to develop realistic expectations, maximize benefit, ensure patient safety, and avoid potentially catastrophic perils.

Potential and real benefits of the electronic health record (EHR) include improved quality of care, cost savings, higher productivity, and easier aggregation and analysis of health data. Specific benefits include providing rapid access to integrated clinical data and extant medical knowledge, improving communication and adherence to clinical guidelines, and decreasing some medical errors. The EHR can also facilitate research, education, quality improvement, outcomes assessment, and strategic planning.

While electronic prescribing can reduce certain types of medication errors, it can also increase the rates of other errors and facilitate new types of errors. The medical information space is vastly more complicated than is often appreciated, and EHR software programs are enormously complex. Implementation requires tremendous effort by both clinicians and technical specialists to configure these systems according to the specific needs of an institution and in ways that will enhance care rather than impede it. Technology does not simply replace paper; it also reengineers care—deliberately or not.

Clinical decision support systems (DSSs) help clinicians make better decisions by providing timely, relevant information or by otherwise improving cognitive performance. Passive systems are activated when clinicians request help such as reference material, automated calculations, or data review. Active systems include alerts and reminders that are triggered by preprogrammed rules governing specific circumstances. Clinical DSS seems most effective when reminders are generated automatically, but this may result in “alert overload,” a real and significant problem.

Human-machine interfaces designed to enhance cognitive performance can be viewed as decision support, particularly for the data-intense critical care unit. More attention must be devoted to developing information-priority, taskspecific, and hypothesis-driven displays. Well-designed displays can significantly reduce task load and time to task completion while reducing errors of cognition.

Telemedicine can be used to ensure equitable access to expert medical care in remote and underserved areas, provide remote patient and provider education, reduce travel requirements, improve patient care, and reduce costs. The application of telemedicine in ICUs can allow off-site intensivists to monitor and care for more ICU

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