COMPUTERS AND PRODUCTIVITY - IS IT TIME FOR A REALITY CHECK

Many clinicians and administrators in academic medical centers have ea gerly embraced the idea of a comprehensive computer-based patient reco rd (CPR), and either are contemplating implementing such a system or h ave 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 potentia l will not be realized because of poor implementation, poor organizati on, or excessive and unanticipated costs. Given the high stakes associ ated with CPR implementations, it is important that medical centers mo ve more cautiously, always asking the question ''What if these systems do not work?'' The author of this article considers worst-case scenar ios of CPR deployment as well as evidence from industry and government that undermines claims that CPR deployment will inevitably confer gre ater productivity and efficiency. He challenges readers to think hard about the cost - benefit ratios of both CRP systems and paper-based sy stems, and to commit to an institutional ''bill of rights'' before for ging ahead with CPR deployment.