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To the Editor: Dr Koppel and colleagues¹ discuss errors that may have occurred as residents, using a CPOE system, chose from preset prescribing templates, sometimes overlooking specific patient needs. My experience in an academic internal medicine residency program suggests that CPOE may also detract from physician development when trainees rely on preset orders in lieu of carefully considering treatment decisions.

In hospitalized patients, there are numerous widely recognized indications for anticoagulation, but with inherent risks and challenges. In an attempt to minimize physician error, a heparin sliding scale has been incorporated into our CPOE system. Once a patient is identified, the heparin algorithm can be instantly selected and signed. The order becomes activated by the bedside nurse, who proceeds to adjust the rate of infusion as directed, checking periodic partial thromboplastin times and notifying a physician only in the event of a critical laboratory value. Thus a complex process, fraught . . . [Full Text of this Article]

Steven M. Hegedus, MD
hegedus-1@medctr.osu.edu
Internal Medicine Residency Training Program
The Ohio State University
Columbus