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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Our primary intent was to expand discussions about CPOE systems to more balanced analyses. CPOE systems will be central components of health care systems and a more judicious view of their potential weaknesses can only strengthen them.

As several letters noted, the CPOE system we studied was old and has since been replaced. However, it represents a widely used system that was continually updated and improved, even during its tenure at the hospital; it was not a historical artifact from the 1990s. Regardless, the question of whether our new system (or any other) has addressed the concerns raised in our article requires empirical investigation. As part of our ongoing work, we are now studying this newer system in actual practice rather than in the design laboratory. Our article focused on the problems of systems integration, clinical and organizational workflow, unanticipated responses (side effects) to enhancements, and human-machine interfaces. . . . [Full Text of this Article]

Ross Koppel, PhD
rkoppel@sas.upenn.edu
Center for Clinical Epidemiology and Biostatistics

Joshua P. Metlay, MD, PhD
Department of Medicine (General Medicine Division)

Abigail Cohen, PhD; A. Russell Localio, JD, MPH, MS; Brian L. Strom, MD, MPH
Department of Biostatistics and Epidemiology
University of Pennsylvania School of Medicine
Philadelphia

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