Drs. Murff and Kannry reply

Dr. Patterson's letter was greatly appreciated and reinforces the major arguments in our paper: that not all order entry systems are created equal and that user satisfaction is important to the acceptance of order entry systems and must be assessed after system implementation.1

Mount Sinai's decision to purchase and implement a computerized physician order entry (CPOE) system was made in the early 1990s. An appropriate system selection committee was formed and reviewed many available proprietary CPOE systems. On the basis of the committee's recommendations, Mount Sinai then chose the CPOE system, a system that other major institutions at that time had either selected or implemented. The committee did have prior knowledge about the available literature assessing CPOE systems, and, as a result, steps were undertaken to carefully implement the system. Thus implementation of our system was performed with few of the problems described by Massaro.1 2

As previously mentioned, user feedback is paramount to the development of a usable system. In our study, we gathered qualitative and quantitative data, which is now the basis for a redesign effort of the Mount Sinai CPOE system. We intend to measure how these new changes will influence physician acceptance of the system. It is our belief that user satisfaction will improve through the incorporation of this feedback into the system's user interface.

All CPOE systems are not equal. Although inefficient proprietary systems do exist, this is no reflection on medical informatics. Instead, the fact that poorly designed systems exist should emphasize the importance of the specialty of medical informatics in collecting and utilizing user feedback to help design and redesign CPOE systems that are highly usable and therefore accepted by clinicians.—HARVEY J. MURFF, MD, AND JOSEPH KANNRY, MD