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First published March 13, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2385
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J Am Med Inform Assoc. 2007;14:389. DOI 10.1197/jamia.M2385.
© 2007 American Medical Informatics Association

In reply

In reply to: "e-Iatrogenesis: The most critical consequence of CPOE and other HIT"

Emily M. Campbell, RN, MSa, Dean F. Sittig, PhDa,b, Joan S. Ash, PhDa,*, Kenneth P. Guappone, MDa and Richard H. Dykstra, MDa,c

a Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
b Department of Medical Informatics, Northwest Permanente, P.C., Portland, OR
c Kaiser Sunnyside Medical Center, Portland, OR

* Correspondence and reprints: Joan Ash, Ph.D., Department of Medical Informatics and Clinical Epidemiology, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098 (Email: ash{at}ohsu.edu).

Received for publication: 01/24/07; accepted for publication: 02/08/07.

We agree with Weiner et al. that adoption of the term "e-Iatrogenesis"1 is both timely and necessary as we begin to identify what we have called "new kinds of errors"2 resulting from CPOE implementation. The computerization of clinical information capture with software tools such as CPOE will doubtlessly cause the emergence of a wide variety of new kinds of errors: "e-Iatrogenesis" provides a clear and concise rubric for these unintended and undesired consequences.

In mid-December, 2006, the London Times reported on the inadvertent prescription of Viagra to a set of patients in the United Kingom.3 This error occurred when general practitioners using the UK’s National Health Service "e-Formulary" attempted to prescribe "Zyban" (a medication commonly used to assist patients in smoking cessation). The system mistakenly selected "sildenafil" (the generic name for Viagra) instead. A spokesperson for the NHS denied that any untoward effects had resulted, and that immediate steps had been taken to rectify the error, including notifying over 900 practitioners at more than 300 clinics warning them of the potential problem for their patients.

e-Iatrogenesis may have several causes. The example from the UK could have arisen from a poorly defined interface (where, for example, auto-completion could have selected the wrong item from a pick list), a programming error within the e-Formulary system, or poor end-user training or experience. Regardless of the cause, it is imperative that we acknowledge both the potential for and occurrence of these errors and work to prevent them or quickly correct them when they are identified.

We note that e-Iatrogenesis may not be the most important type of unintended adverse consequence related to CPOE in the view of all stakeholders impacted by CPOE. As a patient, e-Iatrogenesis might be the biggest concern. However, to a physician it might be more work and new work, for a nurse it might be communication, and as an information technology leader, it might be never ending demands related to the technology. It all depends on one’s perspective.

We applaud the authors on their coinage of the term and concur that adopting this term will help all of us focus more clearly on this significant issue.


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  1. Weiner JP, Kfuri T, Chan K, Fowles JB. e-Iatrogenesis: The most critical unintended consequence of CPOE and other HIT[Letter to the editor] J Am Med Inform Assoc 2007;14:387-388.[Free Full Text]
  2. Campbell EM, Sittig DF, Ash J, Guappone K, Dykstra R. Types of unintended consequences related to computerized order entry J Am Med Inform Assoc 2006;13:547-556.[Abstract/Free Full Text]
  3. Lister D. The Latest Smoking Cure: Viagra. Times Online. 2007Available at: http://www.timesonline.co.uk/article/0,8122-2502175.html. Accessed January 8.



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This Article
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