I grew up listening and watching waves break along the shores of Nova Scotia. But it was not until I actually ventured out into the cold Atlantic water that I realized the power and forces of change that were working below the surface. As a physician, the same can be said about my decade long experience with physician order entry (POE). There have been moments when I have wondered if the wave will ever break, hoping for the time when this powerful tool would become ubiquitous in clinical practice. There have been moments when I have seen the forces of POE change medical practice for the better, helping ensure safer, faster and more efficient delivery of care. And there have been moments when I have seen the wave crash violently, causing chaos, frustration and harm. Yet I remain absolutely convinced that without POE, pursuit of the electronic patient record (EPR) is simply a bad idea, a poor use of technology and a tool of limited value, with a questionable return on investment.

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