At many practices, the economy has forced doctors to make stark choices as their patients find it harder to pay for care.

As the number of uninsured Americans spiked in 2009, physicians began offering new payment options, networking with other doctors to boost referrals, and accepting more Medicaid and uninsured patients. Doctors say they're spending more time helping patients who can't afford prescriptions, tests and other needed care.

The uninsured population reached 50.7 million in 2009, according to Census Bureau estimates released Sept. 16 -- the largest number since 1987, when the Census began its current method of estimating the uninsured.

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An electronic nearly hard-stop alert as part of an inpatient computerized physician order entry (CPOE) system seemed to be extremely effective in changing prescribing but resulted in clinically important treatment delays in some patients, according to the results of a randomized controlled trial reported in today's issue of the Archives of Internal Medicine.

"The effectiveness of [CPOE] systems has been modest, largely because clinicians frequently override electronic alerts," write Brian L. Strom, MD, MPH, from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues. "When soft order alerts appear on the computer screen, clinicians are alerted about potential problems associated with the particular prescription order and are presented with alternative treatments available for consideration. In contrast, when hard stop-order alerts appear on the screen, the clinician's order is blocked from further execution to avert potentially serious reactions."

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