Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.15265/IY-2016-048
Unintended Consequences: New Problems, New Solutions
Contributions From 2015Correspondence to:
Publication History
10 November 2016
Publication Date:
06 March 2018 (online)
Summary
Objective: To select the best of the 2015 published papers on unintended consequences of healthcare information technology (HIT).
Method: Literature searches in several areas of scholarship, including IT, human factors, evaluation studies, medical errors, medical informatics, and implementation science. Also, because the specific terms “unintended consequences” were not often included in abstracts and titles, a more nuanced search algorithm was developed.
Results: We identified 754 papers that had some empirical research on unintended consequences of HIT. An initial screen of titles and abstracts reduced this to 171 papers of potential interest. We then further filtered out papers that did not meet the following criteria: 1) the paper had to report an original empirical investigation, and 2) the impact reported had to be not negligible, i.e., in quantitative studies, the results related to unintended consequences were statistically significant; and in qualitative studies the relevant themes emerged were prominent. This resulted in 33 papers of which 15 were selected as best paper candidates. Each of these 15 papers was then separately evaluated by four reviewers. The final selection of four papers was made jointly by the external reviewers and the two section editors. Conclusions: There is a growing awareness of the importance of HIT’s unintended consequences—be they generated by the HIT vendors, the implementation process, the consultants, the users, or most probably, some combination of the above. There has also been greater creativity in use of data sources, including secondary data (e.g., medical malpractice cases and surveys) and a wider acceptance of mixed methods to identify unintended consequences. Unfortunately, the complexity of causes mitigates the value of recommendations to avoid unwanted outcomes. Suggestions are often contentious rather than obvious, setting-specific, and not universally applicable. “Lessons learned” often take on generalized—and perhaps platitudinous—forms, such as: “plan extra time,” “involve all of the stakeholders,” “recognize the different needs of different units or disciplines.” The greater awareness of these problems, and the increased desire to identify and eliminate them is clearly reflected in the area’s growing literature. We are hopeful the topic will receive additional attention and the discipline will improve its ability to identify and address these unexpected and usually adverse outcomes.
#
Keywords
Medical informatics - adverse events - International Medical Informatics Association - yearbook - unintended consequences
#
-
References
- 1 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors.. J Am Med Inform Assoc 2004; 11 (Suppl. 02) 104-12.
- 2 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors.. JAMA 2005; 293 (Suppl. 010) 1197-203.
- 3 Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC. et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.. Pediatrics 2005; 116 (Suppl. 06) 1506-12.
- 4 Chaudhry B. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care.. Ann Intern Med 2006; 144 (Suppl. 010) 742-52.
- 5 Nebeker JR, Hoffman JM, Weir CR, Bennett CL, Hurdle JF. High rates of adverse drug events in a highly computerized hospital. High rates of adverse drug events in a highly computerized hospital.. Arch Intern Med 2005; 165 (Suppl. 010) 1111-6.
- 6 Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review.. JAMA 2005; 293 (Suppl. 010) 1223-38.
- 7 Bloomrosen M, Starren J, Lorenzi NM, Ash JS, Patel VL, Shortliffe EH. Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.. J Am Med Inform Assoc 2011; 18 (Suppl. 01) 82-90.
- 8 Zheng K, Abraham J, Novak LL, Reynolds TL, Gettinger A. A survey of the literature on unintended consequences associated with health information technology: 2014-2015.. Yearb Med Inform 2016 (manuscript under review).
- 9 Harrison MI, Koppel R, Bar-Lev S. Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis.. J Am Med Inform Assoc 2007; 14 (Suppl. 05) 542-9.
- 10 Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE. et al. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.. Clin Infect Dis 2008; Sep 15 47 (Suppl. 06) 747-53.
- 11 Koppel R, Lehmann CU. Implications of an emerging EHR monoculture for hospitals and healthcare systems.. J Am Med Inform Assoc 2015; Mar 22 (Suppl. 02) 465-71.
- 12 Grémy F. Hardware, software, peopleware, subjectivity.. A philosophical promenade Methods Inf Med 2005; 44 (Suppl. 03) 352-8.
- 13 Pirnejad H, Bal R, Shahsavar N. The nature of unintended effects of health information systems concerning patient safety: a systematic review with thematic synthesis.. Stud Health Technol Inform 2010; 160 (Suppl. 01) 719-23.
- 14 Carling CL, Kirkehei I, Dalsbø TK, Paulsen E. Risks to patient safety associated with implementation of electronic applications for medication management in ambulatory care—a systematic review.. BMC Med Inform Decis Mak 2013; 13: 133.
- 15 Voshall B, Piscotty R, Lawrence J, Targosz M. Barcode medication administration work-arounds: a systematic review and implications for nurse executives.. J Nurs Adm 2013; 43 (Suppl. 010) 530-5.
- 16 Gephart S, Carrington JM, Finley B. A systematic review of nurses’ experiences with unintended consequences when using the electronic health record.. Nurs Adm Q 2015; 39 (Suppl. 04) 345-56.
- 17 Marcilly R, Ammenwerth E, Roehrer E, Pelayo S, Vasseur F, Beuscart-Zéphir MC. Usability flaws in medication alerting systems: impact on usage and work system.. Yearb Med Inform 2015; 10 (Suppl. 01) 55-67.
- 18 Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley L, Westbrook J. The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times: A mixed method study.. Appl Clin Inform 2015; 6 (Suppl. 03) 443-53.
- 19 Cifuentes M, Davis M, Fernald D, Gunn R, Dickinson P, Cohen DJ. Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.. J Am Board Fam Med 2015; 28 (Suppl. 01) S63-S72.
- 20 Fitzpatrick G. Integrated Care and the Working Record.. Health Informatics Journal 2004; 10 (Suppl. 04) 291-302.
- 21 Hardey M, Payne S, Coleman P. ‘Scraps’: Hidden nursing information and its influence on the delivery of care.. JAdv Nurs 2000; 32 (Suppl. 01) 208-14.
- 22 Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic Health Record-Related Events in Medical Malpractice Claims.. J Patient Saf 2015 Nov 6.
- 23 Campos-Castillo C, Anthony DL. The double-edged sword of electronic health records: implications for patient disclosure.. J Am Med Inform Assoc 2015; 22 (Suppl. 01) e130-e140.
- 24 Bossen C, Groth JL, Witt F. Medical secretaries’ care of records: the cooperative work of a non-clinical group.. In: Proceedings of Computer-Supported Cooperative Work; 2012 p. 921-30.
- 25 Holten Møller NL, Vikkelsø S. The Clinical Work of Secretaries: Exploring the Intersection of Administrative and Clinical Work in the Diagnosing Process.. In: Dugdale J.C, Masclet MA, Grasso JF, oujut P. Hassanaly, editors. From Research to Practice in the Design of Cooperative Systems: Results and Open Challenges. London: Springer; 2012. p. 33-47.
Correspondence to:
-
References
- 1 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors.. J Am Med Inform Assoc 2004; 11 (Suppl. 02) 104-12.
- 2 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors.. JAMA 2005; 293 (Suppl. 010) 1197-203.
- 3 Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC. et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.. Pediatrics 2005; 116 (Suppl. 06) 1506-12.
- 4 Chaudhry B. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care.. Ann Intern Med 2006; 144 (Suppl. 010) 742-52.
- 5 Nebeker JR, Hoffman JM, Weir CR, Bennett CL, Hurdle JF. High rates of adverse drug events in a highly computerized hospital. High rates of adverse drug events in a highly computerized hospital.. Arch Intern Med 2005; 165 (Suppl. 010) 1111-6.
- 6 Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review.. JAMA 2005; 293 (Suppl. 010) 1223-38.
- 7 Bloomrosen M, Starren J, Lorenzi NM, Ash JS, Patel VL, Shortliffe EH. Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.. J Am Med Inform Assoc 2011; 18 (Suppl. 01) 82-90.
- 8 Zheng K, Abraham J, Novak LL, Reynolds TL, Gettinger A. A survey of the literature on unintended consequences associated with health information technology: 2014-2015.. Yearb Med Inform 2016 (manuscript under review).
- 9 Harrison MI, Koppel R, Bar-Lev S. Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis.. J Am Med Inform Assoc 2007; 14 (Suppl. 05) 542-9.
- 10 Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE. et al. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.. Clin Infect Dis 2008; Sep 15 47 (Suppl. 06) 747-53.
- 11 Koppel R, Lehmann CU. Implications of an emerging EHR monoculture for hospitals and healthcare systems.. J Am Med Inform Assoc 2015; Mar 22 (Suppl. 02) 465-71.
- 12 Grémy F. Hardware, software, peopleware, subjectivity.. A philosophical promenade Methods Inf Med 2005; 44 (Suppl. 03) 352-8.
- 13 Pirnejad H, Bal R, Shahsavar N. The nature of unintended effects of health information systems concerning patient safety: a systematic review with thematic synthesis.. Stud Health Technol Inform 2010; 160 (Suppl. 01) 719-23.
- 14 Carling CL, Kirkehei I, Dalsbø TK, Paulsen E. Risks to patient safety associated with implementation of electronic applications for medication management in ambulatory care—a systematic review.. BMC Med Inform Decis Mak 2013; 13: 133.
- 15 Voshall B, Piscotty R, Lawrence J, Targosz M. Barcode medication administration work-arounds: a systematic review and implications for nurse executives.. J Nurs Adm 2013; 43 (Suppl. 010) 530-5.
- 16 Gephart S, Carrington JM, Finley B. A systematic review of nurses’ experiences with unintended consequences when using the electronic health record.. Nurs Adm Q 2015; 39 (Suppl. 04) 345-56.
- 17 Marcilly R, Ammenwerth E, Roehrer E, Pelayo S, Vasseur F, Beuscart-Zéphir MC. Usability flaws in medication alerting systems: impact on usage and work system.. Yearb Med Inform 2015; 10 (Suppl. 01) 55-67.
- 18 Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley L, Westbrook J. The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times: A mixed method study.. Appl Clin Inform 2015; 6 (Suppl. 03) 443-53.
- 19 Cifuentes M, Davis M, Fernald D, Gunn R, Dickinson P, Cohen DJ. Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.. J Am Board Fam Med 2015; 28 (Suppl. 01) S63-S72.
- 20 Fitzpatrick G. Integrated Care and the Working Record.. Health Informatics Journal 2004; 10 (Suppl. 04) 291-302.
- 21 Hardey M, Payne S, Coleman P. ‘Scraps’: Hidden nursing information and its influence on the delivery of care.. JAdv Nurs 2000; 32 (Suppl. 01) 208-14.
- 22 Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic Health Record-Related Events in Medical Malpractice Claims.. J Patient Saf 2015 Nov 6.
- 23 Campos-Castillo C, Anthony DL. The double-edged sword of electronic health records: implications for patient disclosure.. J Am Med Inform Assoc 2015; 22 (Suppl. 01) e130-e140.
- 24 Bossen C, Groth JL, Witt F. Medical secretaries’ care of records: the cooperative work of a non-clinical group.. In: Proceedings of Computer-Supported Cooperative Work; 2012 p. 921-30.
- 25 Holten Møller NL, Vikkelsø S. The Clinical Work of Secretaries: Exploring the Intersection of Administrative and Clinical Work in the Diagnosing Process.. In: Dugdale J.C, Masclet MA, Grasso JF, oujut P. Hassanaly, editors. From Research to Practice in the Design of Cooperative Systems: Results and Open Challenges. London: Springer; 2012. p. 33-47.