Yearb Med Inform 2016; 25(01): 7-12
DOI: 10.15265/IY-2016-023
IMIA and Schattauer GmbH
Georg Thieme Verlag KG Stuttgart

New Unintended Adverse Consequences of Electronic Health Records

D. F. Sittig
1   University of Texas Health Science Center at Houston, School of Biomedical Informatics and UT-Memorial Hermann Center for Health Care Quality and Safety, Houston, TX, USA
A. Wright
2   Harvard Medical School and Brigham and Women’s Hospital, Department of Medicine, Boston, MA, USA
J. Ash
3   Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, Portland, OR, USA
H. Singh
4   Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
› Author Affiliations
Further Information

Publication History

10 November 2016

Publication Date:
06 March 2018 (online)


Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display.