Understanding Unintended Consequences and Health Information Technology

Summary

Objective: No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs.

Methods: A literature review was conducted for the period 2000-2015 using the search terms “unintended consequences” and “health information technology”. 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs.

Results: We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs.

Conclusions: While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues.

Keywords

Unintended consequences - health information technology - social - organizational

• References

• 1 Ash JS, Sittig DF, Dykstra RH, Guappone K, Carpenter JD, Seshadri V. Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inform 2007; 76 (01) S21-7.
• 2 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: 542-9.
• 3 Kuperman GJ, McGowan JJ. Potential Unintended Consequences of Health Information Exchange. J Gen Intern Med 2011; 28 (12) 1663-6.
• 4 Kushniruk AW, Triola MM, Borycki EM, Stein B, Kannry JL. Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application. Int J Med Inform 2005; 74 (07) 519-26.
• 5 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 (01) 82-90.
• 6 Melby L, Hellesø R. Introducing electronic messaging in Norwegian healthcare: Unintended consequences for interprofessional collaboration. Int J Med Inform 2014; 83 (05) 343-53.
• 7 Kuziemsky CE, Borycki E, Nøhr C, Cummings E. The nature of unintended benefits in health information systems. Stud Health Technol Inform 2012; 180: 896-900.
• 8 Smith SW, Koppel R. Healthcare information technology’s relativity problems: a typology of how patients’ physical reality, clinicians’ mental models, and healthcare information technology differ. J Am Med Inform Assoc 2014; 21: 117-31.
• 9 Scott P. Exploiting the information revolution: call for independent evaluation of the latest English national experiment. J Innov Health Inform 2015; 22 (01) 244-9.
• 10 Stead WW, Lin HS. (eds). Computational technology for effective health care. Washington, DC: National Academies Press; 2009
• 11 Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 17: 617-23.
• 12 Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform 2013; 82 (05) e73-86.
• 13 Lluch M. Healthcare professionals’ organisational barriers to health information technologies-a literature review. Int J Med Inform 2011; 80 (12) 849-62.
• 14 Kuziemsky CE. Review of social and organizational issues in health information technology. Healthc Inform Res 2015; 21 (03) 152-60.
• 15 Templier M, Paré G. A framework for guiding and evaluating literature reviews. Communications of the Association for Information Systems, 2015; 37 (06) 112-37.
• 16 Andersen PER, Jensen T. Evaluating an Electronic Patient Medicine Module Implementation in two Hospital Settings: an Occasion for new Types of Errors. In: Proceedings of the European Conference on Information Management and Evaluation. Academic Conferences Limited; 2007. P. 13-20.
• 17 Jensen TB. Can We Rely on Electronic Medical Record Systems to Reduce Medication Errors?. AMCIS 2010 Proceedings. Paper 353.
• 18 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: 104-12.
• 19 Ash JS, Sittig DF, Poon EG Guappone K, Campbell E, Dykstra R. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 4 (04) 415-23.
• 20 Bar-Lev S, Harrison MI. Localization of Health Information Technology: How Users ‘Repair’ Electronic Medical Systems?. 2005 Academy of Management 2005 Annual Meeting: A New Vision of Management in the 21st Century, AOM. 2005, 6 p.
• 21 Campion TR, Waitman LR, May AK, Ozdas A, Lorenzi NM, Gadd CS. Social, organizational, and contextual characteristics of clinical decision support systems for intensive insulin therapy: a literature review and case study. Int J Med Inform 2010; 9 (01) 31-43.
• 22 Holden RJ, Rivera-Rodriguez AJ, Faye H Scanlon MC, Karsh BT. Automation and adaptation: nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cogn Technol Work 2013; 15 (03) 283-96.
• 23 Nanji KC, Rothschild JM, Boehne JJ, Keohane CA, Ash JS, Poon EG. Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. J Am Med Inform Assoc 2014; 21: 481-6.
• 24 Novak L, Brooks J, Gadd C, Anders S, Lorenzi N. Mediating the intersections of organizational routines during the introduction of a health IT system. Europ J Inf Syst 2012 21(5).
• 25 Novak LL, Anders S, Gadd CS, Lorenzi NM. Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation. J Am Med Inform Assoc 2012; 19 (06) 1043-4049.
• 26 Novak LL, Holden RJ, Anders SH, Hong JY, Karsh B-T. Using a sociotechnical framework to understand adaptations in health IT implementation. Int J Med Inform 2013; 82 (12) e331-e344.
• 27 Quan SD, Wu RC, Rossos PG, Arany T, Groe S, Morra D. et al. It’s not about pager replacement: An in-depth look at the interprofessional nature of communication in healthcare. J Hosp Med 2013; Mar;8 (03) 137-43.
• 28 Scott-Cawiezell J, Madsen RW, Pepper GA, Vogelsmeier A, Petroski G, Zellmer D. Medication safety teams’ guided implementation of electronic medication administration records in five nursing homes Jt Comm. J Qual Patient Saf 2009; 35: 29-35.
• 29 Sherer SA, Meyerhoefer CD, Sheinberg M, Levick D. Integrating commercial ambulatory electronic health records with hospital systems: An evolutionary process. Int J Med Inform 2015; Sep;84 (09) 683-93.
• 30 Wong MC, Cummings E, Turner P. User-centered design in clinical handover: Exploring post-implementation outcomes for clinicians. Stud Health Technol Inform 2013; 192 1-2 253-7.
• 31 Wu R, Appel L, Morra D, Lo V, Kitto S, Quan S. Short message service or disService: Issues with text messaging in a complex medical environment. Int J Med Inform 2014; 83: 278-84.
• 32 Borycki EM, Kushniruk AW, Bellwood P, Brender J. Technology-induced Errors. Methods Inf Med 2012; 51 (02) 95-103.
• 33 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I. Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
• 34 Nilsson F, Darley V. On complex adaptive systems and agent-based modelling for improving decision-making in manufacturing and logistics settings: Experiences from a packaging company. International Journal of Operations and Production Management. 2006; 26 (12) 1351-73.
• 35 Zhou Y, Ancker JS, Upadhye M, McGeorge NM, Guarrera TK, Hegde S. et al. The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study. Inform Prim Care 2013; 21 (01) 21-9.
• 36 Borycki EM, Kushniruk AW, Carvalho CJ, Kuo MH. A systematic review of qualitative and quantitative methods used to identify and study technology-induced errors in computerized physician order entry (CPOE). Asia Pacific Association for Medical Informatics (APAMI) 2009; November 22-26: 32-7.