Summary
Introduction: The introduction of health information technology into clinical settings is associated
with unintended negative consequences, some with the potential to lead to error and
patient harm. As adoption rates soar, the impact of these hazards will increase.
Objective: Over the last decade, unintended consequences have received great attention in the
medical informatics literature, and this paper seeks to identify the major themes
that have emerged.
Results: Rich typologies of the causes of unintended consequences have been developed, along
with a number of explanatory frameworks based on socio-technical systems theory. We
however still have only limited data on the frequency and impact of these events,
as most studies rely on data sets from incident reporting or patient chart reviews,
rather than undertaking detailed observational studies. Such data are increasingly
needed as more organizations implement health information technologies. When outcome
studies have been done in different organizations, they reveal different outcomes
for identical systems. From a theoretical perspective, recent advances in the emerging
discipline of implementation science have much to offer in explaining the origin,
and variability, of unintended consequences.
Conclusion: The dynamic nature of health care service organizations, and the rapid development
and adoption of health information technologies means that unintended consequences
are unlikely to disappear, and we therefore must commit to developing robust systems
to detect and manage them.
Keywords
Safety - error - electronic health records - computer provider order entry - human-computer
interaction - incident reporting.
