Summary
Objective: To summarize recent research on unintended consequences associated with
implementation and use of health information technology (health IT). Included in the
review are original empirical investigations published in English between 2014 and
2015 that reported unintended effects introduced by adoption of digital interventions.
Our analysis focuses on the trends of this steam of research, areas in which unintended
consequences have continued to be reported, and common themes that emerge from the
findings of these studies.
Method: Most of the papers reviewed were retrieved by searching three literature databases:
MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round
used more restrictive search terms specific to unintended consequences; the second
round lifted the restrictions to include more generic health IT evaluation studies.
Each paper was independently screened by at least two authors; differences were resolved
through consensus development.
Results: The literature search identified 1,538 papers that were potentially relevant;
34 were deemed meeting our inclusion criteria after screening. Studies described in
these 34 papers took place in a wide variety of care areas from emergency departments
to ophthalmology clinics. Some papers reflected several previously unreported unintended
consequences, such as staff attrition and patients’ withholding of information due
to privacy and security concerns. A majority of these studies (71%) were quantitative
investigations based on analysis of objectively recorded data. Several of them employed
longitudinal or time series designs to distinguish between unintended consequences
that had only transient impact, versus those that had persisting impact. Most of these
unintended consequences resulted in adverse outcomes, even though instances of beneficial
impact were also noted. While care areas covered were heterogeneous, over half of
the studies were conducted at academic medical centers or teaching hospitals. Conclusion:
Recent studies published in the past two years represent significant advancement of
unintended consequences research by seeking to include more types of health IT applications
and to quantify the impact using objectively recorded data and longitudinal or time
series designs. However, more mixed-methods studies are needed to develop deeper insights
into the observed unintended adverse outcomes, including their root causes and remedies.
We also encourage future research to go beyond the paradigm of simply describing unintended
consequences, and to develop and test solutions that can prevent or minimize their
impact.
Keywords
Unintended consequences - health information technology - patient safety - electronic
health records - medical order entry systems - Health Information Technology for Economic
and Clinical Health Act
