Abstract
In this chapter, we highlight unexpected outcomes created by technology use in clinical settings. We define unintended consequences as both positive serendipitous results as well as negative, unintended, and potentially harmful consequences of technology in use. A review of different classification systems for studying the unanticipated impacts of health information technology (HIT) is followed by specific examples from the use of electronic health records (EHR). EHR systems are one example of how even well-designed technology can yield unexpected results. Although HIT such as EHRs has the potential to improve care by reducing the burden placed on its users, it can also increase memory demands, alter communication channels, and provoke sub-optimal decision-making. This can lead to errors, inefficiencies in workflows, overdependence on technology and, importantly, risk to patients. By understanding the impact of technology on performance we can potentially manage the negative unintended consequences engendered by HIT systems allowing such systems to function as expected. Additionally, by understanding unanticipated beneficial outcomes, we can promote the development of future tools that further induce positive results.
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- 1.
CPOE is often the HIT component under study given its rich and tangible connection between design and potential safety events such as medication errors.
- 2.
This case has additional complications regarding the appropriateness of sulfonamide allergies. Please see the original publication for details.
- 3.
In line with Hollnagel and Woods, all performance, or work, in healthcare is considered cognitive, from procedures to decision-making, including the cognitive processes of mental, physical, social, and behavioral activities.
Additional Readings
Bloomrosen, M., Starren, J., Lorenzi, N., Ash, J. S., Patel, V. L., & Shortliffe, E. (2011). Anticipating and addressing the unintended consequences of health IT and policy: A report from the AMIA 2009 Health Policy Meeting. Journal of the American Medical Informatics Association, 18(1), 9.
Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R. J., et al. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14–25.
Harrison, M. I., Koppel, R., & Bar-Lev, S. (2007). Unintended consequences of information technologies in health care an interactive sociotechnical analysis. Journal of the American Medical Informatics Association, 14, 542e9.
Patel, V. L., & Kannampallil, T. G. (2014). Human factors and health information technology: Current challenges and future directions. International Medical Informatics Association (IMIA) Yearbook of Medical Informatics, 58–66.
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Franklin, A. (2015). The Unintended Consequences of the Technology in Clinical Settings. In: Patel, V.L., Kannampallil, T.G., Kaufman, D.R. (eds) Cognitive Informatics for Biomedicine. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-319-17272-9_11
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