Unintended Adverse Consequences of Health IT Implementation: Workflow Issues and Their Cascading Effects

The implementation of health information technology (IT) in clinical settings can introduce adverse effects to workflow, such as new or increased work, interruptions and distractions, delays or inefficiencies, duplicated work practices, and changed or disrupted communication. These adverse effects, if not managed properly, can result in increased clinician cognitive load and escalated patient safety risks. In this chapter, we summarize the literature on unintended adverse consequences of health IT related to clinical workflow. Based on prior research, we categorize these effects as primary and secondary unintended consequences to conceptualize the workflow issues and their cascading effects. By considering workflow issues as primary consequences and beginning to unpack the complex relationship between these issues and their impact on clinical work, we can better anticipate and address the adverse effects associated with health IT implementation.

[1]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[2]  Ronald Piscotty,et al.  Barcode Medication Administration Work-Arounds: A Systematic Review and Implications for Nurse Executives , 2013, The Journal of nursing administration.

[3]  Aziz Sheikh,et al.  A Qualitative Exploration of Workarounds Related to the Implementation of National Electronic Health Records in Early Adopter Mental Health Hospitals , 2014, PloS one.

[4]  Farah Magrabi,et al.  Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review , 2017, J. Am. Medical Informatics Assoc..

[5]  Ram D. Sriram,et al.  Workflow and electronic health records in small medical practices. , 2010, Perspectives in health information management.

[6]  Eric G. Poon,et al.  Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy , 2014, J. Am. Medical Informatics Assoc..

[7]  A. Sheikh,et al.  Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals , 2016, BMJ Quality & Safety.

[8]  D. Coplen.  Types of Unintended Consequences Related to Computerized Provider Order Entry , 2007 .

[9]  Constance M. Johnson,et al.  Safety Issues Related to the Electronic Medical Record (EMR): Synthesis of the Literature from the Last Decade, 2000‐2009 , 2011, Journal of healthcare management / American College of Healthcare Executives.

[10]  Joanna Abraham,et al.  Unintended Consequences of EHR Systems: A Narrative Review , 2017 .

[11]  Madhu C. Reddy,et al.  Privacy practices in collaborative environments: a study of emergency department staff , 2014, CSCW.

[12]  D. Maslove,et al.  Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature , 2011, Journal of intensive care medicine.

[13]  Raj M. Ratwani,et al.  Implications of electronic health record downtime: an analysis of patient safety event reports , 2018, J. Am. Medical Informatics Assoc..

[14]  Wardah Zainal Abidin,et al.  A SYSTEMATIC LITERATURE REVIEW ON SAFE HEALTH INFORMATION TECHNOLOGY USE BEHAVIOUR , 2016 .

[15]  D. Kashiwagi,et al.  All CLEAR? Preparing for IT Downtime , 2017, American journal of medical quality : the official journal of the American College of Medical Quality.

[16]  Joan S. Ash,et al.  An Unintended Consequence of CPOE Implementation: Shifts in Power, Control, and Autonomy , 2006, AMIA.

[17]  Yunan Chen,et al.  Privacy management in dynamic groups: understanding information privacy in medical practices , 2013, CSCW.

[18]  Jane M Carrington,et al.  Validity and Reliability of a New Measure of Nursing Experience With Unintended Consequences of Electronic Health Records , 2016, Computers, informatics, nursing : CIN.

[19]  Jane M Carrington,et al.  A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record , 2015, Nursing administration quarterly.

[20]  Monica Chiarini Tremblay,et al.  A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. , 2016, Research in social & administrative pharmacy : RSAP.

[21]  Robert C. Wu,et al.  Research and applications: The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals , 2013, J. Am. Medical Informatics Assoc..

[22]  Dean F. Sittig,et al.  Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care , 2016, Appl. Clin. Inform..

[23]  Chia-An Chao,et al.  The impact of electronic health records on collaborative work routines: A narrative network analysis , 2016, Int. J. Medical Informatics.

[24]  Samson W. Tu,et al.  Patient Safety in Guideline-Based Decision Support for Hypertension Management: ATHENA DSS , 2002, J. Am. Medical Informatics Assoc..

[25]  Suzanne Bakken,et al.  Approaches to Workflow Analysis in Healthcare Settings , 2012, Nursing Informatics.

[26]  N. Menachemi,et al.  Benefits and drawbacks of electronic health record systems , 2011 .

[27]  Vimla L. Patel,et al.  Technology for Emergency Care: Cognitive and Workflow Considerations , 2006, AMIA.

[28]  Thu-Trang T. Hickman,et al.  Computerised prescribing for safer medication ordering: still a work in progress , 2015, BMJ Quality & Safety.

[29]  Kai Zheng,et al.  Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective , 2010, J. Am. Medical Informatics Assoc..

[30]  Ann Shepard.  Disaster Recovery and the Electronic Health Record , 2017, Nursing administration quarterly.

[31]  Arun Vishwanath,et al.  The impact of electronic medical record systems on outpatient workflows: A longitudinal evaluation of its workflow effects , 2010, Int. J. Medical Informatics.

[32]  Bart van den Hooff,et al.  Mobile devices in the operating room: Intended and unintended consequences for nurses’ work , 2016, Health Informatics J..

[33]  Joan S. Ash,et al.  Research Paper: Types of Unintended Consequences Related to Computerized Provider Order Entry , 2006, J. Am. Medical Informatics Assoc..

[34]  Vimla L. Patel,et al.  The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care , 2007, Int. J. Medical Informatics.

[35]  Marc Berg,et al.  Review Paper: The Impact of Computerized Provider Order Entry Systems on Inpatient Clinical Workflow: A Literature Review , 2009, J. Am. Medical Informatics Assoc..

[36]  C. Kuziemsky,et al.  Understanding Unintended Consequences and Health Information Technology , 2016, Yearbook of Medical Informatics.

[37]  Roland Bal,et al.  The nature of unintended effects of health information systems concerning patient safety: A systematic review with thematic synthesis , 2010, MedInfo.

[38]  Madhu C. Reddy,et al.  Designing for privacy management in hospitals: Understanding the gap between user activities and IT staff's understandings , 2015, Int. J. Medical Informatics.

[39]  Po-Yin Yen,et al.  Understanding and Visualizing Multitasking and Task Switching Activities: A Time Motion Study to Capture Nursing Workflow , 2016, AMIA.

[40]  Enrico Coiera,et al.  Technology, cognition and error , 2015, BMJ Quality & Safety.

[41]  Jennifer Lai,et al.  Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis , 2007 .

[42]  Bart van den Hooff,et al.  Dealing with Dissonance: Misfits between an EHR System and Medical Work Practices , 2017, ICIS.

[43]  Vimla L. Patel,et al.  Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting , 2011, J. Am. Medical Informatics Assoc..

[44]  Joan S. Ash,et al.  Research Paper: Emotional Aspects of Computer-based Provider Order Entry: A Qualitative Study , 2005, J. Am. Medical Informatics Assoc..

[45]  Douglas H. Fernald,et al.  Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care , 2015, The Journal of the American Board of Family Medicine.

[46]  Elske Ammenwerth,et al.  Usability flaws of medication-related alerting functions: A systematic qualitative review , 2015, J. Biomed. Informatics.