Developing a Guide to Identifying and Remediating Unintended Consequences of Implementing Health Information Technology

While there are many benefits to the use of electronic health records (EHRs), implementing them can have unanticipated and undesirable consequences, referred to as "unintended consequences." Because health care environments are highly complex, the technologies used within them are also by necessity complex. This intersection of complex environments and technologies creates subtle unintended consequences when EHRs are implemented. These result from interactions between the EHR and the health care work environment and between the EHR and the technical and physical infrastructure. Because unintended consequences can undermine provider acceptance, increase costs, lead to failed implementations, and even result in harm to patients, it is important that they are understood and mitigated. This project developed a guide on how to avoid, understand, identify, and remediate unintended consequences of implementing health information technology.

Content for the guide was based on the literature, practice-oriented guides for EHR implementation and use, research conducted by the project team, and interviews with organizations that recently implemented EHRs. Content was targeted to the full range of health care organizations, from solo physician practices to large hospital systems. Users of the guide are expected to be EHR implementers including chief information officers, directors of clinical informatics, EHR champions or "super users," administrators, information technology specialists, and clinicians involved in EHR implementation. Users of EHRs, such as physicians and nurses, may also find the guide useful.

The main objectives of the project were to:

• Synthesize the existing knowledge on types and causes of unintended consequences and strategies to avoid or address undesired consequences.
• Develop the draft version of the guide and instructions for its use.
• Pilot test the guide at three additional sites to assess its usability and usefulness.
• Revise the guide and disseminate final version in a Web-accessible format through several methods.

The guide is organized in three primary sections: Avoid Unintended Consequences; Understand and Identify Unintended Consequences; and Remediate Unintended Consequences. Case examples and tools are presented throughout the guide to aid users in understanding the issues, and having access to the tools to avoid, identify, and remediate the unintended consequences within their own organizations.