The Unintended Consequences of the Technology in Clinical Settings

This chapter highlights unexpected outcomes created by technology use in clinical settings. We define unintended consequences, including 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), patient portals, and telemedicine. EHR systems exemplify how even well-designed technology can yield unexpected results. Although HIT 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, patient risk. 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.