A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

Journal: IMIA Yearbook
ISSN: 0943-4747

Unintended Consequences: New Problems and New Solutions

Issue: 2016: IMIA Yearbook 2016
Pages: 13-29

A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

Special Section: Unintended Consequences: New Problems and New Solutions


K. Zheng (1), J. Abraham (2), L. L. Novak (3), T. L. Reynolds (4), A. Gettinger (5)

(1) Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, USA; (2) Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; (3) Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, TN, USA; (4) School of Information, University of Michigan, Ann Arbor, MI, USA; (5) Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington DC, USA


Patient safety, Electronic health records, Medical order entry systems, Health information technology, unintended consequences, Health Information Technology for Economic and Clinical Health Act


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.

You may also be interested in...

Contribution of the IMIA Working Group on Patient Safety

Section 11: Public Health ans Epidemiology Informatics

Working Group Contribution

E. Borycki (1), E. Cummings (2), J. W. Dexheimer (3), Y. Gong (4), S. Kennebeck (5), A. Kushniruk (1), C. Kuziemsky (6), K. Saranto (7), J. Weber (1), H. Takeda (8)

Yearb Med Inform 2015 : 207-215


M. E. Gregory (1, 2), E. Russo (1, 2), H. Singh (1, 2)

Appl Clin Inform 2017 8 3: 686-697

Interoperability and EHR

Research Article

Special Topic: Interoperability and EHR

K. T. Adams (1), J. L. Howe (1), A. Fong (1), J. S. Puthumana (1), K. M. Kellogg (1, 3), M. Gaunt (4), R. M. Ratwani (1, 3)

Appl Clin Inform 2017 8 2: 593-602