This Article Full Text Full Text (PDF) Figure 1 All Versions of this Article: M2384v1 14/5/542    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Harrison, M. I. Articles by Bar-Lev, S. Search for Related Content PubMed PubMed Citation Articles by Harrison, M. I. Articles by Bar-Lev, S.

Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis

^a Agency for Healthcare Research and Quality, Rockville, MD
^b University of Pennsylvania, Philadelphia, PA
^c Ruppin Academic Center, Emek Hefer, Israel.

^_* Correspondence and reprints: Michael I Harrison, PhD, Senior Research Scientist, Organizations and Systems, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, 540 Gaither Rd., Rockville, MD 20850 (Email: Michael.Harrison{at}ahrq.hhs.gov).

Received for publication: 01/24/07; accepted for publication: 06/18/07.

Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization’s sociotechnical system—its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners’ awareness of unanticipated consequences that only become evident during HIT implementation.

This article has been cited by other articles:

				P. J. Scott and J. S. Briggs A Pragmatist Argument for Mixed Methodology in Medical Informatics Journal of Mixed Methods Research, July 1, 2009; 3(3): 223 - 241. [Abstract] [PDF]

				H. Singh, S. Mani, D. Espadas, N. Petersen, V. Franklin, and L. A. Petersen Prescription Errors and Outcomes Related to Inconsistent Information Transmitted Through Computerized Order Entry: A Prospective Study Arch Intern Med, May 25, 2009; 169(10): 982 - 989. [Abstract] [Full Text] [PDF]

				B. Kaplan and K. D. Harris-Salamone Health IT Success and Failure: Recommendations from Literature and an AMIA Workshop J. Am. Med. Inform. Assoc., May 1, 2009; 16(3): 291 - 299. [Abstract] [Full Text] [PDF]

				R. Koppel and D. Kreda Health Care Information Technology Vendors' "Hold Harmless" Clause: Implications for Patients and Clinicians JAMA, March 25, 2009; 301(12): 1276 - 1278. [Full Text] [PDF]

				K. Zheng, R. Padman, M. P. Johnson, and H. S. Diamond An Interface-driven Analysis of User Interactions with an Electronic Health Records System J. Am. Med. Inform. Assoc., March 1, 2009; 16(2): 228 - 237. [Abstract] [Full Text] [PDF]

				G. Fairbrother and L. A. Simpson It Is Time! Accelerating the Use of Child Health Information Systems to Improve Child Health Pediatrics, January 1, 2009; 123(Supplement_2): S61 - S63. [Abstract] [Full Text] [PDF]

				K. T. WING The name of the devil. Cleveland Clinic Journal of Medicine, December 1, 2008; 75(12): 845 - 846. [Full Text] [PDF]

				R. Koppel, T. Wetterneck, J. L. Telles, and B.-T. Karsh Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 408 - 423. [Abstract] [Full Text] [PDF]