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Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors

Affiliations of the authors: Oregon Health & Science University, Portland, OR (JSA); Erasmus University, Rotterdam, The Netherlands (MB); University of New South Wales, Sydney, Australia (EC).

Correspondence and reprints: Joan S. Ash, PhD, Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098; e-mail: <ash{at}ohsu.edu>.

Received for publication: 10/03/03; accepted for publication: 10/27/03.

Medical error reduction is an international issue, as is the implementation of patient care information systems (PCISs) as a potential means to achieving it. As researchers conducting separate studies in the United States, The Netherlands, and Australia, using similar qualitative methods to investigate implementing PCISs, the authors have encountered many instances in which PCIS applications seem to foster errors rather than reduce their likelihood. The authors describe the kinds of silent errors they have witnessed and, from their different social science perspectives (information science, sociology, and cognitive science), they interpret the nature of these errors. The errors fall into two main categories: those in the process of entering and retrieving information, and those in the communication and coordination process that the PCIS is supposed to support. The authors believe that with a heightened awareness of these issues, informaticians can educate, design systems, implement, and conduct research in such a way that they might be able to avoid the unintended consequences of these subtle silent errors.