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First published June 28, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2384
Journal of the American Medical Informatics Association 2007;14(5):542-549
© 2007 American Medical Informatics Association


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Submitted on January 24, 2007
Accepted on June 18, 2007

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

Michael I. Harrison PhD1*, Ross Koppel PhD2, and Shirly Bar-Lev PhD3

Affiliation of the authors: 1 Agency for Healthcare Research and Quality, Rockville, MD; 2 University of Pennsylvania, Philadelphia, PA; 3 Ruppin Academic Center, Emek Hefer, Isreal

* To whom correspondence should be addressed.

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.




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[Abstract] [Full Text] [PDF]




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