Categorizing the unintended sociotechnical consequences of computerized provider order entry

Area of Science:

• Health Informatics
• Clinical Systems Implementation
• Sociotechnical Systems Analysis

Background:

• Computerized provider order entry (CPOE) systems are increasingly adopted in outpatient settings.
• Understanding the full impact of CPOE implementation is crucial for optimizing healthcare delivery.
• Previous research has not fully captured the spectrum of unintended consequences.

Purpose of the Study:

• To identify and categorize unintended consequences of CPOE implementation in outpatient clinics.
• To refine and apply an expanded Diffusion of Innovations theory framework for analyzing these consequences.

Main Methods:

• An interdisciplinary team conducted ethnographic observations and interviews over seven months at four clinics.
• Unintended consequences were systematically categorized using an adapted Diffusion of Innovations theory framework.

Main Results:

• The Diffusion of Innovations framework was expanded to better classify consequences.
• Unintended consequences were found to be desirable, undesirable, direct, indirect, or a combination thereof.
• Undesirable consequences included errors, security issues, alert fatigue, workflow disruptions, ergonomic challenges, interpersonal conflicts, and reimplementation difficulties.

Conclusions:

• Implementing and reimplementing clinical information systems like CPOE results in multifaceted consequences.
• The expanded Diffusion of Innovations theory provides a valuable framework for analyzing the complex outcomes of CPOE adoption.