Categorizing the unintended sociotechnical consequences of computerized provider order entry.
OBJECTIVE
To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting.


METHODS
Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics.


METHODS
Instances of unintended consequences were categorized using an expanded Diffusion of Innovations theory framework.


RESULTS
The framework was clarified and expanded. There are both desirable and undesirable unintended consequences, and they can be either direct or indirect, but there are also many consequences that are not clearly either desirable or undesirable or may even be both, depending on one's perspective. The undesirable consequences include error and security concerns and issues related to alerts, workflow, ergonomics, interpersonal relations, and reimplementations.


CONCLUSIONS
Consequences of implementing and reimplementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences.
Ash
Joan S
JS
Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR 97201-3098, USA. ash@ohsu.edu
Sittig
Dean F
DF
Dykstra
Richard H
RH
Guappone
Kenneth
K
Carpenter
James D
JD
Seshadri
Veena
V
D000553:Ambulatory Care; D004059:Diffusion of Innovation; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D050316:Medical Order Entry Systems; D009922:Oregon; D012962:Sociology, Medical