title: Categorizing the unintended sociotechnical consequences of computerized provider order entry.
abstract: 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.
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR 97201-3098, USA. ash@ohsu.edu
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Richard H
authors.initials: RH
authors.lastname: Dykstra
authors.forename: Kenneth
authors.initials: K
authors.lastname: Guappone
authors.forename: James D
authors.initials: JD
authors.lastname: Carpenter
authors.forename: Veena
authors.initials: V
authors.lastname: Seshadri
mesh_terms: 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