title: Unintended consequences of health information technology: evidence from veterans affairs colorectal cancer oncology watch intervention.
abstract: OBJECTIVE
  We evaluated the Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder implemented in Veterans Integrated Service Network 7 (including eight hospitals) to improve CRC screening rates in 2008.
  
  
  METHODS
  Veterans Affairs (VA) administrative data were used to construct four cross-sectional groups of veterans at average risk, age 50 to 64 years; one group was created for each of the following years: 2006, 2007, 2009, and 2010. We applied hospital fixed effects for estimation, using a difference-in-differences model in which the eight hospitals served as the intervention sites, and the other 121 hospitals served as controls, with 2006 to 2007 as the preintervention period and 2009 to 2010 as the postintervention period.
  
  
  RESULTS
  The sample included 4,352,082 veteran-years in the 4 years. The adherence rates were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention sites in 2006, 2007, 2009, and 2010, respectively, and the corresponding rates in the controls were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage point decrease in likelihood of adherence (P < .001). Additional analyses showed that the intervention was associated with a 5.6-percentage point decrease in likelihood of screening colonoscopy among the adherent, but with increased total colonoscopies (all indicators) of 3.6 per 100 veterans age 50 to 64 years.
  
  
  CONCLUSIONS
  The intervention had little impact on CRC screening rates for the studied population. This absence of favorable impact may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physician fatigue resulting from the large number of clinical reminders implemented in the VA.
authors.affiliation: Associate Professor, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, Columbia, SC 29208, USA. jbian@sccp.sc.edu
authors.forename: John
authors.initials: J
authors.lastname: Bian
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Maria
authors.initials: M
authors.lastname: Ribeiro
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
mesh_terms: D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008490:Medical Informatics; D008875:Middle Aged; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs