title: Unintended adverse consequences of introducing electronic health records in residential aged care homes.
abstract: OBJECTIVE
  The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences.
  
  
  METHODS
  A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals.
  
  
  RESULTS
  Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members.
  
  
  CONCLUSIONS
  Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting.
authors.affiliation: School of Information Systems and Technology, University of Wollongong, Wollongong, NSW 2522, Australia. ping@uow.edu.au
authors.forename: Ping
authors.initials: P
authors.lastname: Yu
authors.forename: Yiting
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Gong
authors.forename: Jiajie
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001292:Attitude to Computers; D003142:Communication; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards*; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D055815:Young Adult
keywords: Electronic health records; Implementation; Interview; Long term care; Nursing documentation; Sociotechnical approach; Unintended adverse consequences