Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis
- Affiliation of authors: Agency for Healthcare Research and Quality, Rockville, MD; University of Pennsylvania, Philadelphia, PA; Ruppin Academic Center, Emek Hefer, Israel
- Correspondence and reprints: Michael I Harrison, PhD, Senior Research Scientist, Organizations and Systems, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, 540 Gaither Rd., Rockville, MD 20850; email: <Michael.Harrison{at}ahrq.hhs.gov>
- Received 24 January 2007
- Accepted 18 June 2007
Abstract
Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization’s sociotechnical system—its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners’ awareness of unanticipated consequences that only become evident during HIT implementation.
Footnotes
-
The following individuals made helpful comments on drafts of thismanuscript or reported incidents that contributed to our developmentof the manuscript: David Douglas, MD, Portland VA Medical Center(Portland, OR); Joseph Francis, MD, MPH, Department of VeteransAffairs (Washington, DC); Jennifer Lai, BA, BSN, RN, Hospital of theUniversity of Pennsylvania (Philadelphia, PA); Cynthia Palmer, MS,Agency for Healthcare Research and Quality (AHRQ) (Rockville, MD);Nancy Rodenhausen MS, RN, N.Y. Downtown Hospital (NY); ChristineA. Sinsky, MD, Medical Associates, P.C. (Dubuque, Iowa); FrankSites, RN, Penn E-lert eICU, Univ. of Pennsylvania Health System(Philadelphia, PA); Claudia Steiner, MD, AHRQ (Rockville, MD); JoelL. Telles, PhD, Main Line Health (Bryn Mawr, PA); Prof. Michel Vilette,Argo Paris Tech (Paris, France). The following individuals providedinvaluable technical assistance in preparing the manuscript: SandraCummings and Mary Rolston of AHRQ's Public Affairs Division andCaryn McManus of AHRQ's Information Resources Center. ShirlyBar-Lev's research was part of her doctoral dissertation in Sociology atBar Ilan University. Her research was supported by a DissertationFellowship from that institution and supervised by Michael Harrison.Ross Koppel was supported in part by a grant from the Agency forHealthcare Research and Quality (P01 HS11530).This article is written by an employee of the US Government and isin the public domain. This article may be republished and distributedwithout penalty.
The views expressed in this paper do not necessarily represent thoseof any U.S. government agency, but rather reflect the opinions of theauthors.
IRB approval was not requested.
