Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis |
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| Institution: | 1. Agency for Healthcare Research and Quality, Rockville, MD;2. University of Pennsylvania, Philadelphia, PA;3. Ruppin Academic Center, Emek Hefer, Israel.;1. University of Kragujevac, Faculty of Technical Sciences Čačak, Department of Information Technology, Svetog Save 65, 32 000 Čačak, Serbia;2. University of Belgrade, Faculty of Agriculture, Nemanjina 6, 11080 Beograd, Zemun, Serbia;1. School of Mechanical Engineering, University of Birmingham, Birmingham B15 2TT, United Kingdom;2. Engineering Technical College-Baghdad, Middle Technical University, Baghdad, Iraq;3. Advanced Manufacturing and Engineering (AME), Coventry University, School of Engineering and Computing, CV6 5LZ, United Kingdom;1. Department of Preventive Medicine and Public Health, University of Kansas School of Medicine – Wichita, United States;2. Department of Epidemiology and GH Sergievsky Center, Columbia University, United States;3. Department of Biostatistics and GH Sergievsky Center, Columbia University, United States;4. Department of Health Science, University of Alabama, United States;5. Department of Public Health Sciences, Wichita State University, United States;6. Department of Neurology, Emory University, United States;7. Department of Neurology and GH Sergievsky Center, Columbia University, United States;1. Department of Anesthesia, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;2. Department of Anesthesia, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-0861, Japan;3. Department of Urology, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;1. Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, Madison, WI, USA;2. Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA |
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| 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. |
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