Understanding Unintended Consequences and Health Information Technology:. Contribution from the IMIA Organizational and Social Issues Working Group.

objectiveNo framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs.

methodsA literature review was conducted for the period 2000- 2015 using the search terms "unintended consequences" and "health information technology". 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs.

resultsWe identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs.

conclusionsWhile there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues.