Categorizing the unintended sociotechnical consequences of computerized provider order entry

Objective: To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting. Design: Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics. Measurements: Instances of unintended consequences were categorized using an expanded Diffusion of Innovations theory framework. Results: The framework was clarified and expanded. There are both desirable and undesirable unintended consequences, and they can be either direct or indirect, but there are also many consequences that are not clearly either desirable or undesirable or may even be both, depending on one's perspective. The undesirable consequences include error and security concerns and issues related to alerts, workflow, ergonomics, interpersonal relations, and reimplementations. Conclusion: Consequences of implementing and reimplementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences.