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Intended and Unintended Consequences of Introducing a New Electronic Health Record in an Emergency Department

Author: Vickie D. Nguyen, MA

Primary Advisor: Vimla L. Patel, PhD, DSc

Committee Member: Jiajie Zhang, PhD

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.


The purpose of this study is to examine the intended and unintended consequences that can happen when a new technology such as an electronic health record (EHR) system is introduced into a health care setting, specifically, the emergency department (ED). We conducted a series of ethnographic participant observations and semistructured interviews of ED clinicians before and after implementation of the new EHR system. We identified three major unintended consequences that lead to errors compromising patient safety: 1) the new EHR system generated additional tasks that deviated from regular workflow, 2) the electronic file was found to be too cumbersome for documenting orders, and 3) the new format to find and track patient information was more difficult for completing tasks due to poor interface design. These findings underline a need to continue monitoring unintended consequences with technology implementations into health care environments, and to be able to better predict these consequences.