Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era

This follow-on article moves the discussion forward by adding further dimension to the issue of unintended consequences from the perspective of the United States health system.

Unintended Consequence 1: Failed Expectations

The Path Forward

Implementation of a new EHR will inevitably add to the complexity of the several aspects of care, and as users adapt to the system, they demand new customizations. These customizations are often added to updated EHR versions that demand extensive local testing and an implementation process almost as complex, risky, and labor intensive as the implementation of a newly adopted EHR. In such a scenario, simple pretest-posttest designs are ineffective. A paradigm shift on the choice of research designs for HIT studies is needed to produce more longitudinal evaluations able to detect time-sensitive effects common to HIT interventions and to assess a large set of measures capable of detecting the diverse effects of such interventions. Furthermore, as HIT interventions are subject to context-dependent factors, assessment of potential covariates is of paramount importance, as demonstrated elsewhere. A better understanding of the full impact of HIT on the US health system will demand more comprehensive evaluations that assess a large sample of agreed-upon measures shared across researchers to allow comparison of outcomes across studies by future systematic reviews ­– and potential meta-analyses. In addition to increasing our understating of HIT impact on a national scale, such an approach has the potential to produce compelling evidence to the need for improving HIT effectiveness and can lead us to a more realistic assessment of the real value of the ARRA investment in HIT.