Overcoming the unintended adverse consequences of implementing health IT through human resource and knowledge management

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of Computerized Physician Order Entry (CPOE) implementation include unfavorable workflow issues, generation of new types of errors, untoward changes in communication patterns, and problems of paper persistence.However, gaps remain in understanding why UACs from HIT implementation occur, and how they may be overcome. The technology-in-practice (TIP) framework emphasizes the role of human agency (or individual action) in enacting structures of technology use (or technologies-in-practice) and other social structures within the organization. As such, given a set of UACs from HIT implementation, the TIP framework can help trace them back to specific actions (types of HIT-in-practice) and institutional conditions (social structures).However, insofar as the TIP framework can help understand causes of UACs, it does not shed light on how they may be overcome through strategic action. By contrast, the knowledge-in-practice (KIP) framework, which emanates from both human resource and knowledge management literatures, helps understand how information and communication technologies (ICTs) such as "Intranets" and the "Virtual Office" can be used alongside existing HIT systems (e.g., CPOE) to create new social structures, generate new KIP, and transform HIT-in-practice. This chapter integrates the TIP and KIP literatures to develop an integrated framework for understanding and overcoming the UACs from HIT implementation. The framework is applied to existing evidence on UACs from CPOE implementation, to explain why they occur, and how they may be overcome. The application and ensuing discussion provide insight into strategies for successful HIT implementation in healthcare organizations, as well as recommendations for future research.