While the healthcare industry contemplates the positive impact of the stimulus, it is also important to pause and consider the “unintended consequences” of incenting IT adoption. According to Robert Norton in the Concise Encyclopedia of Economics, “The law of unintended consequences, often cited but rarely defined, is that actions of people—and especially of government—always have effects that are unanticipated or unintended. Economists and other social scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it”. While unintended consequences can result in a positive unexpected benefit, the reverse or negative effect is typically the one highlighted. Stated in simple terms, each cause has more than one effect; and typically at least one unforeseen effect.
Researchers at Oregon Health & Science University have identified nine specific unintended consequences associated with CPOE. On a regular basis I see unintended consequences earlier stage applications such as clinical documentation, medication administration and departmental systems. Examples include nurses who continue document at shift change versus when the intervention/medication occurred –not realizing that today’s systems will track timing and record this as a potential medical error; automated assessments requiring extensive time to complete; and workarounds to compensate for awkward or inconvenient applications of bar code technologies. Will the HIT stimulus just layer on to an already shaky house of cards?
Any time you try to change something as complex as healthcare, there will be unintended consequences. Lessons can be learned from Massachusetts’s recent experimentation with healthcare reform. An unintended consequence of giving everyone healthcare insurance, has created a shortage of primary care physicians link. Another example, the recent CMS focus “never events” had two goals – improve patient safety and reduce costs. An unintended consequence is that providers are spending a great deal of time on unnecessary patient care and creating the perfect chart.
Providers should not wait until all of the details of the stimulus are defined to prepare for both the intended and unintended consequences of IT adoption. There are three steps you can take today to be ready:
- Assess the value and effectiveness of your investment in information technology and electronic medical records today, including unintended consequences that are specific to your organization
- Understand specific midcourse corrections you can make to address the consequences you already know about and can predict based on the lessons of those who have gone before you
- Develop and begin to implement an action plan