Module I: Introduction to Unintended Consequences

• Common Examples of Unintended Consequences: A research paper that highlights some of the most common types of EHR related unintended consequences.
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Module II: Avoid Unintended Consequences

• Organizational Assessment Tools: The AHRQ National Resource Center for Health IT includes a number of tools that can help you assess organization's readiness for EHR implementation. Interested users can search for such tools in AHRQ's Health IT Survey Compendium.

• Setting and Achieving Goals: The Doctor's Office Quality – Information Technology program has developed a useful document on goal setting. AHRQ has developed an HIT Evaluation Guide that can help you develop plans to achieve your goals and measure your success.
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• Meaningful Use: CMS provides information about the Federal EHR incentive program
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• Regional Extension Centers: Find your local ONC Regional Extension Center.
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• Workflow Assessment: AHRQ has developed a Workflow Assessment for Health IT Toolkit. In addition, the California Healthcare Foundation provides a tutorial on workflow analysis and process mapping.
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• Health IT Journeys: The Office of the National Coordinator for Health Information Technology (ONC) has collected a number of success stories from early adopters of EHRs.
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• Failure Modes and Effects Analysis: (FMEA) is a systematic method used to proactively evaluate healthcare processes and to identify and assess potential vulnerabilities. The Department of Veterans Affairs provides a tutorial on how to apply the FMEA methodology in healthcare settings.
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• Meaningful Use Criteria: Requirements for Stage 1 Meaningful Use.
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• Example User Survey: The New York Department of Health and Mental Hygiene and Columbia University developed a survey to assess how the EHR is being used in your organization.
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• Copy and Paste Toolkit: The American Health Information Management Association has developed a toolkit that includes resources to help healthcare providers develop policies related to the use of copy and paste, training materials to promote the appropriate use of copy and paste, and methods to monitor the use of copy and paste within their EHR.
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Module III: Understand and Identify Unintended Consequences

• Interactive Sociotechnical Analysis: Is a framework to help you understand the types of interactions that can result in unintended consequences.
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• Other resources for understanding unintended consequences: Several other researchers have proposed frameworks for understanding EHR-related unintended consequences, Including Sittig's sociotechnical model for studying health information technology in complex adaptive healthcare systems, Henriksen's Human Factors Framework, Vincent's Framework for analysing risk and safety in clinical medicine, and Carayon's SEIPS model
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• Issues Log Template: The issue log is a central repository of information about EHR-related unintended consequences. This Excel workbook serves a basic example of what an Issues Log might look like. Your organization may wish more or less functionality (for example, the ability to query, or allow users to submit issues via the web). This template should be adapted and modified to meet the needs of your organization.
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Module IV: Remediate Unintended Consequences

• Starter Set Questions: This document contains a list of questions that you can use or adapt to identify the root causes of your EHR-related problems.
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• Root Cause Analysis: AHRQ has made information and tools related to conducting root cause analyses available through its patient safety network.
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• Causal Statements and Corrective Actions: A Microsoft Excel template for keeping track of your own Causal Statements and Corrective Actions.
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• Develop a Detailed Remediation Plan: The following template is adapted from the remediation planning process used at Kaiser Permanente of Colorado. This document is designed to help health care organizations of all shapes and sizes develop detailed plans for remediating unintended consequences.