Identification of Opportunities and Limitations


Just as no two system implementations are the same, no two evaluation plans are, either. Every system implementation has unique attributes that require the development of a unique evaluation plan; however, nurse informaticists may be able to reuse parts of evaluation plans in similar practice settings or expanded research efforts. When considering existing evaluation plans for future use, it is important not to overlook a plan’s limitations. These limitations may lead to unintended consequences if they are not examined with a keen eye.

In this Discussion, you analyze the limitations of your evaluation plan and opportunities for future application. In addition, you develop strategies for minimizing unintended consequences resulting from your own evaluation plan.


To prepare:


  • Review this week’s Learning Resources, focusing on the limitations and opportunities highlighted in the research articles.
  • Review your evaluation plan, assessing the possible limitations.
  • Consider the plan’s contributions to your organization and to nursing as a whole. Assess future opportunities for building on this research.
  • Research the Walden Library for an article detailing unintended consequences of an HIT implementation. Consider strategies for minimizing unintended consequences resulting from your evaluation plan.

By tomorrow Tuesday 1/31/17, post minimum of 550 words in APA format with a minimum of 3 references from the list below. Include the level one headers as numbered below:

1)       A brief summary of the limitations of your evaluation plan.

2)      Also describe future opportunities that could build upon your evaluation plan.

3)      Summarize the article you identified that deals with unintended consequences, and outline strategies for avoiding unintended consequences stemming from your own evaluation plan. Include the reference in proper APA format. (See Attached PDF)


Required Readings


    Bethell, C. D., Kogan, M. D., Strickland, B. B., Schor, E. L., Robertson, J., & Newacheck, P. W. (2011). A national and state profile of leading health problems and health care quality for US children: Key insurance disparities and across-state variations. Academic Pediatrics, 11(Supp 3), S22–S33.

    Retrieved from the Walden Library databases.

This article describes a study that evaluated the commonality of health problems and special health care needs in children at the national and state levels in the United States. The study examined issues surrounding health care quality in relation to insurance, access to care, special needs, and demographics.


 Bloomrosen, M., Starren, J., Lorenzi, N. M., Ash, J. S., Patel, V. L., & Shortliffe, E. H. (2011). Anticipating and addressing the unintended consequences of health IT and policy: A report from the AMIA 2009 Health Policy Meeting. Journal of the American Medical Informatics Association, 18(1), 82–90.

Retrieved from the Walden Library databases.

The authors of this article highlight discussions from the American Medical Informatics Association’s 2009 Annual Health Policy Meeting. In the article, the authors outline the conference’s recommendations for coping with unintended, unanticipated, and undesirable consequences of health information technology implementation.


    Jimmieson, N. L., & Griffin, M. A. (1998). Linking client and employee perceptions of the organization: A study of client satisfaction with health care services. Journal of Occupational and Organizational Psychology, 71(1), 81–96.

Retrieved from the Walden Library databases.

The authors of this article describe a study that sought to determine how organizational characteristics may serve as predictors of client satisfaction. In addition, the authors make recommendations for future research involving employee perceptions of working environments.


    Novak, L. L., Anders, S., Gadd, C. S., & Lorenzi, N. M. (2012). Mediation of adoption and use: A key strategy for mitigating unintended consequences of health IT implementation. Journal of the American Medical Informatics Association, 19(6), 1043–1049.

Retrieved from the Walden Library databases.




    In this article, the authors explore the work of nurses who serve as mediators of the adoption and use of a Bar Code Medication Administration (BCMA) system. The authors identify three key themes that are critical to mediation work.


    Romano, M. J., & Stafford, R. S. (2011). Electronic health records and clinical decision support systems: Impact on national ambulatory care quality. Archives of Internal Medicine, 171(10), 897–903. Retrieved from

 This article describes an analysis of data from the 2005–2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The analysis focuses on whether a higher quality of care can be correlated with the introduction of electronic health records and clinical decision support systems.


    Walden University. (2012). Presentations. Retrieved from

This site gives suggestions for creating an effective presentation. It includes tips on such things as the use of contrast, repetition, and alignment in your presentation.


IMIA Yearbook of Medical Informatics 2016


© 2016 IMIA and Schattauer GmbH

New Unintended Adverse Consequences
of Electronic Health Records
D. F. Sittig1, A. Wright2, J. Ash3, H. Singh4
1 University of Texas Health Science Center at Houston, School of Biomedical Informatics and

UT-Memorial Hermann Center for Health Care Quality and Safety, Houston, TX, USA
2 Harvard Medical School and Brigham and Women’s Hospital, Department of Medicine, Boston, MA, USA
3 Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology,

Portland, OR, USA
4 Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E.

DeBakey Veterans Affairs Medical Center, Houston, Texas; and
Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

Although the health information technology industry has made
considerable progress in the design, development, implementation,
and use of electronic health records (EHRs), the lofty expectations
of the early pioneers have not been met. In 2006, the Provider
Order Entry Team at Oregon Health & Science University described
a set of unintended adverse consequences (UACs), or unpredictable,
emergent problems associated with computer-based provider
order entry implementation, use, and maintenance. Many of these
originally identified UACs have not been completely addressed
or alleviated, some have evolved over time, and some new ones
have emerged as EHRs became more widely available. The rapid
increase in the adoption of EHRs, coupled with the changes in the
types and attitudes of clinical users, has led to several new UACs,
specifically: complete clinical information unavailable at the point
of care; lack of innovations to improve system usability leading to
frustrating user experiences; inadvertent disclosure of large amounts
of patient-specific information; increased focus on computer-based
quality measurement negatively affecting clinical workflows and
patient-provider interactions; information overload from marginally
useful computer-generated data; and a decline in the development
and use of internally-developed EHRs. While each of these new
UACs poses significant challenges to EHR developers and users
alike, they also offer many opportunities. The challenge for clinical
informatics researchers is to continue to refine our current systems
while exploring new methods of overcoming these challenges and
developing innovations to improve EHR interoperability, usability,
security, functionality, clinical quality measurement, and informa-
tion summarization and display.

Electronic Health Records (EHRs), usability, confidentiality,
quality indicators, data display, medical informatics

Yearb Med Inform 2016:7-12