Although rapid digital transfor- mation appears safe based on in-patient mortality or sentinel

events

15. Sullivan C, Staib A, Ayre S, Daly M, Collins R, Draheim M, Ashby R. Pioneering digital disruption:
Australia’s first integrated digital tertiary hospital. Med J Aust 2016; 205: 386–9.
doi:10.5694/mja16.00476

89. Barnett ML, Mehrotra A, Jena AB. Adverse inpatient outcomes during the transition to a new
electronic health record system: observational study. BMJ 2016; 354: i3835. doi:10.1136/bmj.i3835

Clinician resistance to EMR can be overcome by using clinical change leaders (typically well
respected and networked) at the unit or department level and across professional streams (PAH
had 460 clinical change leaders). These folkcan reassure, motivate and empower others to
accept change, fully engage in testing and training, and resist scepticism.33,35,38,39

33. Simon SR, Keohane CA, Amato M, Coffey M, Cadet B, Zimlichman E, Bates DW. Lessons learned from
implementation of computerized provider order entry in 5 community hospitals: a qualitative study.
BMC Med Inform Decis Mak 2013; 13: 67. doi:10.1186/1472-6947- 13-67

35. Øvretveit J, Scott T, Rundall TG, Shortell SM, Brommels M. Improving quality through effective
implementation of information technology in healthcare. Int J Qual Health Care 2007; 19: 259–66.
doi:10.1093/intqhc/mzm031

38. Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting
and implementing computerized physician order entry systems in U.S. hospitals. Health Aff(Millwood)
2004; 23: 184–90. doi:10.1377/hlthaff.23.4.184

39 Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health

information technology innovations: an inter- pretative review. Int J Med Inform 2013; 82: e73–86.
doi:10.1016/ j.ijmedinf.2012.10.007

rapid and disruptive change requires senior leaders to articulate a clear and compelling vision
of the future throughout the organisation.37

37. Ash J, Gorman P, Lavelle M, Lyman J, Fournier L. Investigating physician order entry in the
field: lessons learned in a multi-center study. Stud Health Technol Inform 2001; 84: 1107–11.

Clinician resistance will lessen if the perceived level of alteration to their work practices brings
perceived offsetting benefits.38 A coherent message about the benefits (see Box 3) and need
for change must be communicated
38 Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to
adopting and implementing computerized physician order entry systems in U.S. hospitals.
Health Aff(Millwood) 2004; 23: 184–90. doi:10.1377/hlthaff.23.4.184

large-scale change can engender staff anxiety about patient safety. EMRs can foster new,
unique safety risks and increase some adverse events and medical errors.90–93

90. Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic health record-related events in
medical malpractice claims. J Patient Saf2015; in press. doi:10.1097/PTS.0000000000000240

91 Meeks DW, Smith MW, Taylor L, Sittig DF, Scott JM, Singh H. An analysis of electronic health record-
related patient safety concerns. JAm Med Inform Assoc 2014; 21: 1053–9. doi:10.1136/amiajnl-2013-
002578

92 Magrabi F, Liaw ST, Arachi D, Runciman W, Coiera E, Kidd MR. Identifying patient safety problems
associated with information tech- nology in general practice: an analysis ofincident reports.BMJQualSaf
2016; 25: 870–80. doi:10.1001/archinternmed.2011.327

93 Weiner JP, Kfuri T, Chan K, Fowles JB. ‘e-Iatrogenesis’: the most critical unintended consequence of
CPOE and other HIT. J Am Med Inform Assoc 2007; 14: 387–8. doi:10.1197/jamia.M2338

Multiple feeder systems from multiple vendors rather than one interoperable EMR program also
increase risk.94

94. Bae J, Rask KJ, Becker ER. The impact of electronic medical records on hospital-acquired
adverse safety events: differential effects between single-source and multiple-source systems.
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Various digital disruption ‘syndromes’ that manifest at an individual and organisational level
have been described by us95 and others,49,96–106 and need to be anticipated and responded
to.
95. Sullivan C, Staib AB. Digital disruption ‘syndromes’ in a hospital: important considerations for the
quality and safety of patient care during rapid digital transformation. Aust Health Rev 2017; in press.
doi:10.1071/AH16294

96. Lee J, McCullough JS, Town RJ. The impact of health information technology on hospital productivity.
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97 Kossman SP. Perceptions of impact of electronic health records on nurses’ work. Stud Health Technol
Inform 2006; 122: 337–41.

98 Rahadhan P, Poon SK, Land L. Understanding unintended conse- quences for EMR: a literature
review. Stud Health Technol Inform 2012; 178: 192–8.
99 Stewart E, Kahn D, Lee E, Simon W, Duncan M, Mosher H, Harris K, Bell J, El-Farra N, Sharpe B.
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Med 2015; 10: 525–9. doi:10.1002/jhm.2379

100 Bowman S.. Impact ofelectronic health record systems on information integrity: quality and safety
implications. Perspect Health InfManag 2013; 10: 1c.

101 Bryant AD, Fletcher GS, Payne TH. Drug interaction alert override rates in the meaningful use era: no
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102 Goddard K, Roudsari A, Wyatt JC. Automation bias: a systematic review offrequency, effect
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103 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health
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M2384

104 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom
ST, Weaver C, Zhang J. American Medical Informatics Association. Enhancing patient safety and quality
ofcare by improving the usability ofelectronic health record systems: recommendations from AMIA.
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105 Morrison C, Jones M, Blackwell A, Vuylsteke A. Electronic patient record use during ward rounds: a
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106 Dagnone RV, Wilson R, Goldstein DH, Murdoch J, Rimmer MJ, Van Den Kerkhof EG. How do patients
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