It has probably been highly cited because it highlights a problem that had not been systematically studied before: the unintended consequences of health information systems. It may also be of interest to multiple disciplines because it is not only of interest to the medical informatics readership of the journal, but also to the broader health care community, to computer scientists, and to social scientists. I also think that, because it is based on studies from the U.S., the Netherlands, and Australia, it emphasizes the international nature of the issue.

It presented for the first time a systematic description of the kinds of unintended consequences that we sensed existed but did not perhaps acknowledge. Unintended consequences in health care are not easy to study using either quantitative or qualitative methods, but the ethnographic methods used in our work allowed us to develop accurate descriptions of the issues.

Medical errors happen with or without information technology. However, information systems have been touted by some as the solution to the problem. The health care industry is far behind other areas in its use of information technology and it is rushing to catch up. This paper points out that errors can occur because of information systems, so it is a warning that we need to be careful.

My research team, funded by the National Library of Medicine, NIH, was in the field studying success factors for implementing computerized physician-order entry (CPOE) systems and became aware of many unintended consequences, such as physicians entering orders for the wrong patient, so we started classifying them. At the same time, my colleagues Marc Berg at Erasmus University Medical Center in The Netherlands and Enrico Coiera at the University of New South Wales, in Sydney, Australia, were discovering similar issues using similar methods in their countries. The three of us met at an international conference and decided to work together to categorize and describe what we had witnessed.