Table 1.

Previously identified unintended adverse consequences related to the use of Electronic Health Records (EHRs) by clinicians (adapted from Campbell et al. [12]).

More/new work for clinicians	EHRs often create new work for clinical and non-clinical staff, which is most prominent at the point of care (e.g., alerts, required data entry fields, and details of complex orders).
Unfavorable workflow issues	EHRs often highlight mismatches between intended and actual work processes in the clinical setting by adding to previously defined ineffective or dysfunctional workflows.
Never ending demands for system changes	As EHR use increases, it becomes increasingly difficult to standardize, update, test, and maintain the hardware infrastructure, application software, and clinical content.
Paper persistence	Paper continues to be used as a temporary, portable, disposable, data input and output medium.
Changes in communication patterns and practices	Use of EHRs often replaces synchronous, interpersonal conversations regarding provision of care with asynchronous computer-mediated messaging, often leading to an “illusion of communication.”
Negative emotions	Specific EHR features, functions, or series of events that result in users succeeding or failing in reaching their goal(s), trigger emotions that can affect their ability to carry out complex physical and cognitive tasks.
New kinds of errors	New kinds of errors can result from problematic data presentations, confusing order options, inappropriate text entries, misunderstandings related to test, training, and production versions of the system, and workflow process mismatches, to name just a few.
Changes in the power structure	Clinicians experience a loss of power or professional autonomy when EHRs prevent them from ordering the types of tests or medications they prefer, or force them to comply with clinical guidelines they may not embrace, or limit their narrative flexibility through structured data entry.
Overdependence on technology	Health care organizations are becoming increasingly dependent on their EHR for many aspects of clinical care delivery. When the system is unavailable, chaos may ensue.