How do unintended consequences emerge from EHR implementation? An affordance perspective

Drawing upon an affordance-actualisation perspective, we aim to advance our knowledge of the emergence of unintended consequences from the implementation of Electronic Health Record (EHR) systems. Prior research has not yet deeply understood how these unintended consequences unfold. We investigate how the (non-)actualisation of affordances produces unintended consequences. Our exploratory case study of an EHR system implemented in Italy reveals four types of actions (flexing, bypassing, avoiding, and reorganising) through which different types of unintended consequences occur with the (non-)actualisation of affordances. We explain and theorise how interactions among technology features and psychosocial and organisational constraints/enablers contribute to users' perception of affordances and technological constraints. This, in turn, influences different types of user actions, leading to unintended consequences. Our findings and insights contribute to the literature on unintended consequences and help organisations better manage implementing new systems.