Table 2

The five themes, and associated subthemes, for unintended consequences of healthcare technologies on patient safety

Key themes	Potential patient safety consequences	Subthemes
Theme 1: inequity of access	Reduced access to health services	Disparities in use and access to healthcare technologies due to: Physical diversities and neurodiversities Digital poverty Low digital literacy ‘Postcode lotteries’ in healthcare services
Theme 2: increased end-user burden	Reduced psychological safety, alert overload and/or increased opportunity for error	Additional patient tasks and psychological burden Increase in patient anxiety Due to feeling the need to constantly check that the technology is working Due to misinterpreting or overthinking their health data Increased healthcare professional burden due to multiple log-ins and alert fatigue and/or having to input patient health data into multiple systems Lack of interoperability between different technologies resulting in fragmentation of patient health data
Theme 3: loss of human element of healthcare	Reduced psychological safety and/or potential increase in diagnostic error	Reduced in-person interactions Increased social isolation for patients Increased risk of missed symptoms, incorrect diagnoses and delays in accessing healthcare Potentially receiving distressing health-related information without in-person support
Theme 4: over-reliance on technology	Reduced psychological safety and/or reduction in backup systems and safeguards leading to mismanagement of healthcare conditions	Patients develop psychological dependence on technologies, then feel ‘a sense of abandonment’ when these are no longer available ‘Illusion of communication’ Patients perceive that information they enter into patient-held technologies will be seen and acted on by healthcare professionals, when this may not always be the case Healthcare professionals perceive that they will be alerted by the technologies if patients’ health information displayed to them is incorrect when this may not always be the case Assumptions that technologies will always work as expected, which limits provision of back-up systems for when they fail Healthcare professionals’ trust in information generated by and/or displayed to technologies, when this may not always be appropriate
Theme 5: unclear responsibilities	Reduced psychological safety	Unclear responsibilities if health deteriorates Unclear responsibilities when things go wrong Unclear responsibilities surrounding the security of stored data