CMS Makes Annual SAFER Guides EHR Self-Assessment a Requirement

Aug. 16, 2021
The Safety Assurance Factors for EHR Resilience (SAFER) Guides are made up of checklist-based self-assessment tools to improve the safety of how EHRs are used

The SAFER Guides, a set of checklist-based self-assessment tools to improve safety of how EHRs are used, have seen limited uptake so far, but a recently released final rule from the Centers for Medicare & Medicaid Services (CMS) makes attestation to having completed an annual assessment of all nine guides in the SAFER Guides measure a requirement under the Protect Patient Health Information objective.

The Safety Assurance Factors for EHR Resilience (SAFER) Guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. A 2018 study published in the Journal of the American Medical Informatics Association, found that health systems were not fully implementing the guides.

For the study, researchers conducted risk assessments of eight organizations of varying size, complexity, EHR type, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within the nine guides. In each guide, recommendations were organized into three broad domains: “safe health IT” (45 total recommendations); “using health IT safely” (80 total recommendations); and “monitoring health IT” (15 total recommendations).

The data revealed that the eight sites fully implemented 25 out of 140 (18 percent) SAFER recommendations. The mean number of “fully implemented” recommendations per guide ranged from 94 percent (system interfaces—18 recommendations) to 63 percent (clinical communication—12 recommendations). Adherence was higher for “safe health IT” domain (82 percent) versus “using health IT safely” (73 percent) and “monitoring health IT” (67 percent).

The researchers concluded, “Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.”

On Aug. 2, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule updates Medicare payment policies and rates for operating and capital-related costs of acute care hospitals and for certain hospitals and hospital units excluded from the IPPS for FY 2022. Under the rule, hospitals must attest to having completed an annual assessment of all nine guides in the SAFER Guides measure, under the Protect Patient Health Information objective;

On Twitter, Hardeep Singh, M.D., a professor of medicine and health services research at the Baylor College of Medicine who co-led the creation of the SAFER Guides, said, “This is good news for patient safety and health IT because hospitals will now self-assess safety of their EHR use. This could empower organizations to address their EHR-related problems.

Singh called it a “reminder that research need not be just about publications, grants and promotions. Making products to impact clinical care – tools, strategies, guides – should be the norm and incentivized.”

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