The Office of the National Coordinator for Health IT (ONC) published updated safety best practices, called the Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides, to identify recommended practices to optimize the safety and safe use of electronic health records (EHRs).
The SAFER Guides were initially published in January 2014 and due to the rapid evolution of health IT since the original guides’ release, ONC has updated the best practices and included feedback from healthcare providers and EHR developers based on best practices and experiences, ONC stated. The updated Guides also include recommendations from the Electronic Health Record Association, the National Quality Forum, the National Academy of Medicine and the American Medical Informatics Association.
The SAFER Guides consist of nine guides organized into three broad groups—foundational guides, infrastructure guides and clinical process guides.
In a blog post about the updated SAFER Guides, Andrew Gettinger, M.D., Acting Deputy National Coordinator for Health IT, Rebecca Freeman, Ph.D., R.N., Chief Nursing Officer, and Thomas A. Mason, M.D., Acting Director, Office of Clinical Quality and Safety, wrote that the Guides are compilations of evidence-based, expert-recommended practices for a key focus area, in a checklist-based format. Each Guide includes recommendations, checklists, and note templates that can be used by teams to thoroughly assess the safety and usability of EHRs while lessening data-related burdens.
“The inherent safety of a health IT system depends on the interactive work of software developers, EHR implementers, and clinical users of EHRs. All of these stakeholders have a shared responsibility to make, maintain, and use the system safely. Yet, we often hear that the health IT in use today often falls short of users’ expectations. EHR usability—the ease with which an EHR can be employed to help deliver care—and the safety of a system is heavily influenced by two key design decision processes: (1) the developers’ decisions about the functionalities or capabilities in the software created by the developer, and (2) those decisions made by the installing facility or practice when the EHR is implemented and customized,” Gettinger, Freeman and Mason wrote in the blog post.
Key updates to the Guides include:
- A new recommendation to the Test Results and Follow-up Reporting Guide to improve communication of abnormal results to patients which is based on recommendations from the National Academy of Medicine.
- An update to the Contingency Planning Guide reflecting best practices for prevention and mitigation of ransomware attacks as well as new recommendations about “downtimes,” those times when systems are partially (response times are unacceptably slow) or completely unavailable. These both represent multiple safety issues.
Writing in the blog post, the ONC leaders stated said there have been examples of EHR developers using the SAFER Guides recommendations to help their customers set up and safely use health IT. “In some cases, developers have used the Guides to create manuals that help their customers configure and implement their system for improved usability and safety. And some health care organizations have shared feedback on their experiences using the original Guides,” the ONC leader.
