Making Health IT SAFER

“The more health IT you have, the more prepared you need to be.” That’s the motto of the developers who crafted the Safety Assurance Factors for EHR Resilience (SAFER) Guides—the latest effort by the Department of Health & Human Services (HHS) to help providers more safely use health IT products.

The SAFER Guides are a suite of self-assessment tools, checklists and recommended practices that focus on the safe use and safety of EHRs. The materials include foundational, clinical process and infrastructure guides that cover organizational responsibilities, clinician communication, contingency planning, system interfaces and more.

The guides were released pursuant to the July 2013 HHS Health IT Patient Safety Action and Surveillance Plan, and are designed to complement existing health IT safety tools and research developed by the Agency for Healthcare Research and Quality and the Office of the National Coordinator for Health IT (ONC).

The need for guidance on EHR safety was illustrated in several studies documenting widespread EHR safety issues, says Dean Sittig, PhD, University of Texas School of Biomedical Informatics, and guide developer—who spoke at an ONC webinar on Jan. 30.

A survey of 369 healthcare professionals found that 53 percent admitted to at least one EHR-related safety event in the previous five years and 10 percent experienced more than 20 events. The most frequently cited EHR-related safety concerns included incorrect patient identification, extended EHR unavailability (either planned or unplanned), failure to heed a computer-generated warning or alert and system-to-system interface errors, according to Sittig, who authored the Journal of Healthcare Risk Management study.

Nuts & Bolts

The two-year development of the guides involved extensive stakeholder engagement as well as pilots at Geisinger Health System in Danville, Pa., Family Physicians Group in Orlando, Fla., Partners HealthCare in Boston and four independent Colorado clinics.

These pilots confirmed that the guides’ implementation is best done through multidisciplinary teams, that a three-point assessment scale is most effective and that the guides’ practices should apply to both ambulatory and large-scale practices.

The SAFER Guides reflect a socio-technical model that factors in people, processes and technology for safe and effective EHR use, says Hardeep Singh, MD, MPH, chief of the health policy, quality & informatics program at the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center in Houston. As such, the guides focus on three phases of health IT use, including safe health IT (data availability, data integrity and data confidentiality); safely using health IT (complete/correct EHR use; EHR system usability); and monitoring safety (safety surveillance, optimization and reporting).

Each guide contains 10 to 25 recommended practices and allow organizations to self-assess as fully implemented, partially implemented or not implemented. They include planning worksheets so providers can set goals and track progress.

This is just the beginning, say the developers. “I think the practices will evolve over the years. This is just draft one, and we can do better creating benchmarks,” Singh says.

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