The Doctor’s Advocate | Second Quarter 2014
SAFER Guides for Electronic Health Record Implementation and Use
Problems with electronic health record (EHR) implementation and use are common. Examples include the following:
- Unwillingness by vendors to modify their systems to meet the complex workflows of the real-world practice setting.
- Failure to use a team approach involving physicians and other healthcare professionals in leadership positions to ensure that their clinical concerns are met.
- Not adequately addressing known problems with EHR use, e.g., “alert fatigue” as a result of too many alerts, problems locating where lab and x-ray results are filed (or misfiled), difficulty correcting progress note entry errors, and unnecessary operational complexity.
The Office of the National Coordinator for Health Information Technology recently released the Safety Assurance Factors for EHR Resilience (SAFER) Guides. They are a practical, useful, and comprehensive suite of tools developed to assist healthcare institutions, medical groups, and physician offices with EHR implementation.
I recommend that all physicians, medical groups, and healthcare institutions that are considering implementation or replacement of an EHR visit the SAFER Guides website and spend an hour becoming familiar with those guides that address the areas of greatest interest or concern. The free guides—which can be downloaded as PDF files or used online—provide a well-organized work plan for tackling the organizational complexities of EHR implementation and use. In order to ensure that clinically important considerations are addressed, the guides apply a structured team approach involving everyone whose professional life will be permanently affected by the EHR.
The SAFER Guides are designed to help healthcare organizations conduct self-assessments to optimize the safe use of electronic health records in nine areas. The last three in the following list are of particular importance to physicians:
- High Priority Practices
- Organizational Responsibilities
- Contingency Planning
- System Configuration
- System Interfaces
- Patient Identification
- Computerized Provider Order Entry with Decision Support
- Test Results Reporting and Follow-Up
- Clinician Communication
Each of the nine SAFER Guides begins with a Checklist of recommended practices that indicates the extent to which each recommended practice has or has not been implemented.
Links embedded in each Checklist open the corresponding practice Worksheet that gives the rationale for each recommended practice, examples of how to implement each practice, likely sources of input into the assessment of each practice, and fields to record team members and follow-up actions.
You can download the content of each guide (with all of its interactive references and supporting materials) as individual PDFs or download all of the guides in a single zip file by going to www.healthit.gov/saferguide. A link to this website is also posted on our EHR and Telemedicine Resource Center at www.thedoctors.com/ehr.
The guides are based on a literature review, expert opinion, and field testing at a wide range of healthcare organizations—from small ambulatory practices to large health systems. The recommended practices are intended to be useful for all EHR users. However, every organization is unique and will implement a particular practice differently. As a result, some of the recommended practices may not be applicable to every organization.
The SAFER Guides are designed to help deal with safety concerns created by the continuously changing landscape that healthcare organizations face. When using the guides, changes in technology, clinical practice standards, Meaningful Use, and/or HIPAA Security Rule requirements should be taken into account.
Because the guides are designed to help organizations prioritize EHR-related safety concerns, clinician leadership in the organization should be engaged to assess whether and how any recommended practice affects the organization’s ability to deliver safe, high-quality care. To optimize EHR-related safety and quality, collaboration between clinicians and staff should lead to a consensus about the organization’s future path.
At right, see our examples of the Checklist and practice Worksheets from the SAFER Guide for Computerized Provider Order Entry with Decision Support. This Checklist has 29 recommended practices (only number 12 is shown here), and there is a Worksheet for each recommended practice.