ONC Issues Guides for SAFER EHRs

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In their 2014 article "ONC Issues Guides for SAFER EHRs"[1], Sittig, Ash, and Singh describe the importance of the SAFER guidelines developed by sponsorship of the ONC. SAFER is an acronym for Safety Assurance Factors for EHR Resilience. The SAFER guides are self-assessment tools to promote the detection and reduction of risks associated with electronic health records (EHR). The authors assert that the proliferation of EHR has increased the difficulty of health information management (HIM) activities and has escalated the related safety concerns. This is described not only as a correlate to the number of systems in use, but also to their increasing complexity and the number of interfaces being established with other systems. The ONC contracted with the Westat research corporation, Sittig, Ash and Singh to develop these assessment tools. The SAFER project conducted research that informed the structure of the guides, which covered two areas of implementation and use, three that addressed infrastructure, and four that attended to error-prone areas of clinical process. The authors summarize the intent of the guides is to prompt changes in deficient practices or software, and "to help all EHR-related stakeholders develop a shared understanding of the full capabilities and limitations of their health IT systems" [1].

Development Principles & Key Concepts

Guiding principles included the provision of a "roadmap for strengthening existing partnerships among various parties whose ultimate goal is safe and reliable healthcare." [1] Provide a structure for meaningful coordinated work A multidisciplinary team contributed to the thinking during the development process. Specialties included: • Informatics • HIM • Patient Safety • Quality Improvement, Risk Management • Human Factors Engineering • Usability. Consideration of Sociotechnical EHR context - The SAFER guides consider human factors such as local culture, training, workflow and policies.

Recommended Practices for Clinical and Administrative Data and EHRs

1. Available when and Where they are needed 2. Only viewed by authorized users 3. Only modified by authorized users 4. Used correctly and completely throughout the organization 5. Must be designed and implemented to promote safe, effective, and efficient use 6. Must have mechanisms in place to monitor, detect, and report on safety of the EHR

Summary of Organization of the SAFER Guides

( Adapted from Table 1 in Source Article )

Foundational Guides

  • High Priority Practices: Assessment tool to identify needs for safety improvements, Provides recommendations for areas that are "high risk" and "high priority".

Infrastructure Guides

  • Contingency Planning – Assessment and recommendations for functional (business) continuity in the event of infrastructure failure.
  • System Configuration – Assessment and recommendations specific to the physical environment and infrastructure in which the ERH will operate
  • System Interfaces – Assessment and recommendations related to the interconnectivity between disparate hardware and software to enable information exchange.

Clinical Process Guides

  • Patient Identification – Recommendations for creation, maintenance and use of patient records in the EHR
  • Computerized Provider Order Entry with Decision Support – Recommendations specific to ordering medications and tests in the electronic system including integrated clinical decision support.
  • Test Results with Reporting and Follow-up – Recommendations regarding delivery of test results
  • Clinician Communication – Recommendations pertaining to clinical consultation or referral, discharge communications and other continuity of care functions.

Insights and Advice from the SAFER Team

The authors advise that HIM professionals are likely to find most of the guides useful, with particular attention recommended on the Patient Identification guide, as safety begins with accurate identification. The importance of establishing and maintaining functional collaboration across organizational stakeholders is also a point of emphasis. The guides are intended for both an initial use to establish baselines and subsequent repeated use to provide measures for progress toward improved patient safety.


Active participation encouraged here.

M. Taylor: When one considers the recent and rapid proliferation of EHRs across both inpatient and outpatient settings, coupled with their potential impact on patient safety, the need for standards of safe and effective operation of these systems is (or should be) apparent. Sittig, Ash, and Singh have produced a set of guides that address the scope of EHR functionality critical for patient safety. Further, the have crafted them such that healthcare organizations can effectively put them to immediate use. That said, it is important to understand that the intent of these guides is "to be only the beginning of a meaningful conversation on patient safety in EHR enabled healthcare environments." [1]

Articles Mentioning SAFER Guides

Measuring and improving patient safety through health information technology: The Health IT Safety Framework

Development and field testing of a self-assessment guide for computer-based provider order entry.


  1. 1.0 1.1 1.2 1.3 ONC Guides for SAFER EHRs http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/1511123367?accountid=7034