SAFER Electronic Health Records: Safety Assurance Factors for EHR Resilience

SAFER Electronic Health Records: Safety Assurance Factors for EHR Resilience

Electronic health records (EHRs) have the potential to improve the quality and safety of health care. Since the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH), organizations are adopting EHRs at an unprecedented rate. While the challenges of rapid EHR implementation can be numerous and disruptive, most clinicians prefer EHRs over paper records in the hopes of improving care with better access to information at the point-of-care, advanced clinical decision support, and more reliable mechanisms for provider-to-provider communication. Clinicians’ willingness to adopt EHRs is reassuring, especially in these early stages of an EHR-enabled health system where benefits thus far have been difficult to achieve on a broad scale. However, implementation of EHRs and other new technologies carries unintended consequences that need to be addressed. Clinicians have also experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex workflow of real-world practice settings. To respond to these challenges, the Office of the National Coordinator for Health Information Technology (ONC) commissioned the 2012 Institute of Medicine Report Health IT and Patient Safety: Building Safer Systems for Better Care and recently released the Health Information Technology Patient Safety Action and Surveillance Plan that lays out their proposed response to these issues.

National initiatives needed to improve the safety of EHRs must be accompanied by practical and helpful strategies for clinicians on the frontlines of EHR-enabled care delivery. Although organizations are accustomed to developing and using practice standards, clinical guidelines, and evidence-based medicine to provide the best possible care for their patients, they are often unaware of best practices for safe EHR implementation and use. For example, they often have minimal guidance to handle problems such as too many alerts, an EHR that is too slow, or an EHR that requires an excessive number of “clicks” to complete simple tasks. These are not skills routinely expected of healthcare providers in the past. Clinicians are also not privy to other safety concerns embedded in flawed interfaces between the various components of the EHR and in the way the EHR system is configured. Solutions to these problems are often multifaceted, involving analysis and redesign of workflow and organizational processes and procedures that cannot be addressed through improvements in technology alone. Addressing EHR-related safety concerns is thus inherently complex and involves a comprehensive and multifaceted systems-based approach. Organizations must be active in finding and demanding solutions, but they need practical and useful guidance for EHR safety.

The goal of this book is to provide EHR designers, developers, implementers, users, and policy makers with the requisite historical context, clinical informatics knowledge, and real-world, practical guidance to enable them to utilize the SAFER Guides to proactively assess the safety and effectiveness of their EHR implementations. The first five chapters are designed to provide readers with the conceptual knowledge required to understand why and how the guides were developed. The next nine chapters consist of 1-3 articles that focus on the underlying informatics concepts, key research activities, or methods used to develop each of the guides. Each of these chapters concludes with a copy of the guide itself. The final chapter provides a vision for the future of how we can create the required socio-technical infrastructure necessary to oversee the work required to ensure that future generations of EHRs are designed, developed, implemented, and used to improve the overall safety of the EHR-enabled healthcare system.

High Priority Practices: The subset of processes determined to be “high risk” and “high priority” meant to broadly cover all areas that have a role in EHR safety

Computerized provider order entry (CPOE) with clinical decision support: Processes pertaining to electronic ordering of medications and diagnostic tests and aiding the clinical decision making process at the point of care

Test result reporting and follow-up: Processes involved in delivering test results to the appropriate providers

Communication between providers: Communication processes in three high-risk areas: consultations or referrals, discharge-related communications, and patient-related messaging between clinicians

Patient identification: Processes related to creation of new patients in the EHR, patient registration, retrieval of information on previously registered patients, and other patient identification processes

Contingency planning for EHR-based care continuity: Processes and preparations that should be in place in the event that the EHR experiences a hardware, software, or power failure

EHR customization and configuration: Processes required to create and maintain the physical environment in which the EHR will operate, as well as the infrastructure related to the hardware and software that are required to run the EHR

System-system data interfaces: Processes that enable different hardware devices and software applications to be connected both physically and logically so they can communicate and share information

Organizational activities and responsibilities: The organizational activities, processes, and tasks that people must carry out to ensure safe and effective EHR implementation and continued operations

Get the book here: SAFER Electronic Health Records: Safety Assurance Factors for EHR Resilience