Safe Use of Health IT: Safety Assurance Factors for EHR Resilience Guides

Keep up with the latest on information governance as this key strategy emerges for addressing a myriad of information management challenges in healthcare. This blog will highlight the trends and opportunities IG presents for ensuring information is treated as an organizational asset.

By Dawn Paulson, MJ, RHIA


Patient safety is an organizational responsibility. But concern over the astonishing rate of development and adoption of electronic health records (EHRs) in recent years has also provided potential for risk and safety issues. This rapid growth in EHR development has in large part been a response to the Centers for Medicare and Medicaid’s “meaningful use” EHR Incentive Program, as well as the health care vendors growing health information technology (IT) capabilities such as clinical decision support, telehealth, and data analytics. A good health IT program focuses on quality and safety, assesses risk, and implements system changes to the EHR to mitigate potential risks.

IT governance is one of the 10 Information Governance Adoption Model (IGAM™) competencies. IT governance is a critical area to address in order to ensure that an organization’s information can be successfully transmitted and used securely and efficiently to meet an organization’s business and clinical needs. Although IG and IT governance encompass functional areas beyond just health information, it is important to address risks and patient safety issues associated with health information.

In response to the potential risks and patient safety issues, the Institute of Medicine (IOM), the Agency for Healthcare Research and Quality (AHRQ), and the Office of National Coordinator of Health IT (ONC) either published or supported additional reports and tools that provide identification and mitigation of avoidable patient harm or even death.

The Joint Commission, in association with ONC, defines a well-designed and implemented health IT infrastructure as one that:

  • Promotes best practices with implementation of clinical decision support tools
  • Facilitates communication between the healthcare providers and patients
  • Provides physicians with quicker and easier access to patient data
  • Engages patients in their own health care
  • Helps to reduce errors

ONC developed nine Safety Assurance Factors for EHR Resilience (SAFER) Guides to assist healthcare organizations to identify and assess several areas of build and maintenance of their EHR. The SAFER Guides are categorized into three functional groups and each contains a checklist/assessment along with recommendations for ensuring continued safety readiness. Below is a summary of each guide and how they can promote safety and the safe use of health IT.

Foundational Guides

High Priority Practices

  • This defines “high risk” and “high priority” system practices to enhance patient safety and/or the safe use of health IT. At a high level, this foundational guide introduces EHR safety issues that will be covered in any number of the other eight guides in much greater detail.

Organizational Responsibilities

  • Details those elements the healthcare organizations want to address to ensure safety and safe use of EHRs. This guide specifically focuses on actual workflows of the users and efforts to ensure safe use of the EHR.
Infrastructure Guides

System Interfaces

  • This guide provides extensive detail on methods for ensuring the safe use of interfaces, versioning of information, security procedures, and configuration of data.

System Configuration

  • The actual physical environment that the EHR resides is targeted in this guide. It includes not only the initial infrastructure of the hardware and software, but also the configuration review and ongoing maintenance.

Contingency Planning

  • Planned and unplanned downtimes or system unavailability can have a significant impact on patient care/safety. This guide provides direction for processes to minimize unscheduled downtime as well as to have detailed policies and procedures for scheduled downtimes.
Clinical Process Guides

Patient Identification

  • This guide focuses on the technology and workflows to ensure accuracy in the entire patient registration process and import of patient demographics information to prevent identity problems caused by duplicate records or overlays.

Computerized Provider Order Entry (CPOE) with Decision Support

  • The CPOE/Decision Support Guide stresses the importance of technology to ensure safety of the complex order entry and associated decision support. Tools include systems such as alerts, interaction checking, duplicate orders, etc.

Test Results Reporting and Follow-Up

  • This guide closes the loop of the preceding guide—use of safe EHR technology to electronically communicate results on the appropriate patient, to the appropriate provider in a timely manner.

Clinician Communication

  • As one of the most common causes of medical errors and patient harm, this guide targets clinician communication and the potential for errors.
Supporting a Multidisciplinary Safety Team Approach

The SAFER Guides are designed to provide a self-assessment tool in each of the above categories that supports a multi-disciplinary safety team approach to address several potential risks and patient safety issues. The guide then provides tools for healthcare organizations to mitigate such risks and ensure future safe use of health IT.

Healthcare organizations have multiple tools to choose from to ensure patient safety and the safe use of health IT, but the important thing to ensure is that they conduct a full assessment that identifies and addresses any potential risks. After the IT team assesses the different IT options, it is important to communicate these options with other organizational stakeholders/business units to make sure the IT investments will not only meet their needs but also the overall strategic goals of the organization—patient safety being one of many.

Resources Health IT and Safety.

Office of the National Coordinator for Health Information Technology. ONC Health IT Safety Program – Progress on Health IT Patient Safety Action and Surveillance Plan. SAFER Guides. SAFER Domains and Principles.


Dawn Paulson is assistant director, health information management at UW Health – University of WI Hospitals and Clinics.

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