Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guidelines

Introduction Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown. Results During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

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Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol

BMC Medical Informatics and Decision Making ◽

10.1186/1472-6947-13-46 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 25

Author(s):

Hardeep Singh ◽

Joan S Ash ◽

Dean F Sittig

Keyword(s):

Electronic Health Record ◽

Study Protocol ◽

Health Record ◽

Safety Assurance ◽

Electronic Health

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Adherence to recommended electronic health record safety practices across eight health care organizations

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocy033 ◽

2018 ◽

Vol 25 (7) ◽

pp. 913-918 ◽

Cited By ~ 3

Author(s):

Dean F Sittig ◽

Mandana Salimi ◽

Ranjit Aiyagari ◽

Colin Banas ◽

Brian Clay ◽

...

Keyword(s):

Electronic Health Record ◽

Health Care Organizations ◽

National Policy ◽

Health Record ◽

Health It ◽

Clinical Communication ◽

Safety Assurance ◽

Ehr Adoption ◽

Electronic Health ◽

System Interfaces

Abstract Objective The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. Methods We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10–29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: “safe health IT” (total 45 recommendations); “using health IT safely” (total 80 recommendations); and “monitoring health IT” (total 15 recommendations). Results The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of “fully implemented” recommendations per guide ranged from 94% (System Interfaces—18 recommendations) to 63% (Clinical Communication—12 recommendations). Adherence was higher for “safe health IT” domain (82.1%) vs “using health IT safely” (72.5%) and “monitoring health IT” (67.3%). Conclusions Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

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Business: The Electronic Health Record: Front Line Experience

Perspectives on Administration and Supervision ◽

10.1044/aas21.1.18 ◽

2011 ◽

Vol 21 (1) ◽

pp. 18-22

Author(s):

Rosemary Griffin

Keyword(s):

Health Care ◽

Information Technology ◽

Electronic Health Record ◽

Financial Incentives ◽

Best Practice ◽

Health Care Systems ◽

The United States ◽

Health Record ◽

Health Trends ◽

Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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