SAFER Electronic Health Records PDF

INTRODUCTION

Electronic health records (EHRs) have the potential to improve the quality and safety of health care [1]. Since the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH) [2], organizations are adopting EHRs at an unprecedented rate [3]. While the challenges of rapid EHR implementation can be numerous and disruptive, most clinicians prefer EHRs over paper records [4] in the hopes of improving care with better access to information at the point-of-care [5], advanced clinical decision support [6], and more reliable mechanisms for provider-to-provider communication [7]. 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 [8]. 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 [9,10,11]. 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 [12] and recently released the Health Information Technology Patient Safety Action and Surveillance Plan that lays out their proposed response to these issues [13].

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 [14,15], 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 [16]. Clinicians are also not privy to other safety concerns embedded in fl awed interfaces between the various components of the EHR and in the way the EHR system is confi gured. Solutions to these problems are often multifaceted, involving analysis and redesign of workfl ow 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 fi nding and demanding solutions, but they need practical and useful guidance for EHR safety.

With support from the ONC, we used a rigorous, iterative process to develop a set of nine self-assessment guides to optimize the safety and safe use of EHRs (see Table 1) [17]. These guides, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, are designed to help organizations self-assess the safety and effectiveness of their EHR implementations, identify specifi c areas of vulnerability, and change their cultures and practices to mitigate risks.

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 fi rst fi ve 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 fi nal 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.