The Office of the National Coordinator for Health Information Technology has released updated guides to help providers assess the safety and usability of their respective electronic health record systems.

First published in January 2014, the ONC Safety Assurance Factors for EHR Resilience (SAFER) guides are voluntary provider self-assessments that take the form of vulnerability checklists as well as evidence-based recommendations and best practices for how to safely use health IT.

Also See: ONC guide focuses on adopting EHRs to aid patient safety

Recommended best practices in the SAFER guides help organizations know what to do to optimize the safety and safe use of their EHRs. Specifically, the guides address nine areas—high-priority practices; organizational responsibilities; contingency planning; system configuration; system interfaces; patient identification; computerized provider order entry with decision support; test results reporting and follow-up; and clinician communication.

Each guide contains 10 to 25 recommended practices that can be assessed as fully implemented, partially implemented or not implemented.

“These checklists allow you to work through a really simple format for asking yourself questions about your system as it exists right now,” says Rebecca Freeman, ONC’s chief nursing officer. “It gives you the chance to systematically identify gaps or hotspots that may need a little attention.”

Rebecca Freeman

Key updates to the SAFER guides include:

  • The Test Results and Follow-up Reporting Guide, which recommends practices to optimize the safety and safe use of the EHR with respect to diagnostic testing, calls for improving communication of abnormal results to patients. It’s based on recommendations from a 2015 National Academy of Medicine report.
  • The Contingency Planning Guide, which identifies recommended safety practices associated with planned or unplanned EHR unavailability, addresses best practices for prevention and mitigation of ransomware attacks as well as new recommendations about “downtimes”—those times when systems are completely unavailable or partially unavailable, when response times are unacceptably slow.

Freeman notes that she came to ONC “out of the implementation space” where she has “implemented—from start to finish—these health records” in ambulatory and community hospital settings. At the same time, she contends that, despite widespread adoption of EHRs by provider organizations “they’re not super user-friendly for many of our clinicians,” regardless of the healthcare environment in which the systems operate.

“Many of the reasons for usability and user experience issues have to do with the decisions that were made when the system was being put in place,” says Freeman. “What we need to focus on now is how to make the systems more usable and really keep an eye towards safety.”

According to Freeman, usability refers to the extent to which an EHR system supports the cognitive work of the end user, and the extent to which the design of the user interface makes it easy for the user to complete tasks while minimizing the chance of user error.

For instance, she points out that many EHR alerts are often ignored by clinicians who suffer from “alert fatigue,” in which staff are constantly inundated with these notifications and simply tune them out. “There’s a lot of evidence that shows that you only get X number of alerts before people stop paying attention,” Freeman notes. “If your pop-ups aren’t tightly managed from a governance process, then you have too many things firing.”

She asserts that the SAFER guides, which have been downloaded by about 52,000 users to date, can help providers better configure and implement their EHR systems for improved usability and safety. The goal is to optimize them and make sure that they support clinicians rather than detract from their workflow and create more work.

Correctly identifying patients and accurately matching them to their EHRs continues to be a daunting challenge. To avoid these errors, ONC’s Patient Identification SAFER guide identifies recommended safety practices associated with the reliable identification of patients in the EHR.

Nonetheless, the guide warns that “technology configurations alone cannot ensure accurate patient identification” and that “staff also must be supported with adequate training and reliable procedures.”

For her part, Freeman believes that “there’s a lot of good work being done in the private sector” to solve the problem of patient misidentification such as the $1 million National Patient ID Challenge launched by the College of Healthcare Information Management Executives, which aims to create a solution that ensures 100 percent accuracy in matching every patient to their health information to reduce preventable medical errors.

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