The Safety Assurance Factors for EHR Resilience (SAFER) Guides are a set of checklist-based self-assessment tools to improve safety on how EHR’s are used. Consisting of nine guides split into three broad groups that each measure a requirement under the Protect Patient Health Information Objectives.
SAFER helps health systems conduct proactive risk assessments of electronic health record safety related policies, processes, procedures, and configurations.
After a study revealed that only 18% of participating healthcare organizations implemented the recommended EHR safety practices, CMS made it a requirement to complete SAFER assessments.
High Priority Practices
The High Priority Practices SAFER Guide identifies “high risk” and “high priority” recommended safety practices intended to optimize the safety and safe use of EHRs. It broadly addresses the EHR safety concerns discussed in greater detail in the other eight SAFER Guides. Assembling a multi-disciplinary safety team is recommended to complete this guide, as a team will be best equipped to identify which EHR- related safety practices should be addressed first and which of the other SAFER Guides to turn to next.
Completing the self-assessment in the High Priority Practices SAFER Guide requires the engagement of people both within and outside the organization (e.g., EHR technology developers, diagnostic services providers).
Organizational Responsibilities
The Organizational Responsibilities SAFER Guide identifies individual and organizational responsibilities (activities, processes, and tasks) intended to optimize the safety and safe use of EHRs. This guide, compared to all of the other SAFER Guides, focuses chiefly on human behavior and relationships, and it is organized differently than the other guides. In particular, it includes principles that apply to the people who have responsibility for patient safety in EHR-enabled healthcare organizations. Safe EHR implementations require attention to social as well as technical matters.
Contingency Planning
The Contingency Planning SAFER Guide identifies recommended safety practices associated with planned or unplanned EHR unavailability—instances in which clinicians or other end users cannot access all or part of the EHR. Occasional temporary unavailability of EHRs is inevitable, due to failures of software and hardware, infrastructure, as well as power outages and natural and man-made disasters.
Effective contingency planning addresses the causes and consequences of EHR unavailability and involves processes and preparations that can minimize the frequency and impact of such events, ensuring continuity of care.
System Configuration
The System Configuration SAFER Guide identifies recommended safety practices associated with the way EHR hardware and software are configured. EHR configuration includes the creation and maintenance of the physical environment in which the system will operate, as well as the implementation of the required hardware and software infrastructure. Working through this guide with a multi-disciplinary team will focus the team’s attention on configuration-related recommended practices to optimize the safety and safe use of the EHR.
System Interfaces
The System Interfaces SAFER Guide identifies recommended safety practices intended to optimize the safety and safe use of system-to-system interfaces between EHR-related software applications. Many healthcare organizations are involved in planning, implementing, or maintaining enterprise- or community- wide clinical information systems that require integration. Such integration occurs most often via interfaces between software applications, often from different system developers. These interfaces send and receive information, enabling disparate systems to operate on the same data.
Patient Identification
The Patient Identification SAFER Guide identifies recommended safety practices associated with the reliable identification of patients in the EHR. Accurate patient identification ensures that the information presented by and entered into the EHR is associated with the correct person. Technology configurations alone cannot ensure accurate patient identification. Staff also must be supported with adequate training and reliable procedures.
This self-assessment can help identify and evaluate where breakdowns related to patient identification occur in the healthcare setting. The self-assessment focuses on processes within organizations related to the creation of new patient records, patient registration, retrieval of information on previously registered patients, and other types of patient identification activities. The recommended practices can help prevent or detect and mitigate problems caused by duplicate records, patient mix-ups, and overlayed records.
This guide is meant to support and enable patient matching technology and capabilities, focusing on best practices for improving data accuracy, which is the first necessary step to ensuring accurate patient matching.
Computerized Provider Order Entry with Decision Support
The Computerized Provider Order Entry with Decision Support SAFER Guide identifies recommended safety practices associated with computerized provider order entry (CPOE) and clinical decision support (CDS). Completing this self-assessment in collaboration with a multi- disciplinary team will help an organization optimize the safety and safe use of CPOE with CDS in the EHR. The use of CPOE with CDS can improve medication safety as well as ensure that providers who electronically order diagnostic tests and consultations remain in the communication loop. Substantial evidence suggests that well-designed CDS not only enhances the quality of care, but directly improves patient safety by decreasing common errors and preventing omissions or missed opportunities that result in patient harm.
Test Results Reporting and Follow-Up
The Test Results Reporting and Follow-Up SAFER Guide identifies recommended safety practices intended to optimize the safety and safe use of processes and EHR technology for the electronic communication and management of diagnostic test results.
This guide offers recommended practices related to the content and communication of test results to the clinician, as well as recommended practices related to the documentation and follow-up of test results. If implemented and used correctly, EHRs have the potential to improve diagnostic test result reporting and follow-up.
Clinician Communication
The Clinician Communication SAFER Guide identifies recommended safety practices associated with communication between clinicians and is intended to optimize the safety and safe use of EHRs. Communication breakdowns between clinicians are one of the most common causes of medical errors and patient harm.
This self-assessment is intended to increase awareness of practices that can improve the safety of EHR-based communication and support the proactive evaluation of particular risks. It can help identify and evaluate sources of potential communication breakdowns, with a focus on processes related to electronic communication between clinicians. The self-assessment specifically targets three high-risk processes: consultations and referrals, discharge- related communications, and patient-related messaging between clinicians.
For more information on each guide, visit the SAFER page of the HealthIT.gov website.
All MIPS eligible clinicians must attest to completing a SAFER assessment. In order to earn a score greater than zero for the Promoting Interoperability performance category, MIPS eligible clinicians must:
Complete the activities required by the SRA and High Priorities Practices SAFER Guide, submit their complete numerator and denominator or yes/no data for all required measures, and attest to the Actions to limit or restrict compatibility or interoperability of CEHRT statement.
Failure to report at least a “1” in all required measures with a numerator or reporting a “No” for a Yes/No response measure (except for the SAFER Guides measure) will result in a total score of 0 points for the Promoting Interoperability performance category.
*** Hospitals have to do all 9
*** Clinicians have to do 1/9
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