SAFER Electronic Health Records

This important volume provide a one-stop resource on the SAFER Guides along with the guides themselves and information on their use, development, and evaluation. The Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by the editors of this book, identify recommended practices to optimize the safety and safe use of electronic health records (EHRs). These guides are designed to help organizations self-assess the safety and effectiveness of their EHR implementations, identify specific areas of vulnerability, and change their cultures and practices to mitigate risks.
This book provides EHR designers, developers, implementers, users, and policymakers 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 electronic health records EHR implementations.
The first five chapters are designed to provide readers with the conceptual knowledge required to understand why and how the guides were developed. The next nine chapters focus on the underlying informatics concepts, key research activities, and methods used to develop each of the guides. Each of these chapters concludes with a copy of the guide itself. The final chapter provides a vision for the future and 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.
Taken together, the information provided in this book should help any organization, whether large or small, implement its EHR program and improve the safety and effectiveness of its existing EHR-enabled healthcare systems.
This volume will be extremely valuable to small, ambulatory physician practices and larger outpatient settings as well as for hospitals and professors and instructors charged with teaching safe and effective implementation and use of EHRs. It will also be highly useful for health information technology professionals responsible for maintaining a safe and effective EHR and for clinical and administrative staff working in EHR-enabled healthcare systems.

Dean F. Sittig, PhD, is a professor at the School of Biomedical Informatics at The University of Texas Health Science Center at Houston and a member of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas. Dr. Sittig's research interests center on the design, development, implementation, and evaluation of all aspects of clinical information systems. In addition to Dr. Sittig's work on measuring the impact of clinical information systems on a large scale, he is working to improve our understanding of both the factors that lead to success, as well as the unintended consequences associated with computer-based clinical decision support and provider order entry systems. He is the co-author of three award-winning books from the Healthcare Information and Management Systems Society. Hardeep Singh, MD, MPH, is chief of the Health Policy, Quality & Informatics program at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, and associate professor of medicine at Baylor College of Medicine in Houston, Texas. He is a practicing internist and conducts multidisciplinary research on patient safety improvement in electronic health record-based clinical settings. Dr. Singh received the Academy-Health 2012 Alice S. Hersh New Investigator Award for high-impact research of international significance. In April 2014, he received the prestigious Presidential Early Career Award for Scientists and Engineers from President Obama for his pioneering work in the field of diagnostic errors and patient safety improvement.

Introduction. The Context of EHR Safety and the Need for Risk Assessment. 2. Analysis of EHR Safety. 3. User Context of Safe and Effective EHR Use. 4. Conceptual Foundation of SAFER Guides. 5. SAFER Guide Development Methods. 6. Overview of SAFER Guides. 7. Mitigating EHR Downtimes. 8. Safely Configuring and Maintaining EHRs and System-to-System Interfaces. 9. Assessment of Patient Identification Related Practices. 10. Assessment of Computer-based Provider Order Entry with Clinical Decision Support. 11. Assessment of Diagnostic Test Result Reporting and Follow-Up. 12. Assessment of Clinician-to-Clinician E-Communication. 13. Assessment of Handheld Computing Devices. 14. Increasing Resilience in an EHR-Enabled Healthcare Organization. 15. Creating an Oversight Infrastructure for EHR Safety. Index.