1st Edition

SAFER Electronic Health Records Safety Assurance Factors for EHR Resilience

Edited By Dean F. Sittig, Hardeep Singh Copyright 2015
    506 Pages 16 B/W Illustrations
    by Apple Academic Press

    506 Pages 16 B/W Illustrations
    by Apple Academic Press

    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.


    1. The Context of EHR Safety and the Need for Risk Assessment

    Defining Health Information Technology-related Errors: New Developments Since To Err is Human; Dean F. Sittig and Hardeep Singh

    Eight Rights of Safe Electronic Health Record Use; Dean F. Sittig and Hardeep Singh

    Electronic Health Record–Related Safety Concerns: A Cross-Sectional Survey; Shailaja Menon, Hardeep Singh, Ashley N.D. Meyer, Elisabeth Belmont, and Dean F. Sittig

    2. Analysis of EHR Safety

    Review of Reported Clinical Information System Adverse Events in US Food and Drug Administration Databases; Risa B. Myers, Stephen L. Jones, and Dean F. Sittig

    Exploring the Sociotechnical Intersection of Patient Safety and Electronic Health Record Implementation; Derek W. Meeks, Amirhossein Takian, Dean F. Sittig, Hardeep Singh, and Nick Barber

    An Analysis of Electronic Health Record-Related Patient Safety Concerns; Derek W. Meeks, Michael W. Smith, Lesley Taylor, Dean F. Sittig, Jeanie Scott, and Hardeep Singh

    3. User Context of Safe and Effective EHR Use

    Rights and Responsibilities of Electronic Health Record Users; Dean F. Sittig and Hardeep Singh

    Rights and Responsibilities of EHR Users Caring for Children; Dean F. Sittig, Hardeep Singh, and Christopher A. Longhurst

    4. Conceptual Foundation of SAFER Guides

    A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems; Dean F. Sittig and Hardeep Singh

    Electronic Health Records and National Patient Safety Goals; Dean F. Sittig and Hardeep Singh

    5. SAFER Guide Development Methods

    Safety Assurance Factors for Electronic Health Record Resilience (SAFER): Study Protocol; Hardeep Singh, Joan S. Ash, and Dean F. Sittig

    6. Overview of SAFER Guides

    The SAFER Guides: Empowering Organizations to Improve the Safety and Effectiveness of Electronic Health Records; Dean F. Sittig, Joan S. Ash, and Hardeep Singh

    A Red-Flag Based Approach to Risk Management of EHR-Related Safety Concerns; Dean F. Sittig and Hardeep Singh

    High Priority Practices for EHR Safety; SAFER Guides

    7. Mitigating EHR Downtimes

    Contingency Planning for Electronic Health Record-based Care Continuity: A Survey of Recommended Practices; Dean F. Sittig, Daniel Gonzalez, and Hardeep Singh

    Downtime; SAFER Guides

    8. Safely Configuring and Maintaining EHRs and System-to-System Interfaces

    Field Study of the System Interfaces SAFER Guide; Rodney E. Howell, Hardeep Singh, and Dean F. Sittig

    System-System Interfaces; SAFER Guides

    Hardware/Software Configuration; SAFER Guides

    9. Assessment of Patient Identification Related Practices

    Matching Identifiers in Electronic Health Records: Implications for Duplicate Records and Patient Safety; Allison B. McCoy, Adam Wright, Michael G. Kahn, Jason S. Shapiro, Elmer V. Bernstam, and Dean F. Sittig

    SAFER Self-Assessment: Patient Identification; SAFER Guides

    10. Assessment of Computer-based Provider Order Entry with Clinical Decision Support

    Development and Field Testing of a Self-Assessment Guide for Computer-Based Provider Order Entry; Carl V. Vartian, Hardeep Singh, Elise Russo, and Dean F. Sittig

    Computerized Provider Order Entry with Clinical Decision Support; SAFER Guides

    11. Assessment of Diagnostic Test Result Reporting and Follow-Up

    Improving Follow-Up of Abnormal Cancer Screens Using Electronic Health Records: Trust but Verify Test Result Communication; Hardeep Singh, Lindsey Wilson, Laura A Petersen, Mona K Sawhney, Brian Reis, Donna Espadas and Dean F Sittig

    Improving Test Result Follow-up through Electronic Health Records Requires More than Just an Alert; Dean F. Sittig and Hardeep Singh

    Ten Strategies to Improve Management of Abnormal Test Result Alerts in the Electronic Health Record; Hardeep Singh, Lindsey Wilson, Brian Reis, Mona K. Sawhney, Donna Espadas, and Dean F. Sittig

    SAFER Self-Assessment Guide: Test Result Reporting and Follow-up; SAFER Guides

    12. Assessment of Clinician-to-Clinician E-Communication

    Improving the Effectiveness of Electronic Health Record-Based Referral Processes; Adol Esquivel, Dean F. Sittig, Daniel R. Murphy, and Hardeep Singh

    SAFER Self-Assessment Guide: Clinician Communication; SAFER Guides

    13. Assessment of Handheld Computing Devices

    Sociotechnical Evaluation of the Safety and Effectiveness of Point-of-Care Mobile Computing Devices: A Case Study Conducted in India; Dean F. Sittig, Kanav Kahol, and Hardeep Singh

    14. Increasing Resilience in an EHR-Enabled Healthcare Organization

    Resilient Practices in Maintaining Safety of Health Information Technologies; Michael W. Smith, Joan S. Ash, Dean F. Sittig, and Hardeep Singh

    SAFER Self-Assessment Guide: Organizational Activities and Responsibilities for Electronic Health Record (EHR) Safety; SAFER Guides

    15. Creating an Oversight Infrastructure for EHR Safety

    Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards; Hardeep Singh, David C. Classen, and Dean F. Sittig

    Patient Safety Goals for the Proposed Federal Health Information Technology Safety Center; Dean F. Sittig, David C. Classen, and Hardeep Singh



    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.