On January 15, 2014, Office of the National Coordinator for Health Information Technology (ONC) released the Safety Assurance Factors for EHR Resilience (SAFER) Guides. The SAFER Guides can be found here.
The SAFER Guides, which are part of ONC’s Health Information Technology Patient Safety Action & Surveillance Plan (July 2013), are self-assessment tools designed to help health care providers identify and mitigate the safety risks associated with the use of EHR and other technology. Although the SAFER Guides include recommended practices for providers, the ONC has expressly disclaimed their use “for legal compliance purposes,” i.e., to evaluate compliance with EHR incentive program rules, HIPAA, or other laws. See ONC, General Instructions for the SAFER Self Assessment Guides (Jan. 2014).
ONC issued nine different SAFER Guides, organized under three umbrella groups:
1. Foundational Guides
i. High Priority Practices
ii. Organizational Responsibilities
2. Infrastructure Guides
iii. Contingency Planning
iv. System Configuration
v. System Interfaces
3. Clinical Process Guides
vi. Patient Identification
vii. Computerized Provider Order Entry with Decision Support
viii. Test Results Reporting and Follow-Up
ix. Clinician Communication
Each guide includes a checklist of recommended practices (generally falling into one of three “phases” of implementation), as well as worksheets to assess progress in implementing each recommended practice on the checklist.
For example, the High Priority Practices guide includes 18 recommended practices on its checklist, such as “Data and application configurations are backed up and hardware systems are redundant”; “Policies and procedures ensure accurate patient identification at each step in the clinical workflow”; and “The EHR is used for ordering medications, diagnostic tests, and procedures.” For each recommended practice, the provider indicates an implementation status of “Fully in all areas”; “Partially in some areas”; or “not implemented.”
Each recommended practice on the checklist has a link to a corresponding worksheet, which allows the provider to record implementation status, assessment notes, and follow-up actions. The worksheet also lists the staff and departments that may be involved in evaluating implementation, and provides examples of “useful” practices. For example, in the High Priority Practices guide, the worksheet for “EHR is used for ordering medications, diagnostic tests, and procedures” lists the following useful practices (among others): “Free text and ‘miscellaneous’ orders are discouraged by providing appropriate supports” and “Policies and procedures are in place that clearly identify and manage hazards associated with ordering that continues to occur outside of the EHR.”
The SAFER guides are not intended to be static documents completed at a specific time for submission to a regulatory authority. Rather, ONC intends for them to be contemporaneously reviewed and updated as the provider works toward implementing better EHR practices.