Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guidelines

Abstract

We read with interest the Special Section in the March 2015 issue of the Archives about “Empowering Pathology in the Era of the Electronic Health Record,” comprising 5 articles commissioned by the Diagnostic Intelligence and Health Information Technology Committee of the College of American Pathologists.1–5 These articles represent an excellent primer for pathologists about the role of pathology within the larger electronic health record (EHR) environment. The EHR has greatly expanded in the last decade, partly owing to a federal mandate for computerized physician order entry (CPOE) and meaningful use requirements. Previously, radiology and pathology information systems supplied most of the data to the electronic medical record (EMR). However, there has been a shift in balance because clinical services are now generating most of the information within the EMR. As mentioned in the articles of this Special Section, it is imperative for pathologists to engage and participate with their enterprise EHR in order to be a part of the conversation, rather than subject to external rules.As pointed out in this series of published articles, several regulatory agencies inspect our laboratories to ensure compliance within our systems. However, few of these agencies address the interrelation between electronic systems. Recently, the Office of the National Coordinator for Health Information Technology released Safety Assurance Factors for EHR Resilience (SAFER) guidelines.6 These guidelines represent a tool for health systems to evaluate the safety between systems within the EHR environment. They are recommended as a self-assessment tool for health care organizations and intended to increase the safety within the whole EHR environment. This is important because unfortunately the EHR introduces unique and often unexpected patient safety risks.7 It has, however, been shown that proactive assessment of risks and vulnerabilities can help address some of these potential EHR-related safety hazards before harm occurs.8It is important that the pathology community be aware of these guidelines, because the laboratory can help fulfill some of the recommendations. The SAFER guidelines include the following 9 guidelines: high priority practice, organizational responsibilities, contingency planning, system configuration, system interfaces, patient identification, CPOE with decision support, test results reporting and follow-up, and clinician communication. Each SAFER guide consists of a checklist of 10 to 25 recommended practices that reflect basic tenets of safe and effective EHR implementation and use. Some of the checklists that are relevant to pathologists are shown in the Table.We commend the authors for this series of articles related to the EHR and recommend that pathologists also familiarize themselves with the SAFER guidelines in the current EHR-enabled health care era.

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