Feeling SAFER About Healthcare: A Q&A with MEDITECH Senior Director Janet Desroche

1) Why were the Safety Assurance Factors for EHR Resilience (SAFER) Guides created, and who authored/maintains them?

Following the release of the 2012 Institute of Medicine report Health IT and Patient Safety: Building SAFER Systems for Better Care, the Office of the National Coordinator for Health Information Technology (ONC) formed a team to develop self-assessment guides to help organizations proactively detect and reduce patient safety risks associated with EHRs. The resulting products, known as the SAFER Guides, address two foundational aspects of EHR implementation and use, three areas of the computing infrastructure, and four clinically-focused, error-prone processes (resulting in nine guides or topics).

There are three primary authors of the SAFER Guides:

• Dean F. Sittig, PhD: Dean is a professor of biomedical informatics at the University of Texas Health Science Center at Houston.
• Joan S. Ash, PhD, MLS, MBA: Joan is a professor and vice chair in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University.
• Hardeep Singh, MD, MPH: Hardeep is chief of the Health Policy, Quality, and Informatics Program at the VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, and an associate professor of medicine at Baylor College of Medicine.

Both Dean Sittig and Hardeep Singh have led research and published studies that address (1) safe and effective use of technology in the clinical setting and (2) uses of advanced clinical decision support interventions to improve quality and safety, as well as reduce the costs of healthcare.

2) How does MEDITECH utilize the SAFER Guides?

Let’s look at the topic of Patient Identification. As we researched challenges and opportunities related to this subject, we incorporated information from the associated SAFER Guide. The Patient Identification Safe Practices Checklist includes rationale, examples, and suggested stakeholders. While we have employed EHR design principles that align with the recommendations, we must also consider how the software is configured, implemented, and used in the customer’s environment. We’re working diligently to provide customers with guidance on how to best configure customer-defined settings for optimal patient safety, as well as best practices for implementation.

Within the CPOE SAFER Guide, a host of issues are addressed with an emphasis on clinical decision support, effective communication, and effective design of the user experience (including management of alert fatigue). MEDITECH has incorporated the recommendations in the tools we provide to our customers. For example, we just recently presented a Doctors’ Hours session on management of alert fatigue associated with medication ordering alerts.

3) Do we encourage customers to use the guides? Do we know of any customers using them and experiencing success?

During last year’s Customer EHR Patient Safety Advisory Board (CEPSAB) meeting, the SAFER Guides were discussed. We were pleased to hear that several members — those leading EHR-related patient safety efforts within their healthcare organizations — use the guides. Somewhat prompted by guidance provided in The Joint Commission publication for Sentinel Event #54, our customer advisors felt the SAFER Guides were a well-designed framework for ensuring they use their EHR in alignment with best practices. As such, MEDITECH added these resources  to our EHR Safety Corner page — they can be found via the Search function.

4) With so many resources out there, what about SAFER Guides particularly excites and interests you and MEDITECH as a whole?

As I previously mentioned, it is the responsibility of EHR vendors to apply sound principles to EHR software development, so we can maximize the opportunity to provide caregivers with effective, user-centered design and high-functioning clinical decision support — while also minimizing the opportunity for error. In addition, we must continually work with customers to identify where we need to add preventative measures associated with patient safety event avoidance. And, this is still not enough. We must help customers implement the system and monitor its use — promoting optimal workflow that avoids EHR safety issues. The AHRQ (Agency for Healthcare Research and Quality), ISMP (Institute for Safe Medication Practice), ECRI Institute, and other safety organizations are sources for guidance. However, the SAFER Guides pull recommendations from the literature and from these other sources and present them in an easy-to-use checklist format.

5) How does MEDITECH keep pace with ever-changing regulations and initiatives, and how are they communicated to us?

MEDITECH has dedicated staff who closely monitor all Federal and State regulations and standards in order to ensure the development of quality, compliant software. We actively participate with industry workgroups and provide feedback on new legislation. Changes to regulations and standards are tracked in a database, and information is shared with staff to determine necessary action. Furthermore, customers are educated of the related impact via Knowledge Base articles, newsletters, email/task notification, and much more.

6) Looking ahead, are there other utilization plans or ways we can utilize the SAFER Guides in the future?

We will continue to use the SAFER Guides and other resources to inform our software design and implementation recommendations. In addition to expanding how we incorporate the SAFER tools, new topics will inevitably arise. Just recently, a number of studies and prescriptive papers on the risks associated to copying and pasting within electronic Physician Documentation were released. Copy and paste has been a known risk for some time — the American Health Information Management Association (AHIMA) as well as the Office of the Inspector General have provided advisories on the importance of having policies in place. The ECRI Institute and the Partnership for Health IT Patient Safety recently released a guide — Safe Practice Recommendations for the Use of Copy and Paste — which offers in-depth information on the prevalence of copy and paste error in the EHR, how its use can lead to adverse events, and best practice recommendations. This is in alignment with the guidance provided in the SAFER Guides and is information we will incorporate into MEDITECH’s best practices.