Sittig Dean F, Ash Joan S, Singh Hardeep
UT-Memorial Hermann Center for Healthcare Quality and Safety, 6410 Fannin St, UTPB 1100.43, Houston, TX 77030. E-mail:
Am J Manag Care. 2014 May;20(5):418-23.
Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare.
电子健康记录（EHRs）有潜力提高医疗保健的质量和安全性。然而，EHR用户对EHR的设计和可用性特征存在安全担忧，这些特征并未针对现实世界实践的复杂工作流程进行优化。针对EHR和其他健康信息技术实施产生的意外后果，几乎没有应对策略。我们建议，配备EHR的组织应考虑对其基于EHR的医疗系统进行“主动风险评估”的策略，以识别和解决与EHR相关的安全问题。在本文中，我们描述了一种与EHR相关的自我评估策略的概念基础，为机构提供一个安全工作的基础。在美国国家卫生信息技术协调办公室（ONC）的支持下，我们采用了严格的迭代过程来开发一套9种自我评估工具，以优化EHR的安全性和安全使用。这些工具被称为EHR恢复力安全保证因素（SAFER）指南，可用于自我评估EHR实施的安全性和有效性，识别特定的脆弱领域，并创建解决方案和文化变革以降低风险。各种受众都可以进行这些评估，包括不同医疗机构的一线临床医生或护理团队，或大型机构内的临床、质量或行政领导。这些指南采用多方面的基于系统的方法来评估风险，并使组织能够与内部或外部利益相关者（如EHR开发者）合作，优化EHR功能，并利用EHR推动医疗保健质量和安全性的提高。
