Sittig Dean F, Ash Joan S, Wright Adam, Chase Dian, Gebhardt Eric, Russo Elise M, Tercek Colleen, Mohan Vishnu, Singh Hardeep
UT-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Health Science Center at Houston, 6410 Fannin St. UTP 1100.43, Houston, TX, 77030.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code BICC, Portland, OR, 97239-3098.
J Healthc Risk Manag. 2020 Oct;40(2):34-43. doi: 10.1002/jhrm.21434. Epub 2020 Jul 9.
The Office of the National Coordinator for Health Information Technology released the Safety Assurance Factors for EHR Resilience (SAFER) guides in 2014. Our group developed these guides covering key facets of both electronic health record (EHR) infrastructure (eg, system configuration, contingency planning for downtime, and system-to-system interfaces) and clinical processes (eg, computer-based provider order entry with clinical decision support, test result reporting, patient identification, and clinician-to-clinician communication). The SAFER guides encourage healthy relationships between EHR vendors and users. We conducted a qualitative study over 12 months. We visited 9 health care organizations ranging in size from 1-doctor outpatient clinics to large, multisite, multihospital integrated delivery networks. We interviewed and observed clinicians, IT professionals, and administrators. From the interview transcripts and observation field notes, we identified overarching themes: technical functionality, usability, standards, testing, workflow processes, personnel to support implementation and use, infrastructure, and clinical content. In addition, we identified health care organization-EHR vendor working relationships: marine drill sergeant, mentor, development partner, seller, and parasite. We encourage health care organizations and EHR vendors to develop healthy working relationships to help address the tasks required to design, develop, implement, and maintain EHRs required to achieve safer and higher quality health care.
美国国家卫生信息技术协调办公室于2014年发布了电子健康记录弹性安全保障因素（SAFER）指南。我们的团队制定了这些指南，涵盖电子健康记录（EHR）基础设施的关键方面（如系统配置、停机应急计划和系统间接口）以及临床流程（如具有临床决策支持的基于计算机的医嘱录入、检验结果报告、患者识别和临床医生之间的沟通）。SAFER指南鼓励EHR供应商与用户建立健康的关系。我们进行了为期12个月的定性研究。我们走访了9个医疗机构，规模从单医生门诊诊所到大型、多地点、多医院综合医疗网络不等。我们对临床医生、信息技术专业人员和管理人员进行了访谈和观察。从访谈记录和观察现场笔记中，我们确定了总体主题：技术功能、可用性、标准、测试、工作流程、支持实施和使用的人员、基础设施以及临床内容。此外，我们还确定了医疗机构与EHR供应商的工作关系：海军陆战队教官、导师、开发伙伴、销售方和寄生虫。我们鼓励医疗机构和EHR供应商建立健康的工作关系，以帮助完成设计、开发、实施和维护EHR所需的任务，从而实现更安全、更高质量的医疗保健。
