Journal Article

Adherence to recommended electronic health record safety practices across eight health care organizations

Dean F Sittig, Mandana Salimi, Ranjit Aiyagari, Colin Banas, Brian Clay, Kathryn A Gibson, Ashutosh Goel, Robert Hines, Christopher A Longhurst, Vimal Mishra, Anwar M Sirajuddin, Tyler Satterly and Hardeep Singh

in Journal of the American Medical Informatics Association

Published on behalf of American Medical Informatics Association

Volume 25, issue 7, pages 913-918
ISSN: 1067-5027
Published online April 2018 | e-ISSN: 1527-974X | DOI:

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  • Medical Statistics and Methodology
  • Bioinformatics and Computational Biology
  • Biomathematics and Statistics


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The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown.


We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10–29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: “safe health IT” (total 45 recommendations); “using health IT safely” (total 80 recommendations); and “monitoring health IT” (total 15 recommendations).


The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of “fully implemented” recommendations per guide ranged from 94% (System Interfaces—18 recommendations) to 63% (Clinical Communication—12 recommendations). Adherence was higher for “safe health IT” domain (82.1%) vs “using health IT safely” (72.5%) and “monitoring health IT” (67.3%).


Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

Keywords: electronic health records (EHR); patient safety; risk assessment

Journal Article.  3784 words.  Illustrated.

Subjects: Medical Statistics and Methodology ; Bioinformatics and Computational Biology ; Biomathematics and Statistics

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