418 n www.ajmc.com n MAY 2014 TRENDS FROM THE FIELD © Managed Care & Healthcare Communications, LLC E lectronic health records (EHRs) have the potential to improve the quality and safety of healthcare. 1 Since the enactment of the Health Information Technology for Economic and Clinical Health Act (HI- TECH), 2 organizations have been adopting EHRs at an unprecedented rate. 3 While the challenges of rapid EHR implementation can be numerous and disruptive, EHRs have clear potential to improve quality and safety with bet- ter access to information, 4,5 clinical decision support, 6 and more reliable provider-to-provider communication. 7 Nev- ertheless, in the early stages of an EHR-enabled healthcare system, beneits thus far have been diicult to achieve and unintended consequences have emerged. 8 Clinicians have experienced safety concerns from EHR design and usability features that are not optimal for complex work lows in re- al-world practice settings. 9-11 To respond to these challenges, the Oice of the National Coordinator for Health Informa- tion Technology (ONC) commissioned the 2012 Institute of Medicine Report, “Health IT and Patient Safety: Build- ing Safer Systems for Better Care” 12 and recently released the Health Information Technology Patient Safety Action and Surveillance Plan that lays out their response to these issues. 13 National initiatives to improve the safety of EHRs must be accompanied by practical and helpful strategies for those on the front lines of EHR-enabled care delivery. Strategies to address unintended consequences borne from EHR imple- mentation are nonetheless scarce, and frontline clinicians and healthcare organizations (HCOs) are often unaware of best practices for safe EHR implementation and use. For ex- ample, they often have minimal guidance to handle prob- lems such as too many alerts, 14,15 a slow EHR, or an EHR that requires an excessive number of “clicks” to complete tasks. These are not skills routinely expected of healthcare providers in the past. 16 Clinicians are also not privy to safety The SAFER Guides: Empowering Organizations to Improve the Safety and Efectiveness of Electronic Health Records Dean F. Sittig, PhD; Joan S. Ash, PhD, MLS, MBA; and Hardeep Singh, MD, MPH 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 low of real-world practice. Few strategies exist to address unintended consequenc- es 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 con- ceptual 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 Ofice 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 ef- fectiveness of EHR implementations, identify speciic 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 institu- tions. 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. Am J Manag Care. 2014;20(5):418-423