SAFER guides: Safety Assurance Factors for EHR Resilience

The SAFER Guides are self-assessment booklets designed to help healthcare organizations optimize the safety and safe use of electronic health records (EHRs). Each begins with a checklist that can be used by a multidisciplinary team for assessing their organization’s level of implementation of each recommended practice.

CHPSO was among six quality oversight and patient safety organizations to review guidelines and dissemination plans, along with the ECRI Institute, Institute for Safe Medical Practices (ISMP), The Joint Commission (TJC), National Patient Safety Foundation (NPSF), and Pascal Metrics. As part of the roll out, CHPSO plans to ensure that hospitals can share locally developed practices, as there is no set of standard “safest” practices yet identified. Please contact CHPSO if you have any questions.

There are nine guides in all:

  1. High Priority Practices
  2. Organizational Responsibilities
  3. Contingency Planning
  4. System Configuration
  5. System Interfaces
  6. Patient Identification
  7. CPOE with Decision Support
  8. Test Results Reporting and Follow-up
  9. Clinician Communication

Unless a hospital has identified one of the nine topics as its first priority, CHPSO recommends that hospitals begin with the “High Priority Practices” guide, as that guide includes a selection of topics from all other guides.

Except for the “Organizational Responsibilities” guide, each guide is divided into phases and principles:

  1. Phase 1: Address safety concerns unique to EHR technology
    1. Principle: availability
    2. Principle: quality and integrity
    3. Principle: confidentiality
  2. Phase 2: Optimize safe use of EHRs
    1. Principle: complete and correct EHR use
    2. Principle: EHR system usability
  3. Phase 3: Use EHRs to monitor and improve patient safety
    1. Principle: safety surveillance, optimization and reporting

The “Organizational Responsibilities” guide is divided into the following principles:

  1. Defined decision-making activities ensure EHR safety
  2. Activities to optimize EHR quality and data quality ensure EHR safety
  3. Activities to ensure safe use of the EHR to prevent EHR safety hazards
  4. Activities to ensure the availability of information in the EHR to prevent EHR safety hazards
  5. Activities to ensure the availability of information in the EHR to prevent EHR safety hazards
  6. Activities to help the organization learn from EHR safety efforts to prevent EHR safety hazards

Copies of the guides are available for download on this page. More information can be found at