{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:50:35Z","timestamp":1779324635811,"version":"3.51.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,4,26]],"date-time":"2018-04-26T00:00:00Z","timestamp":1524700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Health Care Research and Quality","doi-asserted-by":"crossref","award":["P30HS024459"],"award-info":[{"award-number":["P30HS024459"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007217","name":"VA Health Services Research and Development Service","doi-asserted-by":"publisher","award":["CRE 12-033"],"award-info":[{"award-number":["CRE 12-033"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017101","name":"VA National Center for Patient Safety","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017101","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Health Care Research and Quality","doi-asserted-by":"crossref","award":["R01HS022087"],"award-info":[{"award-number":["R01HS022087"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Health Care Research and Quality","doi-asserted-by":"crossref","award":["P30HS024459"],"award-info":[{"award-number":["P30HS024459"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Health Care Research and Quality","doi-asserted-by":"crossref","award":["R21HS023602"],"award-info":[{"award-number":["R21HS023602"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]},{"name":"HSR&D Center for Innovations in Quality, Effectiveness and Safety","award":["CIN 13-413"],"award-info":[{"award-number":["CIN 13-413"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u201329 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: \u201csafe health IT\u201d (total 45 recommendations); \u201cusing health IT safely\u201d (total 80 recommendations); and \u201cmonitoring health IT\u201d (total 15 recommendations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of \u201cfully implemented\u201d recommendations per guide ranged from 94% (System Interfaces\u201418 recommendations) to 63% (Clinical Communication\u201412 recommendations). Adherence was higher for \u201csafe health IT\u201d domain (82.1%) vs \u201cusing health IT safely\u201d (72.5%) and \u201cmonitoring health IT\u201d (67.3%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocy033","type":"journal-article","created":{"date-parts":[[2018,4,5]],"date-time":"2018-04-05T03:12:47Z","timestamp":1522897967000},"page":"913-918","source":"Crossref","is-referenced-by-count":15,"title":["Adherence to recommended electronic health record safety practices across eight health care organizations"],"prefix":"10.1093","volume":"25","author":[{"given":"Dean F","family":"Sittig","sequence":"first","affiliation":[{"name":"University of Texas\/Memorial Hermann Center for Healthcare Quality and Safety, School of Biomedical Informatics, University of Texas Health Science Center at Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandana","family":"Salimi","sequence":"additional","affiliation":[{"name":"School of Biomedical Informatics, University of Texas Health Science Center at Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjit","family":"Aiyagari","sequence":"additional","affiliation":[{"name":"Michigan Medicine, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Banas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Clay","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Diego, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn A","family":"Gibson","sequence":"additional","affiliation":[{"name":"Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashutosh","family":"Goel","sequence":"additional","affiliation":[{"name":"Bronson Healthcare Group, Western Michigan University Homer Stryker MD School of Medicine, Department of Biomedical Informatics, Kalamazoo, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hines","sequence":"additional","affiliation":[{"name":"Harris County Health System, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher A","family":"Longhurst","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Diego, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vimal","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anwar M","family":"Sirajuddin","sequence":"additional","affiliation":[{"name":"Memorial Hermann Health System, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Satterly","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA"},{"name":"Department of Medicine, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA"},{"name":"Department of Medicine, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,4,26]]},"reference":[{"issue":"12","key":"2020110612381863000_ocy033-B1","doi-asserted-by":"crossref","first-page":"2805","DOI":"10.1377\/hlthaff.2012.0884","article-title":"A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas","volume":"31","author":"Schoen","year":"2012","journal-title":"Health Aff (Millwood)"},{"issue":"12","key":"2020110612381863000_ocy033-B2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s10916-016-0628-9","article-title":"Barriers to electronic health record adoption: a systematic literature review","volume":"40","author":"Kruse","year":"2016","journal-title":"J Med Syst"},{"issue":"5","key":"2020110612381863000_ocy033-B3","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1197\/jamia.M2042","article-title":"Types of unintended consequences related to computerized provider order entry","volume":"13","author":"Campbell","year":"2006","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2020110612381863000_ocy033-B4","first-page":"7","article-title":"New unintended adverse consequences of electronic health records","author":"Sittig","year":"2016","journal-title":"Yearb Med Inform"},{"issue":"5","key":"2020110612381863000_ocy033-B5","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1177\/0018720815576827","article-title":"Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation","volume":"57","author":"Zahabi","year":"2015","journal-title":"Hum Factors"},{"issue":"3","key":"2020110612381863000_ocy033-B6","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.amjmed.2009.07.027","article-title":"Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?","volume":"123","author":"Singh","year":"2010","journal-title":"Am J Med"},{"key":"2020110612381863000_ocy033-B7","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jbi.2015.12.016","article-title":"Measuring the effects of computer downtime on hospital pathology processes","volume":"59","author":"Wang","year":"2016","journal-title":"J Biomed Inform"},{"issue":"5","key":"2020110612381863000_ocy033-B8","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1093\/jamia\/ocw188","article-title":"Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy","volume":"24","author":"Schreiber","year":"2017","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2020110612381863000_ocy033-B9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4338\/ACI-2013-08-RA-0057","article-title":"Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors","volume":"5","author":"Kirkendall","year":"2014","journal-title":"Appl Clin Inform"},{"issue":"3","key":"2020110612381863000_ocy033-B10","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1136\/bmjqs-2012-001419","article-title":"Matching identifiers in electronic health records: implications for duplicate records and patient safety","volume":"22","author":"McCoy","year":"2013","journal-title":"BMJ Qual Saf"},{"issue":"6","key":"2020110612381863000_ocy033-B11","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1136\/amiajnl-2013-001745","article-title":"The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals","volume":"20","author":"Westbrook","year":"2013","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"2020110612381863000_ocy033-B12","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1093\/jamia\/ocv013","article-title":"Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems","volume":"22","author":"Sittig","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"2020110612381863000_ocy033-B13","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1472-6947-13-46","article-title":"Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol","volume":"13","author":"Singh","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"issue":"4","key":"2020110612381863000_ocy033-B14","first-page":"50","article-title":"ONC issues guides for SAFER EHRs","volume":"85","author":"Sittig","year":"2014","journal-title":"J AHIMA"},{"issue":"5","key":"2020110612381863000_ocy033-B15","first-page":"418","article-title":"The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records","volume":"20","author":"Sittig","year":"2014","journal-title":"Am J Manag Care"},{"issue":"19","key":"2020110612381863000_ocy033-B16","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1056\/NEJMsb1205420","article-title":"Electronic health records and national patient-safety goals","volume":"367","author":"Sittig","year":"2012","journal-title":"N Engl J Med"},{"issue":"25","key":"2020110612381863000_ocy033-B17","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1056\/NEJMsr1112158","article-title":"Implementation of the federal health information technology initiative","volume":"365","author":"Blumenthal","year":"2011","journal-title":"N Engl J Med"},{"key":"2020110612381863000_ocy033-B18","article-title":"Improving the safety of health information technology requires shared responsibility: It is time we all step up","author":"Sittig","year":"2017","journal-title":"Healthc (Amst)"},{"issue":"2","key":"2020110612381863000_ocy033-B19","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1136\/amiajnl-2014-002988","article-title":"Patient safety goals for the proposed Federal Health Information Technology Safety Center","volume":"22","author":"Sittig","year":"2015","journal-title":"J Am Med Inform Assoc"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/913\/34150177\/ocy033.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/913\/34150177\/ocy033.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T02:56:17Z","timestamp":1660791377000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/7\/913\/4985886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,26]]},"references-count":19,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,4,26]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocy033","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,7]]},"published":{"date-parts":[[2018,4,26]]}}}