System Interfaces

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Download the PDF guide to access the checklist of recommended practices for self assessment and a supporting worksheet to identify action steps to achieve those recommended practices.

The System Interfaces SAFER Guide identifies recommended safety practices intended to optimize the safety and safe use of system-to-system interfaces between EHR-related software applications. Many healthcare organizations are involved in planning, implementing, or maintaining enterprise- or community-wide clinical information systems that require integration.1 Such integration occurs most often via interfaces between software applications, often from different system developers. These interfaces send and receive information, enabling disparate systems to operate on the same data.

System interface projects are complex because they involve many stakeholders (e.g., clinicians, administrators, and information technologists) in various departments, often with differing agendas. Stakeholders must work with hardware devices and software applications that are developed independently, while integrating them flawlessly with complex clinical work processes. Well-designed and well-developed system interfaces enable reliable physical and logical connection of different systems. System interfaces require physical equipment (e.g., hardware such as plugs, cables, and cards), software that controls the data and information that is exchanged, and concepts (e.g., data protocols and controlled vocabularies) that control the interactions between systems. In addition to these technical issues, interfaces involve social and organizational factors, such as agreements to provide data in a consistent format and to use data to refer to concepts in a consistent manner (i.e., multiple systems must manage and coordinate any change to the meaning of a data item). Processes and preparations must be in place to ensure appropriate configuration and maintenance of interfaces.2 For example, a mapping error between the order entry system and the pharmacy can cause dispensing of the wrong drug.3 Similarly, researchers have identified errors in the transmission of free-text comment fields between the order entry application and the pharmacy system.4

Completing the self-assessment in the System Interfaces SAFER Guide requires the engagement of people both within and outside the organization (such as EHR technology developers). Because this guide is designed to help organizations prioritize interface-related safety concerns, including the meaning of the data in the EHR, clinician leadership in the organization should be engaged in assessing whether and how any particular recommended practice affects the organization's ability to deliver safe, high quality care. Collaboration between clinicians and staff members while completing the self-assessment in this guide will enable an accurate snapshot of the organization’s system interface status (in terms of safety), and even more importantly, should lead to a consensus about the organization's future path to optimize EHR-related safety and quality: setting priorities among the recommended practices not yet addressed, ensuring a plan is in place to maintain recommended practices already in place, dedicating the required resources to make necessary improvements, and working together to prevent and mitigate the highest priority interface-related safety risks introduced by the EHR.

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