SAFER Domains and Principles

The SAFER Guides are designed to help health care organizations (such as hospitals, clinics, and clinician office practices) optimize the safety and safe use of EHRs. Eight of the guides (all except the Organizational Responsibilities SAFER Guide) are organized according to Domains and Principles described below. Domains remind organizations which aspect of health IT safety is being addressed as they adopt EHRs and build safety into their maintenance and use of health IT. Domains overlap, build and depend upon each other. In general, the second and third domains assume that “Domain 1” recommended practices on safety concerns unique to EHRs have been considered and are being addressed. Once the EHR is in clinical use, organizations should consider how to integrate the recommended practices in all domains into routine operations, based upon assessment of those practices. Within each domain, the recommended practices address principles that suggest “why” the recommended practices are needed, although any given recommended practice may support several principles that support health IT safety.

The recommended practices in the Organizational Responsibilities SAFER Guide are organized under the same domains described below, but also map to a unique set of principles applicable across all three domains and relevant for patient safety programs at any phase of EHR adoption, implementation, or use. These principles are described in the Organizational Responsibilities guide itself.

Domain 1 | Safe Health IT — Address Safety Concerns Unique to EHR Technology

Principle: Data Availability

EHRs and the data or information contained within them are accessible and usable upon demand by authorized individuals.

Principle: Data Quality and Integrity

Data or information in EHRs is accurate and created appropriately and have not been altered or destroyed in an unauthorized manner.

Principle: Data Confidentiality

Data or information in EHRs is only available or disclosed to authorized persons or processes.

Domain 2 | Using Health IT Safely — Optimize the Safe Use of EHRs

Principle: Complete/Correct EHR Use

EHR features and functionality are implemented and used as intended.

Principle: EHR System Usability

EHR features and functionality are designed and implemented so that they can be used effectively, efficiently, and to the satisfaction of the intended users to minimize the potential for harm. For information in the EHR to be usable, it should be easily accessible, clearly visible, understandable, and organized by relevance to the specific use and type of user.

Domain 3 | Monitoring Safety — Use EHRs to Monitor and Improve Patient Safety

Principle: Safety Surveillance, Optimization, and Reporting

As part of ongoing quality assurance and performance improvement, mechanisms are in place to monitor, detect, and report on the safety and safe use of EHRs, and to optimize the use of EHRs to improve quality and safety.