Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 1;32(4):755-760.
doi: 10.1093/jamia/ocaf018.

Revisions to the Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides to update national recommendations for safe use of electronic health records

Dean F Sittig  1   2 , Trisha Flanagan  3 , Patricia Sengstack  4 , Rosann T Cholankeril  3 , Sara Ehsan  3 , Amanda Heidemann  5 , Daniel R Murphy  3   6 , Hojjat Salmasian  7 , Jason S Adelman  8   9 , Hardeep Singh  3   6
Affiliations

Revisions to the Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides to update national recommendations for safe use of electronic health records

Dean F Sittig et al. J Am Med Inform Assoc. .

Abstract

The Safety Assurance Factors for Electronic Health Record (EHR) Resilience (SAFER) Guides provide recommendations to healthcare organizations for conducting proactive self-assessments of the safety and effectiveness of their EHR implementation and use. Originally released in 2014, they were last updated in 2016. In 2022, the Centers for Medicare and Medicaid Services required their annual attestation by US hospitals.

Objectives: This case study describes how SAFER Guide recommendations were updated to align with current evidence and clinical practice.

Materials and methods: Over nine months, a multidisciplinary team updated SAFER Guides through literature reviews, iterative feedback, and online meetings.

Results: We reduced the number of recommended practices across all Guides by 40% and consolidated 9 Guides into 8 to maximize ease of use, feasibility, and utility. We provide a 4-level evidence grading hierarchy for each recommendation and a new 5-point rating scale to self-assess implementation status of the recommendation. We included 429 citations of which 289 (67%) were published since the 2016 revision.

Discussion: SAFER Guides were revised to offer EHR best practices, adaptable to unique organizational needs, with interactive content available at: https://www.healthit.gov/topic/safety/safer-guides.

Conclusion: Revisions ensure that the 2025 SAFER Guides represent the best available current evidence for EHR developers and healthcare organizations.

Keywords: electronic health records; health policy; safety.

PubMed Disclaimer

Conflict of interest statement

None declared.

References

    1. Sittig DF, Salimi M, Aiyagari R, et al. Adherence to recommended electronic health record safety practices across eight health care organizations. J Am Med Inform Assoc. 2018;25:913-918. 10.1093/jamia/ocy033 - DOI - PMC - PubMed
    1. Singh H, Ash JS, Sittig DF. Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol. BMC Med Inform Decis Mak. 2013;13:46. 10.1186/1472-6947-13-46 - DOI - PMC - PubMed
    1. Sittig DF, Ash JS, Singh H. The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records. Am J Manag Care. 2014;20:418-423. - PubMed
    1. Sittig DF, Singh H. Toward more proactive approaches to safety in the electronic health record era. Jt Comm J Qual Patient Saf. 2017;43:540-547. 10.1016/j.jcjq.2017.06.005 - DOI - PMC - PubMed
    1. Sittig DF, Sengstack P, Singh H. Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. JAMA. 2022;327:719-720. 10.1001/jama.2022.0085 - DOI - PubMed

Publication types

LinkOut - more resources