The 8 Rights of Safe EHR Use

The recent passage of the American Recovery and Reinvestment Act of 2009 stimulus package is putting tremendous pressure on physicians in small practices and larger healthcare organizations to implement state-of-the-art electronic health record (EHR) systems within the next 5 years. Incentive payments, beginning as early as 2011, will be allocated to healthcare facilities that meet the “meaningful use” EHR certification criteria, released by the CMS at the end of 2009. Currently, fewer than 20% of hospitals and less than 10% of physicians in private practice meet these criteria. Ideally, implementation of EHR systems should result in lower costs, less duplication, and greater quality of patient care. Hardeep Singh, MD, MPH, and I developed eight essential recommendations to ensure that EHRs are used safely and effectively. Published as a commentary in the September 9, 2009 JAMA, the “eight rights” were based on a systems engineering model for patient safety to realize the full potential of EHRs. These rights include: 1. Hardware or Software. The EHR system must have proper hardware and software to function correctly and ensure efficient workflow. 2. Content. Standardized terms used to describe clinical findings are necessary to ensure that information is shared effectively. 3. User Interface. User interface should allow clinicians to efficiently grasp a complex system in a way they can rapidly recognize and respond to problems. 4. Personnel. Trained and knowledgeable software designers, developers, trainers, and implementation and maintenance staff are essential for EHRs to work safely. 5. Workflow and Communication. Prior to system implementation, there should be careful workflow analyses and testing that account for EHR use. 6. Organizational Characteristics. Continual improvement relies...