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

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.