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thumbnail VA, an early pioneer in the use of electronic health records, has also supported research to promote safe, reliable use of the technology.  ( Photo ©iStock SDI Productions)

VA, an early pioneer in the use of electronic health records, has also supported research to promote safe, reliable use of the technology. (Photo ©iStock SDI Productions)

VA researchers' guidelines on electronic health records adopted into Medicare policy

September 14, 2021

By Mitch Mirkin
VA Research Communications

Guides developed by VA researchers to promote safe use of electronic health records are part of a new federal policy on Medicare reimbursement to hospitals.

The new policy was published Aug. 13 and will take effect in January 2022 . The policy calls for hospitals to take advantage of extensive guides and checklists developed based on years of research by Dr. Hardeep Singh and his team at the Michael E. DeBakey VA Medical Center in Houston. His main collaborator and co-developer has been Dr. Dean Sittig, a professor at UTHealth School of Biomedical Informatics.

"We see this as a landmark development in EHR safety policy that impacts all U.S. hospitals."

‘SAFER Guides‘

Through a series of studies, the researchers developed a comprehensive compendium of safety checklists known as the SAFER Guides. “SAFER” stands for “Safety Assurance Factors for EHR Resilience.” “EHR” is shorthand for electronic health records. The guides are sponsored by the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services.

Singh is a professor at Baylor College of Medicine and an investigator at the Center for Innovations in Quality, Effectiveness and Safety (IQuESt), a VA-funded research center at the DeBakey VA Medical Center.

Stimulating hospitals’ self-assessments

With the new Medicare payment rules, all U.S. hospitals eligible for reimbursement will have to attest annually that they have assessed their electronic health record use based on the SAFER Guides.

The guides cover areas such as communication among clinicians, test results reporting and follow-up, and contingency planning. They walk hospital personnel through detailed steps to ensure they are using electronic health records as safely as possible. Use of the SAFER Guides is one of several requirements and measures in the new Medicare rules.

“This new measure will stimulate hospitals to self-assess various aspects of their EHR-related patient safety proactively, without posing much additional measurement or reporting burden,” notes Singh. “We see this as a landmark development in EHR safety policy that impacts all U.S. hospitals.”

Singh’s research in general has focused on understanding and reducing diagnostic errors; using health information technology to improve health care; and improving the safety of electronic health records. In 2016, he and his team received the Health System Impact Award from VA Health Services Research & Development.

Singh and Sittig have authored or coauthored many influential journal articles reporting findings on patient safety and health information technology, and offering recommendations on how VA and other health care systems could improve in this area.

Singh says it’s gratifying to see how “the products and innovations we create as researchers can impact policy and practice at the national level.”


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The researchers behind the SAFER Guides (see main story) say the makers of electronic health records should design or modify their products to ensure that health care systems can meet the safety recommendations spelled out in the guides.

Drs. Hardeep Singh and Dean Sittig expressed this view in a paper published Sept. 10  in the Journal of the American Medical Association (JAMA).

Referring to new Centers for Medicare and Medicaid Services (CMS) rules that require hospitals to use the SAFER Guides, Sittig says: “What this new rule didn’t do is require EHR developers to use the SAFER Guides. So, we are recommending that developers of EHR systems should annually assess their products as well. This will ensure that their customers can implement and use the EHR as recommended in the SAFER Guides.”

Sittig and Singh recommend three specific strategies to complement the new Medicare rules:

  • EHR developers should self-assess their products annually against SAFER recommendations and indicate whether their EHR can be configured to meet each SAFER recommendation.
  • The Office of the National Coordinator for Health Information Technology should conduct yearly reviews of SAFER recommendations to keep up with EHR design, development, and configuration changes.
  • EHR developers should disseminate guidance to customers on how to implement safety practices related to their product.

The authors say these strategies reinforce the new CMS regulations and more evenly distribute the responsibility for safety improvements.



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