Sensitive Information and the Electronic Patient Record
Sensitive Information and the Electronic Patient Record
With nearly 100% of community health centers utilizing electronic health records (EHR) to care for patients, focus has pivoted from implementation and new workflow development to enhancement in order to drive value and reflect patient needs and population trends. EHR technology presents potential opportunities and significant constraints. Providers frequently document and share potentially sensitive information in the EHR, such as risk for intimate partner violence (IPV), consistent offers of pre-exposure prophylaxis (PrEP), or patient sexual orientation and gender identity (SOGI). Capturing such information can be immensely helpful in providing care tailored to individuals’ needs, but additionally challenges teams to develop workflows that keep the data private rather than risk harm to patients through improper or unintended disclosure.
SAFER-1 High Priority Practices
The High Priority Practices SAFER Guide identifies “high risk” and “high priority” recommended safety practices intended to optimize the safety and safe use of EHRs. It broadly addresses the EHR safety concerns discussed in greater detail in the other eight SAFER Guides.
SAFER-2 Organizational Responsibilities
The Organizational Responsibilities SAFER Guide identifies individual and organizational responsibilities (activities, processes, and tasks) intended to optimize the safety and safe use of EHRs. A safe EHR implementation is critically dependent on the people involved.
SAFER-3 Contingency Planning
The Contingency Planning SAFER Guide identifies recommended safety practices associated with planned or unplanned EHR unavailability—instances in which clinicians or other end users cannot access all or part of the EHR. Occasional temporary unavailability of EHRs is inevitable, due to failures of software and hardware infrastructure, as well as power outages and natural and man-made disasters. Such unavailability can introduce substantial safety risks to organizations that have not adequately prepared.
SAFER-4 System Configuration
The System Configuration SAFER Guide identifies recommended safety practices associated with the way EHR hardware and software are set up (“configured”). EHR configuration includes the creation and maintenance of the physical environment in which the system will operate, as well as the implementation of the required hardware and software infrastructure.