eSafety Processes and Considerations for Implementing a Provincial EHR

Electronic health records (EHRs) are transforming the way healthcare is delivered. They are central to improving the quality of patient care and have been attributed to making healthcare more accessible, reliable and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices(1). This presentation describes how Alberta Health Services (AHS) identified and addressed gaps in their safety systems using Digital Health Canada’s eSafety framework (2). After a detailed audit of programs and systems, AHS embarked on an eSafety transformation project to modernize existing safety standards for a digitally enabled healthcare system of the 21^st century. AHS' eSafety transformation project is the first and largest eSafety initiative of its kind in Canada. The project included fifty-six total deliverables across eight safety domains including: Accountability, Safety Culture, Quality Management, Human Factors, Security Safeguards, Risk Management, Reporting and Effective Response. System level collaboration was required to address all deliverables and embed eSafety into existing practices to ensure safe design, implementation and use of AHS’ new provincial EHR, Connect Care. A high level overview of the project framework, tactical eSafety interventions, and key lessons learned will be provided. One key deliverable will be discussed in detail: the development and implementation of an eSafety Checklist to support safe configuration of EHRs. This checklist was developed to address a gap identified by clinical informatics professionals at AHS. It is estimated that approximately one-third of patient safety incidents following an EHR implementation are caused by its design and use (3). This 642 item checklist was developed to address configuration safety concerns and synthesize best practices in eSafety design for application during the design and build phase of Connect Care. It is a system-agnostic, evidence based tool that has been validated by a panel of experts and has been used to inform safe system design at AHS.