A commentary in the Sept. 9 online edition of the Journal of the American Medical Association sets out a framework of recommendations, based on a systems engineering model for patient safety, to help doctors and hospitals prepare for EHR expansion.

In the commentary, Dean Sittig, PhD, associate professor at the University of Texas School of Health Information Sciences at Houston, and Hardeep Singh, MD, department of medicine, Baylor College of Medicine in Houston, propose eight rights of safe EHR use. The rights, the authors say, “are grounded in Carayon's Systems Engineering Initiative for Patient Safety, a human factors engineering model that addresses work-system design for patient safety.”

The eight rights, or suggestions, that should be followed include:

1. Hardware and software – A clinician or healthcare organization needs to have the right hardware and software in place before implementation can begin.

1. Content – Adoption of a standard EHR vocabulary should be a “prerequisite to implementing advanced clinical decision support.”

1. User interface – EHR information should be readily accessible.

1. Personnel – Healthcare organizations need to hire trained designers, developers, trainers and maintenance staff in order for EHRs to work safely and effectively.

1. Workflow and communication – The EHR needs to be thoroughly tested before a healthcare organization starts implementation.

1. Organizational characteristics – A system needs to be in place to report errors and identify obstacles to safe EHR use.

1. State and federal rules and regulations – Care needs to be taken to ensure that patients’ safety and privacy is protected.

1. Monitoring – Oversight is crucial to the successful implementation of EHR.

“These issues,” said Singh, “are essential to maximize patient care benefits and minimize unintended errors from technology.”