JMIR Publications

ABSTRACT

Background:

Electronic Health Records (EHRs) play a critical role in today’s healthcare by enhancing data management, improving workflows, and supporting clinical decision-making. However, EHR implementation introduces technical and clinical challenges that can compromise patient safety. The SAFER (Safety Assurance Factors for EHR Resilience) guides, developed by the Office of the National Coordinator for Health Information Technology, provide a structured framework for evaluating and optimizing EHR safety practices. Despite extensive research on EHR safety in developed countries, little is known about its implementation in regions with differing healthcare systems, such as Kuwait.

Objective:

This study aims to examine the EHR safety across hospitals in the State of Kuwait via: (i) Conducting a proactive risk-assessment examining current EHR safety practices in the hospitals, and (ii) Proposing recommendations to assist hospitals in improving their EHR safety practices.

Methods:

A quantitative approach was employed to evaluate EHR safety practices in six public hospitals in Kuwait. Multidisciplinary teams completed the SAFER self-assessment questionnaire, scoring their implementation status as “fully,” “partially,” or “not” implemented across nine SAFER guides. Data were analyzed to calculate the percentage of “fully implemented” recommendations for each hospital, guide, and EHR safety domain. Standard deviations were calculated to assess data variability, and comparative analysis was conducted to identify implementation patterns.

Results:

The findings revealed significant variability in the implementation of SAFER recommendations, with an average of 53% of recommendations rated as “fully implemented.” Infrastructure-focused guides, such as System Configuration (77%) and System Interfaces (80%), had the highest implementation rates, while clinical process guides, such as Clinician Communication (25%), scored the lowest. Among the nine SAFER guides, 16 recommendations were unanimously rated as “fully implemented,” while 8 were predominantly rated as “not implemented.” The High Priority Guide showed notable variability, with implementation rates ranging from 17% to 89% across hospitals. Hospitals with longer EHR adoption periods tended to perform better, though hospital size and implementation type showed inconsistent effects on SAFER scores.

Conclusions:

This study highlights the variability and challenges in implementing EHR safety practices in Kuwait’s public hospitals. While technical aspects of EHR safety are prioritized, clinical processes and communication remain underdeveloped, posing risks to patient safety. The SAFER guides proved valuable in identifying gaps and guiding improvements. Future efforts should focus on fostering interdisciplinary collaboration, enhancing leadership engagement, and leveraging advanced technologies to optimize EHR safety. Tailored strategies and further research are essential to adapt SAFER recommendations to Kuwait’s unique healthcare context, contributing to safer and more effective healthcare systems.