SAFER Guides are self-assessment tools made to help healthcare groups check how safe and strong their EHR systems are. CMS and ONC experts first created these guides in 2016. The guides include checklists with recommended steps, worksheets you can use, and examples. They focus on avoiding identification errors, making sure the system is used correctly, managing access controls, and keeping an eye on the EHR’s performance all the time.
In 2025, CMS released updated SAFER Guides needed for the 2026 review year, with proof of completion due in 2027. These newer guides include changes to match new technology and rules. They cover things like using artificial intelligence in care, better cybersecurity, and letting patients see their clinical notes as required by the 21st Century Cures Act.
Hospitals that qualify, like Critical Access Hospitals (CAHs), and medical groups in the Medicare Promoting Interoperability Program must do yearly self-checks with the SAFER Guides. Also, clinicians in the MIPS program or eligible groups must confirm they finished the High Priority Practices SAFER Guide every year. If they don’t, they get a zero score, which hurts their overall ratings and payments.
The SAFER Guides include nine main areas. These are divided into foundational, infrastructure, and clinical process topics:
Each SAFER Guide has a checklist with 10 to 25 recommended steps. During the self-review, healthcare teams check if the steps are fully done, partly done, or not started. The new 2025 guides added new progress levels like “Making Progress,” “Halfway There,” “Substantial Progress,” and “EHR Limitation” if the system does not support a needed feature.
Recommendations have four strength levels:
This system helps groups know what needs their urgent attention.
Using SAFER Guides is not something done once; it needs teams from different areas working together all the time. Healthcare leaders must set up clear plans that include clinicians, IT experts, safety staff, and managers.
Here are important steps for healthcare groups:
Include people from different roles so the review covers technical, clinical, and administrative sides. Clinicians share info about workflows and safety risks. IT people check system abilities and limits. Managers handle policies and compliance.
The organization should pick dates that work with reporting rules, like the December 31 deadline for MIPS clinicians. Preparation means collecting EHR logs, survey results, incident reports, policy papers, and needed data.
Teams use the worksheets to check each suggested practice. They note the current status, gaps, and what needs fixing. The guides give examples and reasons for each practice to help understanding.
After finding gaps, teams make a plan that includes giving out resources, training staff, updating software, and changing policies. Assigning who does what and setting deadlines is important to keep things moving.
SAFER Guides encourage ongoing checks. Groups should do self-assessments regularly—first, then every year, and after big changes like software updates or workflow changes. This helps keep improving safety.
Healthcare groups, especially small practices or Critical Access Hospitals with fewer resources, may need outside help to use SAFER Guides.
CMS offers support through the Quality Payment Program Service Center by phone and email. They answer questions about SAFER Guides and MIPS reporting. The QPP website has documents, registration, and deadlines about SAFER Guide proof.
This group, supported by the Agency for Healthcare Research and Quality, runs webinars with SAFER Guide authors like Dean F. Sittig, Ph.D., and Hardeep Singh, M.D., M.P.H. These sessions explain how to do self-assessments and use SAFER practices in safety culture. They also cover leadership, safety culture, accountability, and involving patients and families.
The AMA offers tools such as the STEPS Forward™ EHR Transitions Module. It helps practices move from paper records to electronic systems. Other trade groups have case studies, guides, and tools for choosing or upgrading EHR functions aligned with SAFER Guide advice.
Besides organizational knowledge, it is important to have health IT experts, EHR makers, and health information management (HIM) professionals involved. HIM professionals especially help with patient ID and record management, key parts in SAFER Guides.
The SAFER Guides focus on current best methods and safety factors for EHRs. The 2025 updates add points about artificial intelligence (AI) in clinical care. AI and automation can help healthcare groups fix gaps found in SAFER self-assessments.
AI tools in EHRs analyze large data in real time. They give alerts, reminders, and suggestions to help clinicians make better decisions. This cuts down errors and helps follow evidence-based rules. When AI matches SAFER’s focus on decision support systems, it makes patient care safer by reducing missed warnings, wrong orders, or delays.
Many risks come from admin mistakes or slow work, such as wrong patient matches or delays in test follow-ups. AI-powered automation creates strong patient matching to cut down ID risks, a major point in SAFER’s Patient Identification Guide.
Also, automated steps for tracking test results and sending follow-up reminders help make sure no critical lab results are missed. These tools lower manual work for clinical and office staff, letting them focus more on patient care.
Good EHR use depends on how workflows are designed. AI looks at how users interact with the system to find common slowdowns or problems. It keeps watching these patterns so groups can improve workflows, fix system settings, and make better interfaces. This ongoing work supports SAFER’s goal of making EHRs safe and effective.
Automated tools that collect and report data help groups prepare SAFER self-assessment paperwork. Dashboards linked to EHRs can pull safety data, progress notes, and usage logs automatically. This makes reviews more accurate and faster.
Medical leaders, owners, and IT managers in the U.S. face challenges shaped by federal rules, budgets, and patient needs. Following Medicare’s Promoting Interoperability and MIPS programs is key to keep funding and avoid penalties.
Medical practices should know SAFER Guides are tools to fit their practice size, resources, and workflows. Small practices might start with high-priority safety steps. Large hospitals can use many SAFER Guides to improve infrastructure.
Building a culture that values safety and constant improvement fits well with SAFER Guide use. Leaders must focus on clear communication, involving staff, and being honest about safety issues and how to fix them. These things help long-term success beyond just following rules.
SAFER Guides are self-assessment tools designed for healthcare organizations to evaluate their electronic health record (EHR) safety practices, identify potential risks, and mitigate those risks, thereby optimizing the safe use of EHRs.
The SAFER Guides are intended for eligible hospitals, critical access hospitals (CAHs), and MIPS eligible clinicians participating in the Medicare Promoting Interoperability Program.
The purpose of the SAFER Guides is to help organizations reduce EHR-related patient safety risks and foster a culture of safety within healthcare settings.
Eligible clinicians under MIPS must report ‘yes’ or ‘no’ on completing an annual self-assessment using the High Priority Practices SAFER Guide.
The self-assessment for MIPS eligible clinicians must be completed by December 31 of the performance year.
Leaving the SAFER Guides measure submission blank will result in a score of 0.
Eligible hospitals and CAHs are required to attest ‘yes’ or ‘no’ to completing an annual self-assessment using all nine SAFER Guides.
Assistance can be sought from the Center for Clinical Standards and Quality help desk or the Quality Payment Program Service Center.
If hospitals do not complete the assessment, they must report ‘no,’ which signifies they have not met the annual self-assessment requirement.
The additional resources section includes documents like the 2023 MIPS Specification Sheet and the MIPS SAFER Guides Fact Sheet.
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