Bridging Global Frameworks and Local Practice: Quantitative Evaluation of Electronic Health Record Safety in Kuwait's Public Hospitals.

Background: Electronic health records (EHRs) play a critical role in today's health care 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 Safety Assurance Factors for Electronic Health Record 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 health care systems, such as Kuwait. Objective: This study aims to examine the EHR safety across hospitals in the State of Kuwait via (1) conducting a proactive risk assessment examining current safety practices and (2) proposing recommendations to improve EHR safety practices. Methods: A quantitative approach was used to evaluate EHR safety practices in 6 public hospitals. Multidisciplinary teams completed the Safety Assurance Factors for Electronic Health Record Resilience self-assessment questionnaire, scoring their implementation status of 165 recommended practices as "fully," "partially," or "not" implemented across 9 Safety Assurance Factors for Electronic Health Record Resilience guides. Data were analyzed to calculate the percentage of "fully implemented" recommended practices 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 recommended safety practices, with an average of 53% rated as "fully implemented" across hospitals. 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 9 guides, 16 recommended practices 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 safety practices scores. Conclusions: The study highlights variability in EHR safety practice implementation across Kuwait's public hospitals, with stronger performance in technical domains and gaps in clinical processes. By applying the Safety Assurance Factors for EHR Resilience guides in a non-US context, the study offers a foundational understanding of EHR safety implementation in Kuwait's public health care system. Given the study's limited scope and reliance on self-reported data, findings should be interpreted with caution. Future research should adopt broader sampling and mixed methods approaches to validate these results and inform the development of context-specific strategies to enhance EHR safety and patient outcomes.