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A critical milestone for hospitals and clinics, deploying an EMR (electronic medical record) system, to receive support from the recent stimulus package will likely need to reach a stage of computerized practician order entry (CPOE) in which physicians are actually entering their orders into the system.  The advancement in EMR interoperability, is choreographed, to a large part, by an 8 stage rating system called EMRAM^SM (EMR Adoption Model). HIMSS Analytics, a division of the Health Information and Management Systems Society (HIMSS), devised the score model in 2005 to help track a hospital’s progress away from paper, supporting healthcare organizations, healthcare IT companies, and consulting firms accomplish just that – a paperless workflow, and perhaps more importantly, a workflow that “includes the 5 rights; right patient, right dose, right time, right drug, right route of administration,” comments Mr. Michael Davis, Executive VP of HIMSS Analytics, providing the highest level of patient safety and reducing the approximately ninety thousand that are killed each year due to errors in medication administration alone, as described in an Institute of Medicine report. Incentives for hospitals to procure and install an EMR, as the healthcare stimulus package is helping to thrust forward, seem to have made an impact as more and more hospitals are implementing the systems.

Healthcare reform, within the American Recovery and Reinvestment Act of 2009, centers on a plan that will invest in electronic health records and new technology that seeks to reduce errors, bring down costs, ensure privacy, and save lives in America’s healthcare system.  To accomplish this foresight, the stimulus package provides healthcare institutions the opportunity to improve and modernize information system infrastructures currently employed to 21st century, truly paperless, electronic medical record systems. 

In pursuit of the goal, EMRAM^SM helps track a hospital’s progress throughout the journey toward an environment where paper charts are completely removed from administering patient care. Monitoring and adhering to an 8 stage process, the EMRAM ^SM defines stage 0 as having no or very little installed ancillaries and stage 7 as having a fully electronic operation, supporting the true sharing and use of patient data, and improving the quality of care and patient safety. The stages are further defined as follows:

• Stage 7 - Medical records are fully electronic; hospital is able to contribute continuity of care document as byproduct of EMR; data warehousing is in use
• Stage 6 - Physician documentation in structured templates; full clinical decision support system in use; full radiological and picture archiving systems in use
• Stage 5 - Closed loop medication administration that addresses every step of medication use process
• Stage 4 - Computerized physician order entry system in use; clinical decision support system in use for clinical protocols
• Stage 3 - Clinical documentation; clinical decision support system in use for error checking; photographic archiving system in use outside radiology
• Stage 2 - Clinical data repository; controlled medical vocabulary, clinical decision support system; may have document imaging
• Stage 1 - Ancillaries (lab, radiology, pharmacy) are installed
• Stage 0 - None of the three ancillaries are installed

Hospitals receive an EMRAM^SM score only through participation in the HIMSS Analytics annual study, which tracks a hospital’s implementation and adoption of each stage, collecting detailed health information technology (HIT) data throughout the process. How difficult is the process and how long does it take?

“It’s a journey,” responds Mr. Davis, saying further that “most of hospitals will tell you that it takes anywhere from 3 to 6 years.”

The time span determination is really about the support and effort put into strategic plans to implement the electronic medical records by the executive teams. The hospitals at stage 7, had significant support and direction from their Chief Executive Officers or Chief Financial Officers, really the whole executive team plus all of their physicians, clinicians, Chief Medical Officers, and Chief Nursing Officers within those environments.

“It is very important to get the ‘buy in’ from the entire team to do it and putting the strategies together.” Mr. Davis explained to MedicExchange, adding, “Some hospitals implement the ‘Big Bang,’ while other hospitals do it incrementally. All these variables impact the timelines but they can be done anywhere from 3 to 6 years.” In 2008, 5,166 hospitals took part in the HIMSS Analytics survey, showing quite an improvement from the year before. 35.7% of hospitals acquired a Stage 3 status, and according to the American Hospital Association (AHA), 68% of hospitals are on track for full EMR adoption.

With stimulus incentives around the corner, the numbers are certainly likely to increase. “Providing the funding, I think,” comments Michael Davis, “will help US hospitals step up to the plate and start to move forward, if they haven't already, and implement these types of systems.” In addition, an increase in full EMR implementation is highly imminent because, as Mr. Davis goes on to say, “the big enterprise EMR vendors out there have very solid products. I think that is going to help a lot too because the vendors are stable and have lots of sites that hospitals can go to look, see, feel, touch, and smell the systems. The maturity of the products is better.” Association executives predict and are encouraged with the advancement of HIT as hospitals would, most likely, be monetary beneficiaries with a 4 or 5 stage rating attainment and beyond.

Interview:

Mr. Michael Davis, Executive VP of HIMSS Analytics explains the purpose and stages of EMRAM^SM ...
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Sources:

http://www.ama-assn.org/amednews/2009/03/16/bisb0316.html

http://www.himssanalytics.org/index.asp