EMR Adoption Model

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Created by the HIMSS Analytics group in 2005, the EMR Adoption Model (or EMRAM) is a tool that scores healthcare facility’s levels of IT systems adoption in the United States and Canada. The Purpose of EMRAM is to promote and support hospitals and other health care systems to implement technology in their practice to improve healthcare delivery. This includes improved patient safety, quality care, health information exchange and a paperless environment.

EMRAM Scoring Levels

There are 8 levels total, 0-7, that rate the level of a facility’s EMR capabilities(2). Provided is HIMSS Analytics’ descriptive summary of each stage, from most basic to advanced: [1]

  1. Stage 0, signifies that the “3 key ancillaries”, radiology, laboratory and pharmacy departments, have not been installed .
  2. Stage 1 indicates the 3 ancillaries have been installed at the organization.
  3. Stage 2 reflects the organization’s abilities to submit data to a clinical data repository (CDR) from key ancillary departments. The data is then available for viewing by medical staff. The CDR must have a controlled medical vocabulary, CDS, and may have Image viewing capabilities.
  4. Stage 3 the organization has installed clinical documentation flow sheets, a clinical decision support system has been executed, and there is image viewing accessibility.
  5. Stage 4 Computerized physician order entry (CPOE) has been implemented. CDS have been modified to allow evidence-based medicine (EBM) practices.
  6. Stage 5 Implementation of “closed loop medication administration environment” has occurred in a minimum of one patient service department. Auto-identification technologies have been synced with the CPOE and pharmaceutical department.
  7. Stage 6 Structured templates are used in a minimum of one patient service department. The radiology PACS system is in use, allowing providers to view all medical images through a “intranet or secure-network”.
  8. Stage 7 The organization has achieved the highest level of integration, and functions in a paperless environment. They have full sharing capabilities with other healthcare facilities and Health Information Exchanges (HIEs).

Please visit the HIMSS Analytics website for Current US and Canada EMR Adoption Model Statistics: http://www.himssanalytics.org/hc_providers/emr_adoption.asp

Current EMRAM Accomplishments

There are currently 57 of 5,000 hospitals in the United States that have achieved Stage 7. [2]

The HIMSS Analytics website has a current list of all hospitals that achieved Stage 7. [3]

ASA Satisfaction of Meaningful Use Requirements

The American Society of Anesthesiology (ASA) has determined that current systems easily meet the following criteria of stage I meaningful use requirements:

  1. Records patient demographics
  2. Contains current problem list
  3. Maintains current medication list
  4. Maintains current allergic medication list
  5. Records smoking status
  6. Implements one clinical decision support function
  7. Contains CPOE capabilities
  8. Protects patient information and secures privacy
  9. Contains lab test results
  10. Uses data for Continuous Quality Improvement (CQI) [4]

Benefits of EMR in the Intraoperative Setting

Automate Perioperative Charting

Surgical management solutions automate perioperative charting across all phases of care which include pre-admission testing (PAT), pre-operative, intra-operative and post-operative in order to streamline workflow and reduce redundancy of effort. Well-established systems such as those offered by Cerner and McKesson share data directly from their established EHR. Clinicians receive vital, real-time information at the point of care, helping to provide better, safer care in the operating room and on the floor. Information about fluids, medications, allergies, and other vital patient data is instantly updated in real time and across settings of care to bolster safe decision making and reduce complications. Real time updates which are automated not only increase efficiency, but increases accuracy as well. The care provider can focus more on taking care of the patient rather than the charts. [5]

Optimize Capacity and Throughput

The medical field ha s many opportunities for operational inefficiency. With the high cost of facilities, equipment and personnel, even the smallest waste can have a large impact on the bottom-line. Bottlenecks are reduced as inefficiencies in scheduling are identified. Underbooked facilities and overutilized personnel can be tracked in an objective manner. Procedure scheduling and operating room management activity has profound effects on impact efficiency and finances, like supply management and patient accounting. Integration be between the various hospital settings helps optimize operating room capacity and throughput, control resource utilization, lower supply costs and maximize revenue-all of which improve clinical and financial performance. [6]

Benchmarking, Analytics and Reporting Tools

Benchmarking, analytics, reporting and scorecarding are various tools hospital systems use to assess the efficacy of new processes and allow the comparison to their peers. Monitor key performance indicators and respond proactively to opportunities to improve the productivity and profitability of surgical services while enhancing patient safety in the operating room. As the public and private sector demands more benchmarking in comparing one system versus another, this data will become useful. The current trend in healthcare is to increase patient value. Patient value is defined as an increase in quality over the cost of medical treatment. To enhance patient value, either the quality must improve or the cost must decrease. Analytics will facilitate in objectively identifying strategies which can achieve both ends. [5]

Related Articles

Improving Perioperative Performance: The Use of Operations Management and the Electronic Health Record


  1. U.S. EMR Adoption model trends. HIMSS Analytics website. 2011. [cited 2012 May 31]; [1 screen]. Available from: URL: http://www.himssanalytics.org/docs/HA_EMRAM_Overview_ENG.pdf
  2. HIMSS analytics honors tucson medical center with stage 7 award. HIMSS News [Online]. 2011 Jun 15. [cited 2012 May 31]; [ 1 screen]. http://www.himss.org/ASP/topics_News_item.asp?cid=77640&tid=10
  3. Stage 7 Hospitals http://www.himssanalytics.org/hc_providers/stage7Hospitals.asp
  4. ASA Analysis and Recommendations. http://www.healthit.gov/archive/archive_files/HIT%20Policy%20Committee/2011/2011-05-11/ASA%20Analysis%20and%20Recommends%20for%20MU%20Requirements%284%29.pdf
  5. 5.0 5.1 Hobson & Company. The Case for a Perioperative- Focused Anesthesia Solution: Multiple Benefits from a Single Solution . http://www.sisfirst.com/pdf/articles/100220.pdf
  6. Mckesson. http://www.mckesson.com/providers/health-systems/department-solutions/access-management/pathways-healthcare-scheduling