EMR Adoption Model: A New EMR Penetration Assessment Tool

Understanding the level of EMR capabilities in hospitals is a challenge in the US healthcare IT
market today. HIMSS Analytics has created an EMR Adoption Model that identifies the levels of
EMR capabilities ranging from the initial CDR environment through a paperless EMR
environment. HIMSS Analytics has developed a methodology and algorithms to automatically
score the approximately 4,000 hospitals in our database relative to their IT-enabled clinical
transformation status, to provide peer comparisons for CDOs as they strategize their path to a
complete EMR and participation in an EHR. The stages of the model are as follows:

Stage 0: Some clinical automation may be present, but all three of the major ancillary
department systems for laboratory, pharmacy, and radiology are not implemented.

Stage 1: All three of the major ancillary clinical systems are installed (i.e., pharmacy,
laboratory, radiology).

Stage 2: Major ancillary clinical systems feed data to a clinical data repository (CDR)
that provides physician access for retrieving and reviewing results. The CDR contains a
controlled medical vocabulary, and the clinical decision support/rules engine for
rudimentary conflict checking. Information from document imaging systems may be
linked to the CDR at this stage.

Stage 3: Clinical documentation (e.g. vital signs, flow sheets) is required; nursing notes,
care plan charting, and/or the electronic medication administration record (eMAR)
system are scored with extra points, and are implemented and integrated with the CDR
for at least one service in the hospital. The first level of clinical decision support is
implemented to conduct error checking with order entry (i.e., drug/drug, drug/food,
drug/lab conflict checking normally found in the pharmacy). Some level of medical
image access from picture archive and communication systems (PACS) is available for
access by physicians via the organization s intranet or other secure networks outside of
the radiology department confines.

Stage 4: Computerized Practitioner/Physician Order Entry (CPOE) for use by any
clinician is added to the nursing and CDR environment along with the second level of
clinical decision support capabilities related to evidence based medicine protocols. If one
patient service area has implemented CPOE and completed the previous stages, then this
stage has been achieved.

Stage 5: The closed loop medication administration environment is fully implemented in
at least one patient care service area. The eMAR and bar coding or other auto identification technology, such as radio frequency identification (RFID), are implemented
and integrated with CPOE and pharmacy to maximize point of care patient safety
processes for medication administration.

Stage 6: Full physician documentation/charting (structured templates) is implemented for
at least one patient care service area. Level three of clinical decision support provides
guidance for all clinician activities related to protocols and outcomes in the form of
variance and compliance alerts. A full complement of radiology PACS systems provides
medical images to physicians via an intranet and displaces all film-based images.

Stage 7: The hospital has a paperless EMR environment. Clinical information can be
readily shared via electronic transactions or exchange of electronic records with all
entities within a regional health network (i.e., other hospitals, ambulatory clinics, subacute
environments, employers, payers and patients). This stage allows the HCO to
support the true electronic health record as envisioned in the ideal model.
The majority of US hospitals are in the early stages of EMR transformation. Currently 19
percent of US hospitals have not achieved Stage 1 and are at Stage 0, 21 percent have
achieved Stage 1, 50 percent have achieved stage 2, approximately eight percent have
achieved stage 3, approximately two percent percent have achieved Stage 4, and less than
one percent of hospitals have achieved stage 5 and stage 6 (see Figure 3).