In part one of Refreshing HIMSS EMRAM Requirements, we discussed how the HIMSS Analytics Acute Care Electronic Medical Record Adoption Model (EMRAM) is more than a decade old and about to be refreshed.
John Hoyt, executive vice president emeritus of HIMSS Analytics, outlined why extensive changes now are needed; provided an overview of some of the overarching adjustments; and drilled down to the details of the changes associated with specific stages.
Under Stage 1, healthcare providers previously were required to supply results from radiology, laboratory and pharmacy systems online. The new requirements add results from picture archiving and communications systems (PACS) to the list.
“PACS, which used to be in Stage 5, is now in Stage 1. PACS is no longer an evolving product. It’s really mature with massive market saturation. In fact, there’s a replacement market in place,” Hoyt said, pointing to the fact that technology implementation has changed significantly in the past decade.
To earn Stage 2 recognition, organizations still need to install and maintain a clinical data repository. However, under the revised definition, users must be able to sign in once to access information from multiple context-aware systems, which is not uncommon in large university hospitals in Europe.
“[Some] hospitals, though, have one system for the ICU, a different system in cardiology, a different system in ED, a different system for MedSurg, but the user doesn’t know that the information is from different systems,” Hoyt said. “That’s what we are looking for. You’ve got to have a single user interface [that enables access to] multiple data stores that have context-aware linkage.”
Another major change that surfaces in Stage 3 and subsequent stages is the fact that healthcare provider organizations will now need to meet specific criteria in more than 50 percent of their departments to get credit for the function.
“When we started EMRAM in 2005, if you were live on one nursing ward you get credit for that function. We are no longer doing that. What we are saying is you must be live on greater than 50 percent of wards or patient bays or inpatient cases,” Hoyt said. In addition, the functionality must be live in the emergency department.
The new requirements also employ a “stair-step” approach that raises the requirements as organizations move up the ladder of stages. For instance, at Stage 3, nursing and allied health will be required to reach 50 percent electronic documentation but at Stage 4, they need to hit 90 percent.
With the proposed new guidelines in place, HIMSS Analytics now is drafting survey questions, definitional text, scoring mechanisms and an implementation timeline. The new criteria are expected to be put into effect no earlier than January 1, 2017. Healthcare provider organizations can look to their trusted healthcare IT partners to help guide them to success under the evolving EMRAM.
The evolution of the HIMSS EMRAM is critical as we continue to advance how we deliver healthcare. We’ve made great strides but there is still plenty of moving forward and pushing for continued innovation and better patient care.