Refreshing HIMSS EMRAM requirements
The HIMSS Analytics Acute Care Electronic Medical Record Adoption Model (EMRAM) – which measures healthcare provider organizations’ technology adoption progress on an eight-stage scale – is more than a decade old. While the model has helped steer hospitals toward greater technology utilization, the time for change has arrived.
With EMRAM leading the way, the journey toward greater technology adoption in healthcare has been well worth the effort.
This year is my 35th anniversary as a nurse. I remember the challenges of paper charts. The days when I needed the chart to reference something but another clinician had the chart – sometimes for hours. It was challenging at times to get a total picture of the patient from the fragmented paper record. Much of our information that was shared was through verbal communication, not written anywhere for reference.
I am a supporter of helping hospitals move to HIMSS Stage 7 because I see value in the EMRAM guidelines. I have seen medication errors decrease due to closed-loop medication administration and clinical decision support. Coordinated care between clinicians is now the standard and not the exception thanks to technology.
EMRAM: Upping the ante
After existing in its current state with only incremental tweaks for the past 10 years, though, HIMSS Analytics is now making substantial changes to the EMRAM in an effort to push healthcare provider organizations even further. During the HIMSS16 session, 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.
To start, Hoyt explained the motivation behind the transformation stems from the desire to up the adoption ante, as healthcare organizations in large part have made substantial progress under the original model and now need to reach for more.
As Hoyt reflected on the events of the past several years, he shed light on this progress. After EMRAM was introduced in 2005, healthcare organizations made slow EMR adoption gains. However, after the Meaningful Use program was signed into law in 2009, EMR adoption accelerated significantly. Indeed, the number of acute-care organizations reaching at least Stage 5 on the scale grew from 3 percent in 2009, to 6 percent in 2013, to 37 percent in 2014, to 67 percent in 2015. With so many hospitals reaching these advanced levels of EMR maturity, the need to make more significant changes to the EMRAM model became apparent.
One of the fundamental changes of the new EMRAM model is that the criteria focus more on the functions accomplished through e-health and less on the descriptions of the technology itself, Hoyt explained. “What do nurses do with a document? What do they document? We’re going to ask for these specific examples. We’re not necessarily asking: do you have a nursing information system?” he said.
In addition, EMRAM standards will become universal, with no variation by continent or region. As such, all organizations reaching certain milestones will be operating on the same plane. “We’re having one worldwide global standard,” Hoyt said.
With the industry reeling from a rash of recent data breaches, HIMSS Analytics also is addressing security in each of the stages, according to Hoyt. However, instead of requiring organizations to implement specific security technologies, they will be asked to simply describe their security protocols.
“The current EMRAM that you know and love has nothing in it about security” – and that is really a vital component with the growing number of data breaches that are affecting healthcare organizations, Hoyt said. “So, now we are building security expectations into each of the stages. We’re not having a requirement; we’re just collecting the data, for some of the items,” he noted. “For example, we’re going to ask for a description of how you physically get into the data center. How do you get in the door? Is it double authentication? Is it key pass? Is it retina scan? For now, we’re just collecting the information. In a couple years, we will probably say ‘OK, let’s go with double authentication, for example.’”
Although the new HIMSS EMRAM requirements are still being vetted, the evolution of the HIMSS EMRAM is exciting because it keeps us moving forward and pushing for continued innovation and better patient care.