Electronic Medical Record Adoption Model (EMRAM)
The HIMSS Electronic Medical Record Adoption Model (EMRAM) is used to assess EMR implementation and adoption of the technology for hospitals and health systems globally, guiding the data-driven advancement of care in a health system’s acute or inpatient care facilities through EMR technology.
With the EMRAM, optimize your EMR implementation to improve patient care and safety. Leveraging information digitally improves patient safety and satisfaction by reducing errors in care, length of stay for patients and duplicated care orders, among other things. Organizations can use the EMRAM to improve person-enabled health and governance and workforce dimensions of digital health in the acute care setting.
Improve Patient Safety
Evaluate and improve patient safety at your acute facilities by optimizing your EMR implementation to provide access to critical information when and where clinicians need it.
Increase Patient Satisfaction
Reduce time and errors in care delivery and see increased patient satisfaction. Enhance care delivery by having the right information at the right time for both the patient and the clinician.
An effective EMR is one that is designed for the distinct uses of the clinicians who work with it. The EMRAM ensures the workflow and content in the digital tool meets the needs of the clinical teams while monitoring compliance with approved standards.
Effective hospital policies and governance for data security are critical components of a successful EMR implementation. The EMRAM guides the organization in policymaking for the appropriate use of the data the EMR stores and the level of access available to clinician teams and others within the organization.
- The hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images and medical images within its EMR environment.
- Data warehousing is used to analyze patterns of clinical data to improve quality of care, patient safety and care delivery efficiency.
- Clinical information can be readily shared via standardized electronic transactions (i.e., CCD) with all entities that are authorized to treat the patient or with a health information exchange (HIE) (i.e., other non-associated hospitals, outpatient clinics, sub-acute environments, employers, payers and patients in a data sharing environment).
- The hospital demonstrates summary data continuity for all hospital services (e.g., inpatient, outpatient, ED, and with any owned or managed outpatient clinics).
- Physician documentation and computerized practitioner order entry has reached 90% (excluding the ED), and the closed-loop processes have reached 95% (excluding the ED).
- Technology is used to achieve a closed-loop process for administering medications, blood products and human milk, and for blood specimen collection and tracking. These closed-loop processes are fully implemented in 50% of the hospital. Capability must be in use in the ED, but the ED is excluded from the 50% rule.
- The eMAR and technology in use are implemented and integrated with computerized practitioner order entry, pharmacy and laboratory systems to maximize safe point-of-care processes and results.
- A more advanced level of clinical decision support (CDS) provides for the “five rights” of medication administration and other “rights” for blood product, human milk administrations and blood specimen processing.
- At least one example of a more advanced level of CDS provides guidance triggered by physician documentation related to protocols and outcomes in the form of variance and compliance alerts (e.g., VTE risk assessment triggers the appropriate VTE protocol recommendation).
- A mobile/portable device security policy and practices are applied to user-owned devices. The hospital conducts annual security risk assessments, and a report is provided to a governing authority for action.
- Full physician documentation (e.g., progress notes, consult notes, discharge summaries, problem/diagnosis list, etc.) with structured templates and discrete data is implemented for at least 50% of the hospital. Capability must be in use in the ED, but the ED is excluded from the 50% rule.
- The hospital can track and report on the timeliness of nurse order/task completion.
- An intrusion prevention system is in use to both detect and prevent possible breaches. Hospital-owned portable devices are recognized and properly authorized to operate on the network and can be wiped remotely if lost or stolen.
- 50% of all medical orders are placed using computerized practitioner order entry (CPOE) by any clinician licensed to create orders. CPOE is supported by a clinical decision support (CDS) rules engine for rudimentary conflict checking, and orders are added to the nursing and clinical data repository environment.
- CPOE is in use in the ED but not counted in the 50% rule.
- Nursing/allied health professional documentation has reached 90% (excluding the ED).
- Where publicly available, clinicians have access to a national or regional patient database to support decision-making (e.g., medications, images, immunizations, lab results, etc.).
- During EMR downtimes, clinicians have access to patient allergies, problem/diagnosis list, medications and lab results. A network intrusion detection system is in place.
- Nurses are supported by a second level of CDS capabilities related to evidence-based medicine protocols (e.g., risk assessment scores trigger recommended nursing tasks).
- 50% of nursing/allied health professional documentation (e.g., vital signs, flowsheets, nursing notes, nursing tasks, care plans) is implemented and integrated with the clinical data repository (hospital defines formula). Capability must be in use in the ED, but the ED is excluded from the 50% rule.
- The Electronic Medication Administration Record (eMAR) application is implemented.
- Role-based access control is implemented.
- Major ancillary clinical systems are enabled with internal interoperability feeding data to a single clinical data repository (CDR) or fully integrated data stores that provide seamless clinician access from a single user interface for reviewing all orders, results, and radiology and cardiology images.
- The CDR/data stores contain a controlled medical vocabulary, and order verification is supported by a clinical decision support rules engine for rudimentary conflict checking.
- Information from document imaging systems may be linked to the CDR at this stage.
- Basic security policies and capabilities addressing physical access, acceptable use, mobile security, encryption, antivirus/anti-malware and data destruction are in place.
- All major ancillary clinical systems are installed (laboratory, pharmacy, radiology and cardiology).
- A full complement of radiology and cardiology PACS systems provides medical images to physicians via an intranet and displaces all film-based images. Patient-centric storage of non-DICOM images is also available
- The organization has not installed all key ancillary department systems (laboratory, pharmacy, radiology and cardiology).