To measure electronic medical record development in hospitals and health systems, HIMSS Analytics, a division of the HIMSS organization, created its HIMSS Analytics EMR Adoption Model, an eight-stage schematic (encompassing Stages 0 through 7) that helps healthcare IT leaders assess their progress in EMR implementation. Since HIMSS Analytics created the model in 2005, it has formally recognized 61 hospitals as reaching Stage 7-61 in the U.S. and one in Seoul, South Korea (as of press time).
Becoming a paperless enterprise is a long and winding road, as the latest Healthcare Information and Management Systems Society (HIMSS) Analytics Stage 7 healthcare organizations-Tucson Medical Center; University of California, San Diego Health System; and Nemours Children's Health System-can attest. It is one fraught with hard work and challenges, but ultimately rich in patient care benefits and financial payoffs.
Here's an inside-and detailed-look at how three hospital systems achieved HIMSS Analytics Stage 7, an objective measure of progress toward EMR implementation.
The commonalities among the latest winners, says John Hoyt, executive vice president, organizational services, HIMSS, are medical staff adoption and the energy to accept the organizational change to make the “best of a new world.” He also notes that having an enterprise system for clinical and financial information doesn't hurt, either. “It's not the only way to do it,” he says. “But it seems to be the most effective for enterprise adoption and the fastest route to goal achievement, which is process redesign and quality improvement.”
The Stage 7 criteria are rigorous, with contenders being analyzed against a 12-page checklist that includes such elements as disaster recovery, quality improvement, deployment methodology, training methodology, governance, HIE, and data warehousing. Hoyt conducts a phone interview before the site visit to ensure the organization is ready for Stage 7. During the day-long site visit, the organization gives a 60- to 90-minute presentation on its IT strategy, and then Hoyt walks the floors (medical imaging, pharmacy, ED, the med/surg floors, and the HIM department, among others), accompanied by two CIOs and a CMIO to evaluate the organization's paperless-ness. The team then makes its decision onsite.
As of yet, there is no Stage 8, but additional stages involving HIE and accountable care readiness are likely to be created. There will however be an ambulatory adoption model rolled out in next few months that will assess patient engagement strategies, as well as other meaningful use criteria. What follows are stories from the latest organizations to reach Stage 7.
TUCSON MEDICAL CENTER
On its way to becoming an accountable care organization, Tucson Medical Center (TMC), a 612-bed community hospital, reached HIMSS' highest level of EMR adoption. In late 2008, the organization took a concerted approach to move to an enterprise electronic health record (EHR) its leaders have dubbed OneChart. Starting in 2001, TMC replaced its order entry system and pharmacy module (with software from the Verona, Wis.-based Epic Systems Corp.), and in January 2009, implemented the rest of the Epic modules, including revenue cycle management.
Frank Marini, vice president and CIO, says TMC began to see improvement in cash collections and denials, as well as improvement in turnaround times, from the ED to inpatient admission. Brian Cammarata, M.D., CMIO, an anesthesiologist by trade, says that medication turnaround time dramatically reduced from an average of 166 minutes to under 10 minutes. Further improvements came when TMC went live with its bar code medication administration (BCMA) in a big-bang approach in June 2010; the hospital averted 6,000 medication errors within the first six months.
Hoyt is impressed by the lack of clinically oriented paper at TMC and with the fact that its electronic medication administration record (eMAR) is the one place to look for all patient medications. Clinical information at TMC is reviewed by the medical executive community via dashboards that are customized for cardiac, neurosurgery, nursing, and other areas, in addition to specific reports for the quality care committee of the board of directors.