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What would be included in HIMSS Level 8 if you were asked to help create it? - @BADR_N111 4/22/2014

Thank you for your question @BADR_N111. According to the EMR Adoption Model (inpatient), or "EMRAM," as the HIMSS Analytics folks call it, HIMSS Analytics Stage 7 capabilities include the following:

"complete EMR; CCD transactions to share data; data warehousing; data continuity with ED, ambulatory, OP." And according to the US Ambulatory EMR Adoption Model, created more recently,

Stage 7 includes the following capabilities: "HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence."

I would say that a Stage 8 for hospitals should incorporate the forward-facing elements in the Ambulatory Adoption Model's Stage 7, as well as performance measurement at the individual provider level (e.g., physician performance and panel analytics dashboards) for employed, and probably also affiliated, physicians, health information exchange with non-affiliated organizations and providers, and robust business intelligence/clinical intelligence. All of these capabilities really are about laying the IT foundation for population health, avoidable readmissions reduction, and quality-based purchasing, among other emerging phenomena.

The reality, of course, is that right now, only a relative handful of hospitals and integrated health systems have all of these elements in place, even in some primitive form. So inevitably, an EMRAM Stage 8 would be aspirational for the vast majority of hospitals and health systems. Still, such a set of capabilities is definitely the direction in which the U.S. healthcare system, under pressure from purchasers and payers to reform itself, is moving.