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Stage 7 HIMSS EMR Stage Still Elusive in 2010

March 11, 2011
by Jennifer Prestigiacomo
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The EMR Adoption Model has a sobering story to tell

As a journalist I get to speak on a daily basis to people doing amazing technological feats with their organizations, agencies, and associations in the pursuit of improving patient care. Just this week I spoke with Seth Foldy, M.D., M.P.H., director of the Centers for Disease Control and Prevention (CDC) Public Health Informatics and Technology Program Office, as well as Debra Konicek, M.S.N., R.N., managing director, College of American Pathologists, about a new grant-funded program to electronically link hospital labs and public health agencies. (Check back next week for the full report and podcast.) I also talked with Vikas Jain, M.D., chief resident, University of Oklahoma, Department of Family Medicine, about he and his colleagues using a secure mobile service to text message each other regarding patient care via smartphones. They can also look up contact information for primary care physicians and specialists to aid in transitions of care for their patients.

HIMSS EMR Adoption Model
By having all of these amazing conversations, I forget what a small percentage of hospitals and healthcare organizations are actually using a complete electronic health record, sharing patient information via a CCD, using a data warehouse, and linking up ED and ambulatory to the central EMR. The slide below from the HIMSS EMR Adoption Model further emphasizes this fact—the first numerical column shows the percentage of organizations who have reached a particular EMR adoption stage by 2010 Q3, and the second numerical column shows the final stats for 2010. I was really surprised to see that only 1 percent of the country is at Stage 7. And this is up three-tenths of a point from last year, when 37 hospitals achieved the highest maturity rating. About half of the country’s healthcare organizations (49 percent) are at Stage 3, having implemented nursing/clinical documentation, CDSS, and utilizing PACS outside of radiology.

Seeing this slide and other similar studies was definitely the wake-up call I needed to realize that even though the goal of this magazine is to share the best practices and lessons learned from organizations in the upper stages of the adoption model, there are still a majority of other organizations just embarking on their meaningful use journey. Please share your stories below in a comment, and tell us where you’re at.

 

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Comments

Jennifer,
Thanks for a provocative post. Indeed, after all of the time, resources, and smart people working on EMRs, why so little penetration to Stage 7?

I touched on this recently in my Ethics and Meaningful Use post. If Stage 7 really does deliver a significant improvement in outcomes, don't we have more of an imperative to get there, fast?

Based on what I've observed, the problem is never laziness, stupidity, incompetence or simply inadequate resources, at either the vendor or provider organization levels. So what is it?

Here's my brief list of major contributors:

1) Harmful Incentives - economic punishment for using resources more wisely. Patient Protection & Affordable Care Act (PPACA) type models will be essential.

2) Leadership Discipline Deficits - too often, the CEO or board thinks that having the pilot and co-pilot fighting each other, in the cockpit, during flight is a good idea. Read that as department chairs, hospitals and physician groups, etc.

3) Inadequate Vision - EMR Adoption is not simply about replacing paper. It is about orchestrating closed loop processes (and not just medication) that was never possible with paper-modeled processes.

Acceleration toward Stage 7 will demand exploiting the depth and breadth of experience that this magazine routinely highlights, rather than a information-technology-based, gap-filling approach grounded in the three failure modes outlined above. As I outlined in my recent BlindSpots series, ARRA/Meaningful Use only gets us to the starting line in the race to improve care.

Joe: Thank you for adding more depth to my post. I really relate to your No. 2 contributor. A past CEO I worked for really believed that creating infighting among his team really was the spirit of innovation, but sadly all it created was chaos, resentment, and laborious workflows.

At the the Population Health & Care Colloquium I went to today in Philly, Sean Sullivan, JD, Co-founder, President and CEO, Institute for Health and Productivity Management, Scottsdale, AZ touched on this subject as well. He was speaking specifically of what bred strong public and private collaboration, but I think this also speaks to healthcare organizational initiatives as well:
-A collaborative effort can't have too many people at the table
-Must be a small group of like-minded team players
-Must have a common purpose and goals
-And must have a bias for action

Joe: Thank you for adding more depth to my post. I really relate to your No. 2 contributor. A past CEO I worked for really believed that creating infighting among his team really was the spirit of innovation, but sadly all it created was chaos, resentment, and laborious workflows.

At the the Population Health & Care Colloquium I went to today in Philly, Sean Sullivan, JD, Co-founder, President and CEO, Institute for Health and Productivity Management, Scottsdale, AZ touched on this subject as well. He was speaking specifically of what bred strong public and private collaboration, but I think this also speaks to healthcare organizational initiatives as well:
-A collaborative effort can’t have too many people at the table
-Must be a small group of like-minded team players
-Must have a common purpose and goals
-And must have a bias for action


Jennifer Presti...