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When It Comes to EHR Adoption, Is Everything Relative?

January 22, 2013
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When it comes to how to judge the pace of EHR adoption, any number of perceptual lenses are possible

The press release published a week ago from the Chicago-based HIMSS Analytics regarding that organization’s recent tracking of electronic health record (EHR) adoption in hospitals was an interesting one, particularly as it could be interpreted in any of a number of ways.

As the organization’s press release noted, progress towards Stages 5, 6, and 7, the top-level stages in the HIMSS Analytics Electronic Medical Record Adoption Model, or “EMRAM,” has accelerated in the past couple of years, not surprisingly, given the influence of the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act. And of course, it’s great news that “In the five most recent quarters for which data is available… acute care hospitals achieving EMRAM Stage 5 or Stage 6 have increased by more than 80 percent; Stage 7 has increased 63 percent.”

Still, the fact that there are still only 105 U.S. hospitals documented as Stage 7 hospitals, and only 451 hospitals currently documented as being Stage 6 hospitals, could also be seen as somewhat disheartening, given that there are nearly 5,000 acute-care hospitals in the United States. That’s about 11 percent of all U.S. hospitals. And in fact, physician documentation  (a “Stage 6” characteristic in the HIMSS Analytics schematic) and sharing of CCD [continuity of care document] data (a “Stage 7” characteristic) components of EHR adoption under the HIMSS Analytics schematic, are core elements under Stage 2 of meaningful use.

So really, everything is relative, isn’t it? Yes, EHR adoption is absolutely accelerating under meaningful use. But the pace of adoption needs to speed up some more, if hospitals are to meet the requirements of MU in the next two years. And those requirements are very common-sensical, when it comes down to it, which is why the HIMSS Analytics schematic harmonizes considerably with the staged requirements under meaningful use.

After all, the core requirements for achieving the stages under the HIMSS Analytics schematic—nursing documentation (Stage 3), CPOE and clinical decision support (Stage 4), Closed-loop medication administration (Stage 5), physician documentation (Stage 6), and true sharing of the CCD (stage 7), which also happen to be core requirements under meaningful use, are core requirements for what the healthcare system needs from  healthcare information technology.

Now, it has been said by many people that the specific elements in the HIMSS Analytics “EMRAM” schematic appear to be arranged slightly arbitrarily, particularly since many hospitals are now implementing physician documentation at the same time or even before closed-loop medication administration (and many experts urge just that sort of strategy). But overall, the logic of the “EMRAM” schematic, just like the logic of the stages of meaningful use, is fundamentally unassailable.

So the remaining question (which of course prompts numerous underlying question) is, how fast can most hospitals in this country make the leap? The jury is out, but what’s clear is that the time to make needed changes and not be considered hopelessly behind as an organization is drawing very near.