Earlier this month, the leaders of HIMSS Analytics, a subsidiary of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), issued a press release announcing significant gains in the percentages of U.S. hospitals reaching advanced stages in electronic medical record/electronic health record (EMR/EHR) development, according to the organization’s widely cited schematic, known as the Electronic Medical Record Adoption Model, or EMRAM.

According to HIMSS Analytics, the percentage of U.S. acute-care hospitals achieving Stages 5 and 6 (of the seven-stage schematic) has increased by more than 80 percent, while the percentage achieving Stage 7 has increased by 63 percent, while hospitals at Stages 0, 1, 2, and 3 have seen decreases of at least 10 percent.

“This data suggests that the HITECH portion of the 2009 stimulus law is achieving its intended result of encouraging increased implementation and meaningful use of electronic health records among hospitals, John Hoyt, executive vice president of HIMSS Analytics, said in a statement within the press release, of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Following up on the announcement, HCI Editor-in-Chief Mark Hagland spoke recently with Michelle Glenn, senior director of product management at HIMSS Analytics, to discuss further the forward movement of EMR/EHR implementation and clinical IS adoption in U.S. hospitals. Below are excerpts from that interview.

Qualitatively speaking, how do you interpret these new results with regard to your organization’s schematic, the EMRAM?

If you look at the elements in Stages 5, 6, and 7, that’s where we’re really seeing the strong growth; hospitals are moving out of the earlier stages. And Stage 5 involves closed-loop medication administration. And in order to begin sharing things electronically, you’ve got to have the systems in place, and structured in a meaningful way, to share the data electronically. And that’s really what Stages 5, 6, and 7 are about. Because Stage 5 involves the capture of data at the bedside; and that’s where you’ve got to have all clinically relevant data in place, so that you’re abiding by the five rights of medication administration.

And that’s where you’ll see huge leaps in the quality of care and the reduction of medical errors. In Stage 6, you get into the physician documentation and the structured data. And what is part of that aspect of sharing data across whole enterprises. And by Stage 7, you can use the data to drive outcomes. So the best way of looking at the model and how it correlates to the meaningful use incentives is that you’re seeing this huge growth in the upper-level stages, and it is that more and more hospitals are capturing more and more clinically relevant data. So more and more hospitals are capturing clinically relevant data at the point of care, and they’ve got the systems in place so that at the point of care, they’re really able to achieve advanced clinical decision support, which is where you’re really going to see improved patient care.

Michelle Glenn

Is the pace about the same as what you were expecting right now?

I don’t know what we were expecting, really; we were expecting the meaningful use stages to drive the adoption of EHRs; but I don’t know whether we were really expecting a faster rate or not. But we obviously are encouraged by it.

Are hospitals moving fast enough right now in their EHR adoption to meet the requirements of meaningful use?

I think they’re probably moving as fast as they can, given the challenges they face, and given the dynamics of the industry. It’s a huge investment; there are a lot of players; the vendors need to provide certified products; and in some cases, they might have to switch systems, in order to ensure that they’ve got a certified EHR in place. And in many cases, they’ve got processes they need to change, and they need to do training, etc. So I think it’s a very positive rate. And from our perspective, again, we’re very encouraged by the rate. To say they should be moving faster, I just can’t speak to that; there are a lot of dynamics that they need to deal with.

above: the HIMSS Analytics EMRAM model/schematic

What kinds of qualitative comments are you hearing from out in the field?

I don’t hear people saying either that it’s harder or easier than they thought it would be; everyone’s just very focused on accomplishing it. What is clear is that some hospitals already have the structures and cultures in place to drive adoption and to drive data collection, and to create an environment that’s really going to improve outcomes through this. So people are just very focused on accomplishing all this.

Is there anything  else you would like to add?

When we go out and do our Stage 7 site visits, one thing they all have in common is that they all have a culture of continuous process improvement, and they move towards the elements they want to see. And that really is the key element that drives the adoption of EHRs.