Mike Davis, a well-known healthcare IT leader, is perhaps best known as one of the developers of the HIMSS Analytics EMRAM [electronic medical record adoption model] schematic, which he and other members of the HIMSS Analytics team developed in 2005. HIMSS Analytics is a division of the Chicago-based HIMSS (Healthcare Information & Management Systems Society). The EMRAM, according to the website devoted to the subject, “is an eight stage (0-7) model that measures the adoption and utilization of EMR functions required to achieve a near paperless environment that harnesses technology to support optimized patient care.” Since the development of the original EMRAM, HIMSS Analytics introduced its an Outpatient Electronic Medical Record Adoption Model, or O-EMRAM, in 2010. The EMRAM model has also been modified for use in various regions of the world.
Meanwhile, in June 2017, Davis joined the Orem, Utah-based KLAS Research, as lead analyst. He continues to assess and analyze the state of electronic health record (EHR)/electronic medical record (EMR) development across the inpatient and outpatient healthcare sectors in the U.S., and internationally. The Colorado-based Davis spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the current state of EHR development, and where things are headed. Below are excerpts from that interview.
When you take a 40,000-feet-up view of the past ten years in terms of EHR development, and consider the trajectory for the next few years, what to do you see? Do you think perhaps that we’re at an inflection point in terms of EHR adoption and optimization right now?
I think you’re right that we’re at an inflection point in all this. As always, I think the government is trying to do the right thing, but sometimes, the execution isn’t right. Meaningful use pushed hospitals to implement EHRs as quickly as possible, but it wasn’t always with the engagement of clinicians. So we’ve got the EHRs going now, but a lot of times, the clinicians are up in arms, because some of them see them purely as billing systems. So where we are today is that, now that we’ve got them implemented, and clinicians have to use EHRs, to report on quality measures—how do we go back now and really work with the clinicians to make these EHRs usable? What are the best approaches to actually accomplishing that, so the systems are able to drive quality of care and patient safety? Those are the things you want to look at now.
In essence, given the legislation that created the meaningful use process, EHRs kind of had to be implemented by shotgun, correct? That was one of the key challenges beginning in 2009 [with the passage of the HITECH Act—the Health Information Technology for Electronic and Clinical Health Act, signed into law in Feb. 2009].
Yes. There were some people who knew what was coming in advance, and that’s what the EMRAM was all about.
Do you feel satisfied that the EMRAM has been used correctly in the industry?
You have to consider the broad history of the efforts to measure EHR adoption both quantitatively and qualitatively. EMRAM was the first objective measure of what was going on with the EMR [in patient care organizations]. Before we introduced EMRAM, there had been efforts, such as the Davies Awards, Most Wired, things like that. But we introduced EMRAM in order to look at the full spectrum of EMR capabilities. And now, at KLAS, we’ve created an initiative called the Arch Collaborative. The icon of KLAS is the Delicate Arch in Canyonlands [Utah—the state where KLAS Research is based]. So they incorporated that symbol. The thing about the organizations that did EMRAM early—the organizations that early on got to Stages 6 and 7—is that those organizations had cultures that were very focused on improving the EMR, and making it something that would be a benefit to their clinicians. And the groups involved in the Arch Collaborative, are comparable groups of people.
The thing is, it’s a bit discouraging every time I hear someone say, “Well, we just bought an EMR from one of the big vendors, and it cost $100 million or $200 million on our EMR, and now, we’re hoping to get something out of it”—that speaks to some of the challenges we still face [in terms of strategically implementing and using EHRs].
Totally agreed. The thing is, the way in which the meaningful use process came about, while it tended to straitjacket EHR implementation processes, without meaningful use under HITECH, we would still have relatively low EHR adoption even now, correct?
Yes, I absolutely agree; had the government not pushed this, we would have made very little progress. The challenge is that the academic people want outcomes data, without understanding the impact on clinician workflow; and the vendors want to quickly modify systems to get payments. And meaningful use has slowed down, and we’ll see if Stage 3 even gets implemented. But I think everyone understands that the data being collected is valuable; and that we’ll be able to get better insights into best practices, and how they’re impacting outcomes, and making sure we reward quality as we pay people; those are pretty important concepts.