The advanced use of electronic
health records is starting to accelerate in hospitals, mainly because of the
government's EHR incentive program, concludes a new analysis of HIMSS
Analytics' Electronic Medical Record Adoption Model (EMRAM) scale. The EMRAM
scale is an eight-stage model that indicates where hospitals stand on the EHR
adoption curve.
A survey by HIMSS Analytics, the
research arm of the Health Information Management and Systems Society,
indicates that during the five quarters ended in September 2012, the number of
U.S. acute care hospitals achieving EMRAM stage 5 or 6 increased by more than
80%; the number of facilities in stage 7 rose 63%.
Nevertheless, the percentages of
hospitals that are actually in these stages show that the majority of facilities
have a long way to go before they realize the full potential of their EHRs. In
the fourth quarter of 2012, HIMSS Analytics figures show, just 1.9% of
hospitals had reached stage 7; 8.2%, stage 6, and 14%, stage 5. Three-quarters
of the hospitals were not yet in stage 5.
Although the EMRAM stages have no
direct relationship to the stages of Meaningful Use in the federal incentive
program, the current distribution of hospitals' IT capabilities raises
questions about their ability to meet the requirements of Meaningful Use stage
2.
On the plus side, a hospital in
EMRAM stage 4 has computerized physician order entry (CPOE) and clinical
decision support, both of which are required in Meaningful Use stages 1 and 2.
Facilities in stage 4 have nursing documentation, error checking, and other
capabilities. But they are missing closed-loop medication administration (stage
5), physician documentation and full clinical decision support (stage 6), and
the ability to exchange standardized summary documents with other providers
(stage 7). All of these are required in Meaningful Use stage 2 except for
physician documentation, which is an optional menu item for eligible
professionals.
Health information exchange
capabilities are moving slowly in the right direction as well, according to
John Hoyt, executive VP of HIMSS Analytics. "Facilities moving to the
upper stages of EMRAM are laying the groundwork for interoperability to
occur," he said in a press release. "Stage 6 and Stage 7 hospitals
are fully prepared for provider-to-provider or facility-to-facility
interoperability, as well as increasing the provider or facility's ability to
provide electronic health data reporting to public health and immunization
registries to support population health review and syndromic surveillance."
In an interview with
InformationWeek Healthcare, Hoyt said, "We still have an accelerating rate
of growth in stages 5, 6 and 7. The biggest hurdle is getting physicians to
enter data on their keyboards. Of course, that's required for stage 1 of Meaningful
Use."
That comment referred to the
Meaningful Use stage 1 requirement that clinicians enter pharmacy orders for
30% of patients with at least one pharmacy order through CPOE. Noting that
HIMSS Analytics has always required medication, lab, imaging and other orders
to be done electronically in stage 4, he observed that some hospitals might not
achieve that level in EMRAM, yet still be able to attest to stage 1 Meaningful
Use.
Providers who achieve stage 5 in
EMRAM could probably meet the Meaningful Use stage 2 requirements, Hoyt said,
partly because they already have full CPOE. In addition, EMRAM stage 5 requires
closed-loop medication administration that matches patient IDs with bar codes
on drug packages. Although the Meaningful Use regs aren't so specific, he said,
they "imply" that kind of medication administration.
Asked why it takes most hospitals
so long to get to advanced stages of EHR implementation, Hoyt pointed out,
"It's really difficult to implement these systems with voluntary medical
staffs." In a highly competitive environment, he noted, hospitals want to
make private practice physicians happy, so they don't want to lean on them too
heavily to enter orders through CPOE or do electronic documentation. But
Meaningful Use has leveled the playing field, he said, making it easier for
hospitals to seek physician participation because their competitors are doing
the same thing.
In addition, he said, it's
expensive and time consuming to fully implement clinical systems. "It's
not just a matter of buying software, it's about process redesign. It takes
leadership and access to capital. That's clearly a problem, especially for
small hospitals -- not leadership, but access to capital," he said.
Many hospitals are doubtful about
their ability to achieve Meaningful Use stage 2. In a recent KPMG survey, 47%
of healthcare executives said they were only "somewhat confident"
about their ability to satisfy these requirements. The biggest challenge, the
respondents said, would be training and change management.
Source: informationweek
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