Most hospitals somewhere along road to EMRs

Even in advance of the stimulus package, adoption of electronic records is increasing.

By Pamela Lewis Dolan — Posted March 16, 2009

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An analysis of hospital health IT systems found that not only are more hospitals implementing electronic medical record systems, compared with a year ago, but the systems are becoming more sophisticated.

HIMSS Analytics, which rates hospital EMR systems on an eight-stage scale, announced in February that 42 hospitals are in the top two tiers of implementation, with 15 hospitals reaching the highest stage for the first time since the group started conducting the quarterly surveys in 2005. Those hospitals will be announced at an April 6 awards ceremony by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

However, those hospitals represented fewer than 1% of the 5,166 hospitals that responded to the survey. More hospitals are somewhere in the middle to lower stages, with functions in place such as clinical documentation, error-detecting clinical decision support and photographic archiving systems outside of radiology.

Michael W. Davis, executive vice president of HIMSS Analytics said he was encouraged by the findings.

"As I look at where the market is moving I think the U.S. has done a pretty good job overall because, remember, all of the stuff they [hospitals] have been doing, they have been funding on their own. There has been no help from the government," Davis said. "I'm just hoping that when we get the funding, we don't mess that up."

The society in 2005 began rating hospitals quarterly with an eight-stage rating system called the EMR Adoption Model. Stage 0 represents no or very little installation, while Stage 7 represents hospitals that are fully electronic with medical records.

The data are self-reported by participating hospitals, with validation by HIMSS for Stage 6 or Stage 7.

Since the survey was published in February, Davis said, more hospitals have entered Stage 6, bringing that total number to 32, with 15 hospitals still in Stage 7.

Recent entries into Stage 6 range from the 4,049-bed UPMC system in Pittsburgh to the 55-bed Parkview Adventist Medical Center in Brunswick, Maine.

The stage that saw the largest increase (from 25.1% to 35.7%) since 2007 was Stage 3, which includes clinical documentation systems that mostly affect the nursing environment.

Hospitals with EMRs in the higher stages are the ones impacting physicians who would be expected to do clinical documentation, create continuity of care records within the EMR, and use clinical support tools for everything from error detection to clinical protocols.

Rod Piechowski, senior associate director of policy for the American Hospital Assn., said he found the survey's findings encouraging, especially when coupled with the AHA's finding that 68% of hospitals are on the road to full EMR adoption.

Don E. Detmer, MD, president and CEO of the American Medical Informatics Assn., said the findings were a "really clear indication of the work that lies ahead." Dr. Detmer said he hoped that forthcoming stimulus package money dedicated to advancing health information technology will help further the efforts.

Davis and Piechowski both said they, too, were encouraged at the potential the stimulus money will bring in advancing EMR use. Davis said while government reporting guidelines, which would qualify hospitals for incentive money, would likely be met with a Stage 4 or 5 system, "those with Stage 6 and Stage 7 should be rewarded too. Just because they did this on their own doesn't mean they shouldn't be rewarded."

Dr. Detmer said he hopes the stimulus money will help pay not only for the hardware and software, but also for the "clinical champions," personnel with the expertise to implement the systems and help train people to use them.

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Stage structure

A recent survey by HIMSS Analytics found hospital EMR systems are becoming more sophisticated and offering more functionality. HIMSS designated most hospitals as being in Stage 3, having "systems that have functions such as error-detecting clinical support and clinical documentation."

Stage Description 2007 2008
Stage 7 Medical records are fully electronic; hospital is able to contribute continuity of care document as byproduct of EMR; data warehousing is in use 0.0% 0.3%
Stage 6 Physician documentation in structured templates; full clinical decision support system in use; full radiological and picture archiving systems in use 0.3% 0.5%
Stage 5 Closed loop medication administration that addresses every step of medication use process 1.9% 2.5%
Stage 4 Computerized physician order entry system in use; clinical decision support system in use for clinical protocols 2.2% 2.5%
Stage 3 Clinical documentation; clinical decision support system in use for error checking; photographic archiving system in use outside radiology 25.1% 35.7%
Stage 2 Clinical data repository; controlled medical vocabulary, clinical decision support system; may have document imaging 37.2% 31.4%
Stage 1 Ancillaries (lab, radiology, pharmacy) are installed 14.0% 11.5%
Stage 0 None of the three ancillaries are installed 19.3% 15.6%

Source: HIMSS Analytics EMR Adoption Model (link)

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External links

Stage 6 hospitals, on the verge of being paperless, as designed by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society (link)

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