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HIMSS: EMRAM Cheat Sheet by

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Introd­uction U.S. EMR Adoption Model

HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) incorp­orates method­ology and algorithms to automa­tically score the more than 5,400 U.S. and approx­imately 650 Canadian hospitals in the HIMSS Analytics database relative to their EMR capabi­lities. Ranging from limited ancillary department systems through a paperless EMR enviro­nment, EMRAM scores provide peer compar­isons for hospital organi­zations as they strategize their path to implem­enting a complete EMR and partic­ipation in an electronic health record (EHR).


The organi­zation has not installed all of the three key ancillary department systems (labor­atory, pharmacy, and radiol­ogy).
All three major ancillary clinical systems are installed (i.e., pharmacy, labora­tory, and radiol­ogy).
Major ancillary clinical systems feed data to a clinical data repository (CDR) that provides physician access for reviewing all orders and results. The CDR contains a controlled medical vocabu­lary, and the clinical decision suppor­t/rules engine (CDS) for rudime­ntary conflict checking. Inform­ation from document imaging systems may be linked to the CDR at this stage. The hospital may be health inform­ation exchange (HIE) capable at this stage and can share whatever inform­ation it has in the CDR with other patient care stakeh­olders.
Nursin­g/c­linical docume­ntation (e.g. vital signs, flow sheets, nursing notes, eMAR is required and is implem­ented and integrated with the CDR for at least one inpatient service in the hospital; care plan charting is scored with extra points. The Electronic Medication Admini­str­ation Record applic­ation (EMAR) is implem­ented. The first level of clinical decision support is implem­ented to conduct error checking with order entry (i.e., drug/drug, drug/food, drug/lab conflict checking normally found in the pharmacy inform­ation system). Medical image access from picture archive and commun­ication systems (PACS) is available for access by physicians outside the Radiology department via the organi­zat­ion’s intranet.
Comput­erized Practi­tioner Order Entry (CPOE) for use by any clinician licensed to create orders is added to the nursing and CDR enviro­nment along with the second level of clinical decision support capabi­lities related to evidence based medicine protocols. If one inpatient service area has implem­ented CPOE with physicians entering orders and completed the previous stages, then this stage has been achieved.
The closed loop medication admini­str­ation with bar coded unit dose medica­tions enviro­nment is fully implem­ented. The eMAR and bar coding or other auto identi­fic­ation techno­logy, such as radio frequency identi­fic­ation (RFID), are implem­ented and integrated with CPOE and pharmacy to maximize point of care patient safety processes for medication admini­str­ation. The “five rights” of medication admini­str­ation are verified at the bedside with scanning of the bar code on the unit does medication and the patient ID.
Full physician docume­ntation with structured templates and discrete data is implem­ented for at least one inpatient care service area for progress notes, consult notes, discharge summaries or problem list & diagnosis list mainte­nance. Level three of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full complement of radiology PACS systems provides medical images to physicians via an intranet and displaces all film-based images. Cardiology PACS and document imaging are scored with extra points.
The hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images, and medical images within its EMR enviro­nment. Data wareho­using is being used to analyze patterns of clinical data to improve quality of care and patient safety and care delivery effici­ency. Clinical inform­ation can be readily shared via standa­rdized electronic transa­ctions (i.e. CCD) with all entities that are authorized to treat the patient, or a health inform­ation exchange (i.e., other non-as­soc­iated hospitals, ambulatory clinics, sub-acute enviro­nments, employers, payers and patients in a data sharing enviro­nment). The hospital demons­trates summary data continuity for all hospital services (e.g. inpatient, outpat­ient, ED, and with any owned or managed ambulatory clinics).

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