HIMSS EMRAM Stage 7

DRH Maestro Taskforce Update

December 8, 2014

Terry Mears, DHTS

Agenda

About HIMSS & HIMSS Analytics

EMR Adoption Model & Trends
Duke Medicines current EMR Adoption status
Overview of DUHS gaps for reaching Stage 7
FY 15 EMRAM Goals
HIMSS Davies Award

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Definitions
HIMSS - Healthcare Information and Management
Systems Society
HIMSS Analytics
HIMSS Analytics EMRAM - EMR Adoption Model
HIMSS Analytics A-EMRAM - Ambulatory EMR
Adoption Model
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HIMSS Analytics Offers

Independent, objective analysis and insights
Accurate, reliable data, information and knowledge
Experienced industry experts skilled in healthcare IT, market
research, analysis and strategy
Value-based solutions that lower cost, increase revenue, and
improve operational and market performance

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HIMSS Analytics EMRAM Survey

Conducted annually in February across the US, Canada and
many international countries
Off-cycle reviews can be requested
Each hospital and ambulatory survey are conducted separately
Stages 0 6 results are dependent upon data reported in on-line
survey tool
Stage 7 requires on-line survey, case studies and site validation
survey (much like Joint Commission)
Stage 7 is Meaningful Use on steroids!

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Why Do We Do This?
Thought leadership
Quality, Safety, Efficiency improvements
To reflect the market
Where is the market heading
To inform government policy
Contributor to architecture of Meaningful Use program
Used around the world to gather data for policy formulation
To drive the market
A useful roadmap for CIOs, governance boards, public policy
Being Stage 6 or 7 is a plus in discussions with credit rating
agencies; reinforces that we are progressing in the healthcare IT
world, which is what they expect us to do.
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Hospital EMRAM
US EMR Adoption ModelSM
Stage

DRH, DUH, DRaH

MU Stage 1

Cumulative Capabilities

Stage7

Complete EMR; CCD transactions to share

data; Data warehousing; Data continuity
with ED, ambulatory, OP

Stage6

2014 Q2

2014 Q3

3.2%

3.4%

Physician documentation (structured

templates), full CDSS (variance &
compliance), full R-PACS

15.0%

16.5%

Stage5

Closed loop medication administration

27.5%

29.5%

Stage4

CPOE, Clinical Decision Support (clinical

protocols)

15.3%

14.5%

Stage3

Nursing/clinical documentation (flow

sheets), CDSS (error checking), PACS
available outside Radiology

25.4%

23.9%

Stage2

CDR, Controlled Medical Vocabulary, CDS,

may have Document Imaging; HIE capable

5.9%

5.3%

Stage1

Ancillaries - Lab, Rad, Pharmacy - All

Installed

2.8%

2.5%

Stage0

All Three Ancillaries Not Installed

4.9%

4.4%

Data from HIMSS Analytics TM Database 2014

N=5,447

N=5,453

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Ambulatory EMRAM
US Ambulatory EMR Adoption ModelSM
Stage

Working to certify here

MU Stage 1

Cumulative Capabilities

2014 Q2

Stage7

HIE capable, sharing of data between the EMR and

community based EHR, business and clinical intelligence

4.30%

Stage6

Advanced clinical decision support, proactive care

management, structured messaging

5.83%

Stage5

Personal health record, online tethered patient portal

5.56%

Stage4

CPOE, Use of structured data for accessibility in EMR

and internal and external sharing of data

1.23%

Stage3

Electronic messaging, computers have replaced the

paper chart, clinical documentation and clinical decision
support

11.42%

Stage2

Beginning of a CDR with orders and results, computers

may be at point-of-care, access to results from outside
facilities

30.74%

Stage1

Desktop access to clinical information, unstructured

data, multiple data sources, intra-office/informal
messaging

34.29%

Stage0

Paper chart based

Data from HIMSS Analytics TM Database 2014

6.63%
N=26,008

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Summary Profile of a Stage 6 and 7

Organization
Use data to drive improved outcomes related to:
Process, Financial, Clinical, Quality & Safety
Are paperless, or near paperless (create no paper)
All clinically relevant data is in the EMR
Are fully committed to continuous process improvement
through collaboration
Strong IT leadership and executive champions
Clinician/end-user champions
Have embraced their technology supplier as a partner
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Review DUHS Stage 7 gaps

Hospital significant technical gaps + clinical
business intelligence gaps
Ambulatory mostly clinical business
intelligence gaps

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Review DUHS Stage 7 gapscont.

Breast milk barcoding
Closed loop mother/baby barcode matching
Must be used in post-partum and nurseries
Epic 2014 functionality available, not implemented
Blood products barcoding
Must be used in all inpatient units and ED
Epic 2014 functionality available, not implemented
Resuscitation medications
All Code meds must be on eMAR prior to patient transfer
Solution in process with Code Narrator

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Review DUHS Stage 7 gapscont.

Scanning of paper documents
Clinically relevant paper documents must be scanned within
24 hrs. of creation or receipt; non-clinical within 72 hrs. of
discharge
Applies to inpatient and ED
Mostly a process/workflow solution needed
Options have been proposed with recommended option
CCD/CCR exchange of patient summary
Can we demonstrate savings in ancillary consumption or a
reduced rate of readmission as a result of HIE participation?
Applies to hospital and ambulatory
Care Elsewhere recently implemented

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Review DUHS Stage 7 gapscont.

Interfaces to vital sign equipment
Where electronically captured, vital signs are recorded
electronically in inpatient and ED
We are okay with fixed monitors, need to have a plan to
address other devices (e.g. portable Dynamaps)
Verbal orders
No more than 10% of inpatient orders are verbal
Need data to verify we are ok. If not, need to address
Disease and risk scores
Will look for calculation/interaction within clinical decision
support
Applies to inpatient and outpatient
Need more ambulatory BPAs, in process
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Review DUHS Stage 7 gapscont.

Trauma in ED
Must demonstrate complete barcoding of meds
In process with Trauma Narrator

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What Are Our EMRAM Goals for

FY15?
Complete off-cycle Ambulatory survey, be at Stage 6 by end of
the calendar year
Identify and document case studies for Stage 7
Close all Stage 7 technical gaps by the end of FY 15 for Hospital
and Ambulatory
Score in the Stage 7 range for Ambulatory Adoption by end of the
fiscal year

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HIMSS Davies Award

Since 1994, the HIMSS Nicholas E. Davies Award of Excellence has
recognized outstanding achievement in the implementation and
value from health information technology, specifically EHRs. The
Awards program promotes EHR adoption through sharing
information and lessons learned on implementation strategies,
financial return on investment and value of the EHR to improve
patient care and outcomes.

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Davies Award
Have you achieved key industry milestones?
Stage 6 or Stage 7 on the HIMSS Analytics EMR Adoption Model
(for Hospitals/Health Systems)
Achieved key Meaningful Use milestones
Achieved sustainable improvement in outcomes through the
utilization of health IT

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Davies Award
What are the Benefits of Applying?
Gain a new perspective on your organizational growth. The case
study process will show you just how much you have
accomplished and where there are opportunities for further
growth.
Best practice guidance on how to leverage health information
technology to improve quality of care, patient safety and revenue.
More powerful financial leverage for additional funding resources.

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Davies Award
Application Process
Pre-application interview
Case study submission (2 required, 3 elective)
Site visit
DUHS goal is to submit for Davies the year after we reach Stage 7
for Hospital and Ambulatory

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How Can You Help?

Awareness
Consider Stage 7 requirements in IT Governance
discussions/decisions

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