EMRAM: A strategic roadmap for effective EMR adoption and maturity

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) incorporates methodology and algorithms to automatically score hospitals around the world relative to their Electronic Medical Records (EMR) capabilities. This eight-stage (0-7) model measures the adoption and utilization of electronic medical record (EMR) functions. Move your organization closer to achieving a near paperless environment that harnesses technology to support optimized patient care by completing each stage below. Our expert advisors are available with helpful tools to move your organization along its journey.

7. Stage

Complete EMR; External HIE; Data Analytics, Governance, Disaster Recovery, Privacy And Security

  • 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, 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, outpatient 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 outpatient clinics).
  • Physician documentation and CPOE has reached 90% (excluding the ED), and the closed-loop processes have reached 95% (excluding the ED).
6. Stage

Technology Enabled Medication, Blood Products, And Human Milk Administration; Risk Reporting; Full CDS

  • Technology is used to achieve a closed-loop process for administering medications, blood products, and human milk, and for blood specimen collection and tracking. These closed-loop processes are fully implemented in 50 percent of the hospital. Capability must be in use in the ED, but ED is excluded from 50% rule. 
  • The eMAR and technology in use are implemented and integrated with CPOE, pharmacy, and laboratory systems to maximize safe point-of-care processes and results.
  • A more advanced level of CDS provides for the “five rights” of medication administration and other ‘rights’ for blood product, and human milk administrations and blood specimen processing.
  • At least one example of a more advanced level of CDS provides guidance triggered by physician documentation related to protocols and outcomes in the form of variance and compliance alerts (e.g., VTE risk assessment triggers the appropriate VTE protocol recommendation).
  • Mobile/portable device security policy and practices are applied to user-owned devices. Hospital conducts annual security risk assessments and report is provided to a governing authority for action.
5. Stage

Physician Documentation Using Structured Templates; Intrusion/Device Protection

  • Full physician documentation (e.g., progress notes, consult notes, discharge summaries, problem/diagnosis list, etc.) with structured templates and discrete data is implemented for at least 50 percent of the hospital. Capability must be in use in the ED, but ED is excluded from 50% rule.
  • Hospital can track and report on the timeliness of nurse order/task completion.
  • Intrusion prevention system is in use to not only detect possible intrusions, but also prevent intrusions. Hospital-owned portable devices are recognized and properly authorized to operate on the network, and can be wiped remotely if lost or stolen.
4. Stage

CPOE With CDS; Nursing And Allied Health Documentation; Basic Business Continuity

  • 50 percent of all medical orders are placed using Computerized Practitioner Order Entry (CPOE) by any clinician licensed to create orders. CPOE is supported by a clinical decision support (CDS) rules engine for rudimentary conflict checking, and orders are added to the nursing and CDR environment.
  • CPOE is in use in the Emergency Department, but not counted in the 50% rule. 
  • Nursing/allied health professional documentation has reached 90% (excluding the ED).
  • Where publicly available, clinicians have access to a national or regional patient database to support decision making (e.g., medications, images, immunizations, lab results, etc.).
  • During EMR downtimes,clinicians have access to patient allergies, problem/diagnosis list, medications, and lab results. Network intrusion detection system in place to detect possible network intrusions.
  • Nurses are supported by a second level of CDS capabilities related to evidence-based medicine protocols (e.g., risk assessment scores trigger recommended nursing tasks).
3. Stage

Nursing And Allied Health Documentation; EMAR; Role-Based Security

  • 50 percent of nursing/allied health professional documentation (e.g., vital signs, flowsheets, nursing notes, nursing tasks, care plans) is implemented and integrated with the CDR (hospital defines formula).
  • Capability must be in use in the ED, but ED is excluded from 50% rule. The Electronic Medication Administration Record application (eMAR) is implemented.
  • Role-based access control (RBAC) is implemented.
2. Stage

CDR; Internal Interoperability; Basic Security

  • Major ancillary clinical systems are enabled with internal interoperability feeding data to a single clinical data repository (CDR) or fully integrated data stores that provide seamless clinician access from a single user interface for reviewing all orders, results, and radiology and cardiology images.
  • The CDR/data stores contain a controlled medical vocabulary and order verification is supported by a clinical decision support (CDS) rules engine for rudimentary conflict checking.
  • Information from document imaging systems may be linked to the CDR at this stage.
  • Basic security policies and capabilities addressing physical access, acceptable use, mobile security, encryption, antivirus/anti-malware, and data destruction.
1. Stage

Ancillaries – Laboratory, Pharmacy, And Radiology/Cardiology Information Systems; PACS; Digital Non-DICOM Image Management

  •  All three major ancillary clinical systems are installed (i.e., pharmacy, laboratory, and radiology).
  •  A full complement of radiology and cardiology PACS systems provides medical images to physicians via an intranet and displaces all film-based images. Patient-centric storage of non-DICOM images is also available.
0. Stage

All Three Ancillaries Not Installed

The organization has not installed all of the three key ancillary department systems (laboratory, pharmacy, and radiology). 


What Are The Advantages Digital Hospitals Provide?
  • Increasing the efficiency in working processes
  • Reducing the paper cost to zero
  • Eliminating the human-made mistakes (such as giving the wrong medicaments)
  • Managing the treatment processes remotely
  • Acquiring all type of data easily whenever needed
  • Managing some processes without human effort through cameras, sensors, early warning systems; (for example, blood test software)
  • Easing the decision making by fastening and increasing the reliability
  • Enabling an atmosphere that fits lean management
  • Bridging the institutions and units to prevent institutional blindness
  • Bringing about 35% efficiency through the smart, green, and paperless health management and hospital models encompassed by the concept of digital hospital 

HIMSS EMRAM Türkiye Ekibi

Asst. Prof. İlker Köse
HIMSS Turkey Director
HIMSS Analytics/Istanbul Medipol University
00 90 216 681 16 30