EMRAM Criteria Update
EMRAM Criteria UpdatePresented by:John H. Daniels, CNM, FACHE, FHIMSS, CPHIMSGlobal Vice PresidentHIMSS AnalyticsHIMSS18
Enabling better healththrough information &technology. 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.2
EMR Adoption Model (EMRAM) - 2005Stage 7Complete EMR; CCD transactions to share data; Datawarehousing; Data continuity with ED, ambulatory, OPStage 6Physician documentation (structured templates), fullCDSS (variance & compliance), full R-PACSStage 5Closed loop medication administrationStage 4CPOE, Clinical Decision Support (clinical protocols)Stage 3Nursing/clinical documentation (flow sheets), CDSS(error checking), PACS available outside RadiologyStage 2CDR, Controlled Medical Vocabulary,CDS, may have Document Imaging; HIE capableStage 1Ancillaries – Lab, Rad, Pharmacy – All InstalledStage 0All Three Ancillaries Not Installed 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.3
Times have changed It was time for more significant changesNeeded to better reflect current state of an advanced EMRenvironmentAll stages were affectedTime to raise the bar globally Focus more on functions accomplished and less ontechnology itselfHow is technology used to improve care quality andpatient safety? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.4
EMR Adoption Model (EMRAM) – 2018 DRAFT Designed initial “strawman” in July 2015 – several iterationsContinued to refine as we progressed towards implementation Focused discussions with international stakeholders individually and in groupsGlobal listening sessionsStage 6 & 7 and Davies organizationsHIMSS Executive InstituteSuppliers of local & international EMR systems and vendors in general 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.5
EMR Adoption Model (EMRAM) - 2018 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.6
Highlights of the Changes
Stage 1 – Main Diagnostic Systems Results On-Line Radiology information system Laboratory information system Pharmacy management system PACS (radiology & cardiology) for DICOM100% filmless Patient centric storage of Non-DICOM images 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.8
Stage 2 – Core Clinical Data Store Clinical Data Repository – Single or multiple fully integrated data stores installed in such a waythat users DO NOT have to sign into different systemsSuch linkages are context aware (i.e., patient does not need to be re-selected in each disparate data store) Data availability 95% - CDR provides access to 95% of lab results and radiology and cardiology reportsRemote access – Information is accessible from outside the hospital Security:Physical access policy in place; security training programAcceptable use policy in place with training programMobile security in placeData destruction policy in placeDevice encryption in placeAnti-virus, anti-malware tools in placePrevention of PHI storage on assets owned by the organization and BYOD (if allowed) 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.9
Questions Do you have a Physical access policy in place and enforced? How often is the physical access policy reviewed and updated? Do you have an acceptable use policy in place and enforced? How often is the acceptable use policy reviewed and updated? Do you provide EMR Security training for new users? Do you provide EMR Security refresher training for existing users? How often do you provide EMR Security refresher training for existing users?What percentage of existing users have received EMR Security refreshertraining within 12 months of their previous training? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.10
Questions Are you encrypting data stored on data storage devices suchas workstations, laptops, and other mobile devices (e.g., harddrives, SSDs, external storage devices, etc.)? Do you have a data destruction policy in place and enforced? Do you have antivirus and antimalware programs in place onall devices connected to your network? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.11
Questions Are all mobile devices (owned by the organization) that are in useand operating on the network registered/authorized for use? Thisincludes all Laptops, Tablets, PDAs, Mobile/Smart Phones, StorageDevices/USB Sticks, and Cameras in use. Can you prevent the storage of protected health information (e.g.,patient data) locally on assets owned by the organization and userowned devices (BYOD). (This includes stationary and mobileworkstations, storage devices such as CD, memory sticks etc.) 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.12
Stage 3 – Care Documentation is On-Line Clinical Documentation - Nurses and allied health professionals (notphysicians) documenting in the EMR using structured templates andcapturing discrete informationVitals, nursing notes, nursing tasks, etc. eMAR is implemented Clinical Documentation 50% – Hospital choses calculation method (50%of all wards, patient days, inpatient cases, etc.) Clinical Documentation live in ED (if ED exists) – Excluded from 50% Security: Role-based access control (RBAC) 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.13
QuestionsIs role-based access control (RBAC) live and in use? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.14
Stage 4 – Physician Orders Are On-Line CPOE 50% (Use same metric previously used) with second level clinical decisionsupport capabilities related to evidenced-based pathways & protocols CPOE live in the ED (if ED exists) – Excluded from 50% Clinical Documentation 90% - Nursing / Allied Health documentation increases to90% (use same calculation method from Stage 3) National / Regional patient database connection - Where publically available,physicians use access to public databases for decision making (e.g., medications,images, immunizations, lab results, etc.) Business continuity - Access to patient allergies, problem & Dx list, medications, andrecent lab results when EMR is down Intrusion detection – Hospital can detect possible network intrusions 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.15
QuestionsIs an Intrusion Detection System live and in use? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.16
Stage 5 – Physician Documentation Physician Documentation using structured templates – Capturing discrete data orderived via NLP for alerts, clinical guidance and to serve analytical capabilities Physician Documentation 50% – Use same calculation method used for clinicaldocumentation in Stage 3 Physician Documentation live in ED (if ED exists) – Excluded from 50% Order/Task Timeliness Monitoring – Hospital can track and report timeliness of nurseorder completion.Recommended goal (not scored): 90% of orders are completed within two hours of scheduled time. Security:Intrusion prevention – Hospital can prevent network/EMR intrusionsPortable device (hospital owned) securityDevices recognized & authorized to operate on networkDevices can be remotely wiped 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.17
Questions Is an Intrusion Prevention System live and in use? Are all mobile devices (owned by the organization) that are in useand operating on the network registered/authorized for use? Thisincludes all Laptops, Tablets, PDAs, Mobile/Smart Phones, StorageDevices/USB Sticks, and Cameras in use. Can all registered/authorized mobile devices (owned by theorganization) that are in use and operating on the network beremotely controlled/wiped if they are lost or stolen? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.18
Stage 6 – Verification at POC via Technology Technology is used to Order medications and blood products ( 50%)Verify medication / blood product orders ( 50%)Verify patient ( 50%)Verify medications / blood product at the point of administration (medication, dose, route, patient, time) ( 50%) Verify human milk mother-baby match where there is communal storage of milk ( 50%)Collect and track specimens ( 50%)Technology-enabled medications / blood products / human milk administration live in ED (if ED exists)– Excluded from 50%Clinical Decision Support – Background algorithms generate at least one alert for physicians triggered byphysician documentation and/or other variablesSecurity:Mobile device security policies applied to BYODBYOD devices must be registered/authorized for useSecurity risk assessment performed annuallyRisk assessments reported to governing authority 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.19
Questions Is there a policy in place and enforced relating to allowing the use ofdevices not owned by the organization (e.g., BYOD)? Are all devices not owned by the organization (e.g., BYOD) that arein use and operating on the network registered/authorized for use? Can all registered/authorized devices not owned by the organization(e.g., BYOD) that are in use and operating on the network providerestricted access to patient records and be remotely controlled/wipedof all critical patient information if they are lost or stolen? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.20
Questions Does the organization conduct periodic security risk assessmentsand report the results to the organization's appropriate governingauthority? How often does the organization conduct security risk assessments? 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.21
Stage 7 – Pervasive of Use and Management Paper charts no longer used to deliver & manage care Mixture of discrete data, medical images, document images availablewithin the EMR Data analytics leveraged to analyze patterns of clinical data to improvequality of care, patient safety, and care delivery efficiency Clinical data can be readily shared in a standardized, electronicmanner as appropriate Summary data continuity for all services is demonstrated 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.22
Stage 7 – Pervasive of Use and Management CPOE 90% - use same calculation method used in Stage 4 Physician Documentation 90% - use same calculation method from Stage 3 Privacy and security program – Present overview of strategy, infrastructure,policy and procedures NON-SCORED:Implementation & use of Anesthesia Information System (five to seven years’ notice)CPOE-enabled infusion pumps (seven to ten years’ notice)Order/Task Timeliness 90% – All orders are completed within two (2) hours ofschedule 90% of the time 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.23
Implemented – 1 January 2018 Market AwarenessFirst Announced at HIMSS16; updates provided at HIMSS17Presented at HIMSS and non-HIMSS events around the worldMultiple media articles published and social media posts Progress to dateStage 7 Preparatory Guide completed and available to Stage 6 & 7 organizationsStage 6 and Stage 7 validations & re-validations have already been completed in:North America, AsiaPac, and Middle East Reminder: Revalidation ProgramValidation is good for three yearsOn-site visit required for revalidation 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.24
EMRAM Stage 7 Validation ProcessThree parts Part I – Logistical prep call Part II – Video conference presentation by candidate on IT SecurityDisaster Recovery/Business Continuity Part III – On-site validationFull day visitOpening candidate presentations followed by department visitsClosing session with validation decision & findings 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.25
We drive the health IT market inthe direction it needs to goEMR Adoption ModelOutpatient EMR Adoption ModelAnalytics Maturity Adoption ModelImprovedPatient Careand Health ITInsightsContinuity of Care Maturity ModelDigital Imaging Adoption Model 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.26
Interested in Learning More?Contact us: info@himssanalytics.org 2018 HIMSS Analytics. All rights reserved. This document contains proprietary information and intellectual property of HIMSS Analytics.Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of HIMSS Analytics.
Neither this document nor any of the information contained herein may be reproduced or disclosed under any circumstances withoutthe express written permission of HIMSS Analytics. EMR Adoption Model (EMRAM) -2018 DRAFT Designed initial "strawman" in July 2015 -several iterations Continued to refine as we progressed towards implementation
Jan 01, 2018 · Prepared For: EMRAM Criteria Update. Presented by: John H. Daniels, GVP, HIMSS Analytics. Philip
highest level on the EMR Adoption Model (EMRAM) and the Outpatient EMR Adoption Model. The EMRAM identifies and scores hospitals and clinics using a progressively sophisticated eight-stage model that charts the path to a fully paperless environment. This prestigious industry award was introduced in 2009 by honoring 15 organizations that had .
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