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EMRAM is the Standard What are the Benefits?
John P Hoyt EVP HIMSS Analytics
SO, WHAT ARE STAGE 7 ORGANIZATIONS? A Little background Required
Who Is HIMSS Analytics ?
• A subsidiary of HIMSS • We collect data on what information systems are deployed
in healthcare systems in the U.S., Canada on a census basis – On a sample basis in Europe, the Middle East and AsiaPac
• From this data, we populate the EMR Adoption Models (EMRAM)
• EMRAM = the acute care model that reflects increased sophistication in deployment and use of healthcare IT
History of the Acute Care EMRAM • The acute care EMRAM was developed in 2005
– Thought leadership for the industry to compliment the HIMSS Analytics data base
– Based on data from 5,400 hospitals in the U.S. and 700 in Canada
• Why the structure? – It is the typical manner by which hospitals rollout enterprise clinical
systems
• Are there any usual variations? – Academic Medical Centers often have CPOE live to enable education for
the medical students and residents
• The first Stage 7 validation occurred in Q4 2008
Data from HIMSS Analytics® Database © 2014 HIMSS Analytics
1.1% 3.1%
13.3%
24.2%
15.7%
27.7%
7.2%
3.2%
5.6%
4.0%
6.1%
12.3%
46.3%
13.7%
6.6%
10.0%
2011 Q2
2014 Q1
N = 5439 N = 5449
Complete EMR, CCDA transactions; Data Analytics to Improve Care
Physician documentation (structured templates), full CDSS, full R-PACS
Closed Loop Medication Administration
CPOE, Clinical Decision Support (clinical protocols)
Clinical documentation, CDSS (error checking)
CDR, Controlled Medical Vocabulary, CDS, HIE capable
Ancillaries - Lab, Rad, Pharmacy - All Installed
All Three Ancillaries Not Installed
Data from HIMSS Analytics® Database © 2014 HIMSS Analytics
0.0% 0.0%
0.6%
0.5%
3.6%
32.5%
28.9%
14.5%
19.4%
0.5%
0.2%
1.7%
33.2%
23.9%
12.2%
28.3%
2014 Q1
Complete EMR, CCDA transactions; Data Analytics to Improve Care
Physician documentation (structured templates), full DCSS , full R-PACS
Closed loop medication administration
CPOE, Clinical Decision Support (clinical protocols)
Clinical documentation , CDSS (error checking)
CDR, Controlled Medical Vocabulary, CDS, HIE capable
Ancillaries – Lab, Rad, Pharmacy – All Installed
All Three Ancillaries Not Installed
N = 639 N = 640
Canada EMR Adoption ModelSM
2011 Q2
Data from HIMSS Analytics® Database © 2014 HIMSS Analytics
1.1%
4.0%
6.1%
12.3%
46.3%
13.7%
6.6%
10.0%
2011 Q2
2014 Q1
N = 5439 N = 5449
Complete EMR, CCDA transactions; Data Analytics to Improve Care
Physician documentation (structured templates), full CDSS, full R-PACS
Closed loop medication administration
CPOE, Clinical Decision Support (clinical protocols)
Clinical documentation, CDSS (error checking)
CDR, Controlled Medical Vocabulary, CDS, HIE capable
Ancillaries - Lab, Rad, Pharmacy - All Installed
All Three Ancillaries Not Installed
+182%
+233%
+297%
-47%
-52%
-44%
3.1%
13.3%
24.2%
15.7%
27.7%
7.2%
3.2%
5.6%
Why Do We Do It?
• Thought leadership – Quality, Safety, Efficiency improvements
• To inform government policy – Numerous countries and regions use HIMSS Analytics to gather data
for their policy formulation
• To reflect the market – Where is the market heading
• To “drive the market”
STAGE 7 STUDIES ON A MACRO SCALE
• Correlations With Stage 7 Status
Source: HIMSS Analytics
Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage
1.9% 4.8% 10.1% 8.1%
4.2% 6.5% 7.9% 9.7% 0.4% 1.7%
6.2% 10.0%
6.4% 6.4%
12.8%
30.1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
0 1 2 3 4 5 6 7
All h
ospi
tals
with
in e
ach
EMR
AM S
tage
EMRAM Stage
3 or less 4 or more
2.3% 6.5%
16.3% 18.1%
10.6% 12.9%
20.7%
39.8%
Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage
0.0% 5.9% 12.8% 14.3% 20.1% 21.8%
30.8%
62.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
All h
ospi
tals
with
in e
ach
EMR
AM S
tage
Tipping Point
38.9
45.5 44.6 45.9 45.9 42.7
49.0
64.3
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
AVG
Clin
ical
Sco
re
EMR Adoption Model Stage
Tipping Point
Tipping Point
Value Based Purchasing (VBP) Clinical Scores
What About Cost Efficiency? Some Ground Breaking Research on the Financial Effect of EMR Deployment
What We Found in Researching • Hospitals that implemented EMR between 1996 and 2009 did
NOT generally see a reduction in operating expense, EXCEPT: – Cost rise immediately during and following implementation and then
fall back to previous levels
• However: – Hospitals in locations with IT intensive industry found cost reductions
after three years – Hospitals in other locations found costs increased
– The initial cost increases was smaller for those in IT intensive locations
The Trillion Dollar Conundrum: Complementarities and Health Information Technology (NBER Working Paper No. 18281)
Used by permission – Avi Goldfarb
Used by permission – Avi Goldfarb
Efficiencies Adjusted for
• Case Mix Index • Quality scores • Readmission rate • Labor input • etc. ….
Hospital Cost Efficiencies BY EMRAM Stage
Early DRAFT Not for Distribution
Used by permission – Eric Ford
ARE YOU STILL QUESTIONING BAR CODE ENABLEMENT?
• Some Are …. But Why ??
4. Knowledge is shared and information flows freely 6. Safety is a system property.
A LITERATURE REVIEW FOR MEDICATION BAR CODING ALSO: BLOOD PRODUCTS AND HUMAN MILK
Where Do Medication Errors Occur?
• 58% of errors occur in administration • 36% of errors occur in transcribing from
handwriting • 6% of errors in ordering, transportation, and
documenting1
1 JHCQ, Vol 26, #6, pgs 5-11
Medication Safety • Comparison with & without BCMA • Timing errors without & with bar codes2
– 6,723 without bar codes : 11.5% timing errors • 3.1% were judged serious ADE
– 7,318 with bar codes: 6.8% timing errors (-40.9%) • 1.6% were judged serious ADE ( -50.8%)
• Wrong Medications – 57.4% • Wrong dose – 41.9% • Improper documentation – 80.3% • Transcription errors: - 100%
2 N Engl J Med 2005; 353:329-331July 28, 2005
Medication Safety • Sentara Health System – Stage 7 & Davies Award
– 12,459 Medication errors avoided per month • SSM Health System – Stage 7
– Journal of Health Care Quality sites 59% reduction in medication errors2
• University of Houston showed BCMA led to decreased time on medication administration and increased time on direct patient care in ICU3
• Medication errors reduced 58%, but timing errors did not change significantly4
• St. Joseph’s Candler reported 66% reduction of errors, excluding timing errors5
2 JHCQ, Vol 26, #6, pgs 5-11 3 Am J Health Syst Pharm. 2011 Jun 1;68(11):1026-31 4 American Journal of Health-System Pharmacy July 1, 2009 vol. 66 no. 13 1202-1210 5 Am J Health-Syst Pharm—Vol 71 Feb 1, 2014, pg 214
• From 1,465 medications administrations observed, errors reduced 56% - mostly timing errors5
• Cardiac surgery – Increased the quantity of drugs administered 21.7% – Increased drug charges by 18.8% – Decreased documentation time by 8 minutes per case6
• St. Jude’s Research Hospital - pediatric dosing & medication administration – Reduced ADE by 47%7
Medication Safety
5American Journal of Health-System Pharmacy Vol 65, pgs 655-659 6 American Journal of Health-System Pharmacy Vol 66, pgs 1110-1115 7 The Journal of Pediatrics Volume 154, Issue 3 , Pages 363-368.e1
USING I.T. TOOLS TO IMPROVE PATIENT ENGAGEMENT •
Target Your Problems and Cohorts
• Rural north central health system attacked CHF readmission rate – Weight gain due to medication insufficiency or behavior factors, is a
strong predictor of readmission
• Gave away blue-tooth enabled weight scales to targeted CHF patients – Reduced readmissions by 42% over 12 months
Target Your Problems and Cohorts • Asthma protocol adherence was an issue with children &
teenagers – Use PHR to engage patients – Improved asthma protocol adherence from 6% to 78% in 18 months
– Teenage obesity & Fit Bits.. Create competitive cohorts with PHR
Thank You ! John P Hoyt Executive Vice President HIMSS Analytics [email protected]
