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A survey by HIMSS Analytics, the research arm of the Health Information Management and Systems Society, indicates that during the five quarters ended in September 2012, the number of U.S. acute care hospitals achieving EMRAM stage 5 or 6 increased by more than 80%; the number of facilities in stage 7 rose 63%.
Nevertheless, the percentages of hospitals that are actually in these stages show that the majority of facilities have a long way to go before they realize the full potential of their EHRs. In the fourth quarter of 2012, HIMSS Analytics figures show, just 1.9% of hospitals had reached stage 7; 8.2%, stage 6, and 14%, stage 5. Three-quarters of the hospitals were not yet in stage 5.
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Although the EMRAM stages have no direct relationship to the stages of Meaningful Use in the federal incentive program, the current distribution of hospitals' IT capabilities raises questions about their ability to meet the requirements of Meaningful Use stage 2.
On the plus side, a hospital in EMRAM stage 4 has computerized physician order entry (CPOE) and clinical decision support, both of which are required in Meaningful Use stages 1 and 2. Facilities in stage 4 have nursing documentation, error checking, and other capabilities. But they are missing closed-loop medication administration (stage 5), physician documentation and full clinical decision support (stage 6), and the ability to exchange standardized summary documents with other providers (stage 7). All of these are required in Meaningful Use stage 2 except for physician documentation, which is an optional menu item for eligible professionals.
Health information exchange capabilities are moving slowly in the right direction as well, according to John Hoyt, executive VP of HIMSS Analytics. "Facilities moving to the upper stages of EMRAM are laying the groundwork for interoperability to occur," he said in a press release. "Stage 6 and Stage 7 hospitals are fully prepared for provider-to-provider or facility-to-facility interoperability, as well as increasing the provider or facility's ability to provide electronic health data reporting to public health and immunization registries to support population health review and syndromic surveillance."
In an interview with InformationWeek Healthcare, Hoyt said, "We still have an accelerating rate of growth in stages 5, 6 and 7. The biggest hurdle is getting physicians to enter data on their keyboards. Of course, that's required for stage 1 of Meaningful Use."
That comment referred to the Meaningful Use stage 1 requirement that clinicians enter pharmacy orders for 30% of patients with at least one pharmacy order through CPOE. Noting that HIMSS Analytics has always required medication, lab, imaging and other orders to be done electronically in stage 4, he observed that some hospitals might not achieve that level in EMRAM, yet still be able to attest to stage 1 Meaningful Use.
Providers who achieve stage 5 in EMRAM could probably meet the Meaningful Use stage 2 requirements, Hoyt said, partly because they already have full CPOE. In addition, EMRAM stage 5 requires closed-loop medication administration that matches patient IDs with bar codes on drug packages. Although the Meaningful Use regs aren't so specific, he said, they "imply" that kind of medication administration.
Asked why it takes most hospitals so long to get to advanced stages of EHR implementation, Hoyt pointed out, "It's really difficult to implement these systems with voluntary medical staffs." In a highly competitive environment, he noted, hospitals want to make private practice physicians happy, so they don't want to lean on them too heavily to enter orders through CPOE or do electronic documentation. But Meaningful Use has leveled the playing field, he said, making it easier for hospitals to seek physician participation because their competitors are doing the same thing.
In addition, he said, it's expensive and time consuming to fully implement clinical systems. "It's not just a matter of buying software, it's about process redesign. It takes leadership and access to capital. That's clearly a problem, especially for small hospitals -- not leadership, but access to capital," he said.
Many hospitals are doubtful about their ability to achieve Meaningful Use stage 2. In a recent KPMG survey, 47% of healthcare executives said they were only "somewhat confident" about their ability to satisfy these requirements. The biggest challenge, the respondents said, would be training and change management.
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)