Are EMRAM Stage 7 Physicians More Successful?

More than a decade ago, HIMSS Analytics introduced their Electronic Medical Record Adoption Model (EMRAM). Since then, many organizations have chased the culminating level, Stage 7, in an effort to gain esteem in the industry, attract the best employees, and increase the value of the IT in their facilities.

But filling all of the requirements is quite a struggle. An organization must have a complete EMR, an external HIE, data analytics, governance, disaster recovery, and privacy and security. Implementing all of those tools can be expensive and risky. Pushing for fast adoption can sometimes overwhelm the clinicians who have to learn and use the tools, causing them to shut down or withdraw.

Many provider organizations in Stages 0–6 wonder whether there are enough validated and quantifiable outcomes of achieving Stage 7 to be worth the effort of getting there. KLAS and HIMSS Analytics teamed up and used the public reporting of Stage 6 and 7 hospitals in the US to help answer that question. The whole report is available here, but here are a few key points to whet your appetite for this data.

The Short Answer: Yes

According to our research, physicians at Stage 7 organizations are more likely to report an above-average user experience. 79% of the Stage 7 hospitals included in the study had a mean EHR-satisfaction score that was above average. Only 47% of the Stage 6 hospitals surveyed could say the same.

But it’s not enough to know that providers are more likely to be satisfied at Stage 7 facilities. KLAS and HIMSS Analytics wanted to know why. We included questions about specific areas of the EHR experience to show where high adoption helps most and where it hasn’t moved the needle yet.

Where Has Stage 7 Made a Difference?

Some factors are stronger influences than others on physician satisfaction and overall success. Which ones stand out? We found that physicians at organizations that have reached Stage 7 are much more likely to say that their EHR:

• Enables clinicians to deliver high-quality healthcare. This is perhaps the most important metric to clinicians and to the industry. After all, if something isn’t ultimately benefitting the patients, is it really worth our time and money?
• Has the needed functionality. Unsurprisingly, one of the largest drivers of physician satisfaction is whether the EHR can do everything it’s supposed to do.
• Provides the expected integration within the organization. This is one of the industry’s relative strengths, and none of the Stage 7 hospitals had fewer than 31% of their physicians agree that their EHR’s internal integration was sufficient.
• Provides the expected integration with outside organizations. While this metric had fairly low scores across the board, the Stage 7 organizations were generally better off in terms of trying to share data with other facilities.

Where Can Stage 7 Organizations Improve?

Unfortunately, adopting to the point of reaching EMRAM Stage 7 has made only small differences in certain areas. Physicians at Stage 7 organizations are not much more likely to say that their EHR:

• Enables efficient care. Physicians at Stage 7 facilities may be able to provide better care than other physicians, but they apparently don’t feel that they can provide that care much more quickly.
• Is easy to learn. Apparently, the entire industry needs to work on providing better education on the EHR. The training programs at Stage 7 organizations don’t appear to significantly outshine those at Stage 6 organizations. Ongoing training is particularly lackluster at most facilities.
• Has the reporting and analytics that physicians need. This metric had lower scores than any other metric in the report. Stakeholders need to continue focusing on reporting and analytics.
• Enables clinicians to deliver patient-centered care. Most of the surveyed physicians, even those in Stage 7 facilities, seem to feel that the EHR keeps them from spending the time they want to spend with their patients.

This data about the strengths and weaknesses of Stage 7 organizations is a lot to chew on, but I know some readers are anxious to learn more. How are physicians at Stage 7 hospitals doing with EHR personalization? Are those physicians more fulfilled? And what about teamwork between the clinical and IT departments? You can read more details about those factors in the full report.

Not the Final Destination

CIOs who assume that reaching Stage 7 will solve all of their organizations’ problems are clearly mistaken. Plenty of work still needs to be done. But at least the physicians in this report have shown aspiring hospitals that deep adoption does yield real outcomes, and they’ve also given the Stage 7 hospitals an idea of where to continue improving.

I’m grateful that healthcare organizations have these standards by which to measure themselves and pioneers to follow. Stage 7 may not be a hospital’s final destination, but the EMRAM stages can serve as mile markers on the way.