As we’ve discussed previously on the ECG blog, successful adoption of an EHR goes beyond implementation and meeting meaningful use (MU) incentives. True adoption requires not only buy-in from multiple stakeholders, including practice leaders, providers, and patients, but also sustained performance improvement.
The Electronic Medical Record Adoption Model (EMRAM) created by HIMSS Analytics in 2005 is a tool used by hospitals to measure their own EHR maturity relative to peers in an inpatient setting. This year, HIMSS Analytics released a model specific to ambulatory practices – the Ambulatory Electronic Medical Record Adoption Model (A-EMRAM). According to HIMSS Analytics:
The A-EMRAM is the next generation tool in monitoring EMR adoption in ambulatory settings. This new evaluation model creates a framework for dialogue among your key stakeholders. It helps you focus on key IT systems that need to be implemented for achieving higher levels of access, quality, efficiency and safety.While the model achieves the stated goal of facilitating conversation, organizations can also leverage the tool as a realistic and achievable call to action to improve utilization of already implemented EHR functionality. Organizations should be encouraged to include MU criteria in these conversations.
While the MU criteria and A-EMRAM model are similar, there is one key element that the tool doesn’t address: actual performance. The A-EMRAM model grades an organization on the level of technology implemented, such as integration with a clinical data repository or structured messaging. Unfortunately, having functionality and using it are two very different things; you can have sinks in every exam room, but you might still have a hand-washing issue.
The model also fails to capture the implementation of a deeper layer of value-added functionality. As an example, in Stage 6 of the A-EMRAM, the capabilities of a personal health record and tethered online patient portal are expected. Many organizations have these technologies but have not deployed high-value functions such as medication refills or secure messaging with a provider. The lack of these specific capabilities related to patient satisfaction or quality improvement does not affect the stage reached on the A-EMRAM model and may lead to an inflated sense of achievement.
Overall, the HIMSS Analytics A-EMRAM model works well alongside the hospital EMRAM to provide a high-level review of an organization’s EHR implementation. The tool can spark conversations and be used as a benchmark, but does not replace a more detailed analysis of system adoption and value.