Every CIO, and pretty much every healthcare executive who has been around for any length of time, knows about the HIMSS EMRAM score. It has really taken off in Australia since the big EMR deployments at Hervey Bay, PA Hospital, and Royal Children’s in Melbourne. Claiming HIMSS Level 6 or Level 7 is a highly effective way of claiming success.
The great thing about it is that even executives with little-to-no knowledge of ICT can quickly grasp the concept of a scorecard.
I am a big supporter of HIMSS. I’ve been to their conferences in the US and Australia and I’m very much in favour of having a yardstick that is easily understood by executives and allows us to have a conversation about “where we are” with digital hospitals and digital health.
Of course there is a “but”. I’m not sure how widely understood it is that HIMSS is a commercial organisation substantially funded by vendors. This is not necessarily a bad thing, but I’m not sure how many people know this fact.
It can create an implication that implementing a full stack of product from Cerner, Epic, Allscripts or whoever is ipso facto a good thing.
So that’s issue number one.
The digital hospital model
Issue number two is that HIMSS EMRAM is not enough. You also need a digital hospital model. This is a model that does not just include clinical systems but extends into the building systems and the administrative systems needed to run a modern digital hospital.
There are a number of these models around. My own company’s model – the Checkley Digital Hospital Model – has gained recognition for its integrated and comprehensive proficiency. Most notably, it has been adopted by Standards Australia and used, with modification, in their new digital hospitals handbook being published this year (2017).
The Checkley Digital Hospital Model recognises the very complex interplay between the various systems that run the modern hospital. Even if you work for an organisation that does not plan to go down this path in the immediate future, I believe your strategy ought to at least look at some of these models in addition to the EMRAM model.
Focusing on a desired result also helps. I like the concept of single view of patient because it speaks to both clinicians and administrators. The clinicians want to see every piece of possible data there is about a patient in order to treat them effectively, and the administrators want to understand the entire patient journey from beginning to end, to every point to the hospital, in order to understand where costs are generated and where efficiencies could be made.
Staffing and support
The third issue with the model is that it does not address staffing and support.
It is one thing to find the capital investment to build a digital hospital from scratch, or, if you are lucky to find the money, to put in a full suite of systems in an existing hospital. It is another thing altogether to be able to source the funds to run these things properly on an ongoing basis.
I believe organisations in the future will need to track their progress much more acutely on how well they provide support for clinical and other staff. As expectations rise with the deployment of additional functionality, the level of support expected will also continue to rise, and organisations will need to track how well they are providing support.
The final point I would make about charting success is that we don’t always know what it looks like when you start the journey.
So my advice would be to definitely keep on using HIMSS EMRAM, but also to stay open to identifying new models and new unexpected benefits as you continue on the digital journey.