The HIMSS EMR Adoption Model, often abbreviated as the EMRAM model, is an 8-stage standard that measures hospitals and health systems on their progress towards achieving the ultimate paperless patient record environment. To get to the highest level, HIMSS Stage 7, is challenging for most health systems as the model requires that hospitals transcend the paper chart, use data warehousing, along with advanced analytics to be better suited to share clinical information both inside and outside the organization.
Ebonye White, DataBank’s Client Engagement Manager, helped a top Mid-Atlantic health system develop its current operational and technical workflows which drove them to meet HIMSS Stage 7 in the spring of 2019. Eager to help share her unique experience around the EMRAM model and Point-of-Care Scanning, we asked her a series of questions that draw from her past experiences that can help other health systems better tackle the toughest HIMSS Stage 7 requirement: no more paper in patient charts.
Q & A
1. When a health system wants to take the step towards HIMSS stage 7, what main process changes should they make so that they’re able to adhere to the relatively strict requirements?
There are three main things that I would suggest: to get a really clear understanding of the hospital’s overall volume, to survey all of their departments, and to involve at least one boots-on-the-ground representative from each department that can ensure the best workflows and people are in place. This enables the hospital to deal with any potential roadblocks as they come up.
2. We all know the toughest HIMSS Stage 7 criteria to meet is that the hospital can no longer use paper charts to deliver and manage patient care but needs to have all of its data, documents, and images within its EMR environment. Can you talk a little bit about the problems that paper-based processes present and how digital transformation can solve those challenges?
A lot of the problems that healthcare organizations face are HIPAA violations and breaches that should be avoided at all costs. When a hospital transitions to a more technical environment and optimizes their EMR so that they remove most of the paper from their workflows, it reduces the chance of allowing documents to “walk away”, get lost, or be misplaced.
3. One of your project sites, a top Mid-Atlantic region-based health system, elected to utilize document and image scanning at the point of care to help eliminate their paper-based processes. Can you talk a little bit about what point of care scanning is and how it works?
Point-of-Care Scanning is exactly what it sounds like…scanning documentation at the point in which a patient is being cared for. This means that nurses’ stations are located right outside of the patients’ rooms, staff are utilizing workstations on wheels, and everyone is ultimately making sure that all documents are being scanned within a certain timeframe.
HIMSS Stage 7 mandates that at a minimum, a hospital should not have paper documents at a nurse’s station for more than 24 hours. The day-long exception period allows staff to obtain any necessary signatures, import the record into an ECM system like OnBase, ensure that the documents are indexed (looked-over and reviewed), and then transported into the EMR.
4. So what’s the value of having this information digitally available in real-time?
One of the greatest things is that most patients have migrated (or are starting to make the transition) over to using a patient portal. More and more records and information is becoming increasingly available and tangible to the patient when they are able to sit at their own computers or devices. Inside the care environment, providers are easily able to find a patient record and relevant documentation. With all of this information available at the physicians’ or caretakers’ fingertips, we are seeing overall quicker turnaround times and improved patient outcomes.
5. What is the greatest improvement that you’ve seen or noticed on site since the project went live?
The greatest improvement that I noticed was that a lot of the nurses’ stations have been decluttered. Removing the physical paper documentation has improved the speed and effort needed to locate a patient record. This has ultimately streamlined their processes as everyone is aware of where things are going, who’s doing what with them, and how quickly they’ll be able to access the documents.
One of my favorite efficiencies is that as soon as the documents are scanned into the patient record, it’s viewable. The documents may not be immediately indexed, but a nurse or physician can see the information immediately in the patient record.
6. Can you talk a little bit about the clinician adoption? How did they react to the new operational and process changes?
The nurses were extremely happy from the start because it reduced their administrative workload. Some providers, however, were a little apprehensive in the beginning as they weren’t sure about the availability of the documents, especially when it came to consent forms. Over time, the physicians began to quickly adopt the new processes and were very happy with how fast and easy it was to access the patient record.
7. What advice would you have to another health system that is looking to take on this endeavor?
It helps to actually have a HIMSS surveyor on-site to help with the mock survey and to shed some light on some of the ever-changing aspects in the hospital’s environment so that whoever is driving the HIMSS Stage 7 initiative internally can ask questions and feel completely ready to tackle some of the unknowns in their environment.