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Perspectives on Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM) accreditation

It’s tempting to think about HIMSS as being just a questionnaire that generates a score to tell you how good your IT is. It’s more than that. Having completed the HIMSS accreditation course as part of Channel 3’s certification process, Paul Henderson gives some initial reactions.

HIMSS is an international TrustPilot-type not-for-profit, that enables organisations to see what a good electronic medical record (EMR) looks like, assesses where they are on their digital transformation journey and helps plan to close the gap or meet their aspiration. NHS England has made no secret of their admiration for HIMSS, and it is likely that trusts will need support to assess themselves and set their plans to attain their required HIMSS level.

Channel 3 recently achieved HIMSS certification and I did the accreditation course with a team of colleagues, which means that we can support organisations along their HIMSS journey.

Completing the course answered several questions we had. This is what we discovered.

Is it just about a HIMSS score?

People can fixate on a HIMSS score but there is more to it than that. EMRAM looks at how organisations digitally enable success in patient experience, clinical outcomes, operational productivity, and care system transformation. So, the new version of the assessment focusses more on proving success than on ticking boxes. It’s a no-brainer to take a benefits-driven approach to the digitisation of services and so I welcome this approach.

Focussing on meaningful patient and user engagement doesn’t mean ‘buy a single EMR’

The definition of an EMR needs further thought because delivering benefits and demonstrating capability does not necessarily mean that you need to buy a single EMR. Some of us will be thinking about unlocking benefits where you have a best-of-breed strategy. For example, there is a renewed push to assess your digital capability by understanding how you build personalised engagement with patients, service users and other people in your area.

How does this sit with HIMSS? There is some interesting patient and user engagement innovation in primary care, so learning lessons from what works there as you develop an acute strategy and capabilities will be increasingly important.

Good to great is achieved by scaling what you do

The HIMSS team have tried to be more flexible in their scoring to recognise that maturity develops over time and has many staging points. We see a lot of pilots in the NHS, which are to be commended, however, maturity is about busting through the glass ceiling of robustness and scalability. We suspect that many hospitals will look at their capability and do some of everything, in theory hitting the top of the HIMSS scale. However, the question to ask is whether the capability is fulfilling the needs of all clinicians, whilst considering who is potentially being held back by a lack of appropriate technology.

Does my EMR work?

On a related point, EMRAM is increasingly less about reviewing up and down time on an EMR, and more about the availability of appropriate tools that enable clinicians to do their jobs. This is a key enabler of clinical effectiveness and there is a risk that organisations that have a great EMR, with very little downtime but the workflow, of which the EMR is a part, sometimes breaks. Many of us recognise that challenge, especially when we have multiple interfaces for multiple systems all trying to support multi-agency teams.

So, what next for HIMSS EMRAM?

EMRAM has been on a journey of its own. When it began, it was about removing paper. It provided a pioneering impetus to help hospitals transfer from paper-based record-keeping into the digital space. There is a sense that, while some paper is necessary, the battle for digital is being won. The focus is on how you use digital records to deliver benefits. Going forward the most effective, and therefore the most mature EMRAM sites, are not only analytics-driven but are also mobilising their data to deliver a wide range of benefits. 


Finally, we need to think about EMR convergence.  What does that mean and how can HIMSS help?

Convergence is currently a hot topic. The challenge is how regional bodies can converge their EMR platforms in a managed way so that there is a much-reduced need for complex integration of technologies, wider coverage of high-quality systems and simplified contractual arrangements that make the best economic sense.  It’s a multi-faceted question. HIMSS provides a helpful framework to enable organisations, potentially through CIOs and people in similar roles, to coalesce around a set of principles and ideas about which elements of an EMR can be shared. What it doesn’t help with is the other stuff, which is equally important. 

Success is almost 80:20 about transforming services versus implementing software. There is no holistic framework that helps define a zone of agreement over what convergence means for all the services you offer, as well as your staff, your patients, your processes, your commercial arrangements, the burden on your support and operational functions and overall operating model. HIMSS has some way to go in helping us to co-produce a state of well-being and independence in our population and subsequently helping us all access the benefits of medical and surgical care.

About the author

Paul Henderson

Paul has over 30 years of health and social care experience, gained in the NHS, software providers and consulting organisations. As a Partner at Channel 3 Consulting he is currently delivering a range of projects to improve technology platforms that support community and social care, use virtual wards to enable new care models and digital strategy and roadmaps for ICSs.

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