Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Highly Functional EMRs Aren’t Necessarily High-Functioning

Posted on July 28, 2011 I Written By

I’ve just turned in a story for InformationWeek Healthcare about the new “Essentials of the U.S. Hospital IT Market, 6th Edition” report from HIMSS Analytics. That report details the progress hospitals and integrated delivery networks have made in IT over the past year and gives an update on how far along providers are according to the HIMSS Analytics EMR Adoption Model. That’s the seven-level scale (eight if you count Stage Zero) that measures adoption of various EMR components.

At the top of the scale, 1 percent of nonfederal hospitals in the U.S. attained Stage 7 in 2010, meaning that the EMR served as the legal medical record for all departments, was capable of exporting patient records as Continuity of Care Documents and had data warehousing and mining in place. That was up from 0.7 percent in 2009. The number of Stage 6 hospitals—with electronic clinician documentation, full clinical decision support and full PACS for radiology—doubled in the same time frame, from 1.8 percent in 2009 to 3.2 percent in 2010.

Here’s how the entire scale breaks down:


Actually, the EMRAM Web page shows newer numbers, through the 2011 second quarter. We’re up to 1.1 percent for Stage 7, 4 percent for Stage 6, 6.1 percent for Stage 5 and 12.3 percent for Stage 4. HIMSS considers Stage 4 to be the closest to the current requirements for “meaningful use” of EMRs.

It’s nice to see progress in installing technology and it’s nice to see hospitals using EMRs in a “meaningful” way, but that doesn’t mean there won’t be problems. As everyone in health IT knows, EMR certification, a prerequisite for meaningful use, does not measure usability, and this still is the first of three stages for meaningful use. That means we’re a long way from perfect, or even ideal. How do I know this?

The mother of a good friend of mine is now on dialysis and eventually will need a kidney transplant because she was given a medication that is contraindicated for Type 2 diabetes, which she suffers from. The harmful interaction resulted in her losing about 80 percent of normal kidney function. This happened at a HIMSS Analytics EMRAM Stage 7 hospital. Apparently, either the patient record didn’t show she was diabetic, the medication order didn’t get flagged, or the ordering physician, pharmacy and administering nurse all missed or ignored an alert. As the chart above illustrates, the medication loop should have been closed by Stage 5.

I’m not going to name the hospital or give any more details because there’s a good chance a malpractice suit is coming. I’m also aware of a medical informaticist with a long history of implementing and working with EMRs losing his mother due to a medical error that an EMR exacerbated. Again, I’ve been asked not to say more because of the legal ramifications.

It’s no secret that healthcare is in trouble. In this push to install technology and earn Medicare and Medicaid bonuses for meaningful use, we can’t take our eyes off the ultimate goal, creating a safer health system.

Beware of Errors on Test or Demo EMR System

Posted on May 12, 2009 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m sure that many of my readers have experienced the awkwardness of an error happening during the demo or training of an EMR system. I’ve been on both sides of the fence (watching or doing a demo) and let’s just say it’s really uncomfortable for both sides. Those that have experienced it know that the most common explanation for the error is “This is the demo system and so we haven’t finished setting everything up.” Or in the case of the training system, “This is the training system and so with all of the people training on this system it has some errors from those training on it.”

In some cases, this is completely true. When I’m training my staff for an update to our EMR software, there has been a number of occasions where I was just too lazy to set something up on our test database and it doesn’t work quite right. So, it does happen.

The difference between myself (most of the time) and those demoing and training you on an EMR system is that I’ll make note of the problem and make sure that indeed it was something I could easily fix. If I can’t, then I escalate it to our EMR vendor for resolution before we proceed with the upgrade. Those showing you the demo or training you might do the same. However, if you’re training on the system, there’s little chance the fixes they request will be implemented before you implement the system.

Even more to the point is that far too often it’s not something to do with the test or demo system, but is often an error in the program itself. It’s a good idea to evaluate the error you saw. This can be a real challenge since the trainer is often going to blow by the error as quickly as possible. However, don’t be afraid to call them out on the error. This is going to be the heart of your practice. Make sure you really know if those errors were temporary or chronic. Nothing’s more of a pain than regular errors from your EMR software.