Since 2005 and 2012 respectively, HIMSS Analytics, the research arm of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), has tracked the adoption of electronic medical record (EMR) technologies within hospitals and clinics, using the EMR Adoption Model (EMRAM) and Ambulatory EMR Adoption Model. Institutions work to complete the eight stages (0 - 7), with the goal of reaching Stage 7: an environment where paper charts are no longer used. This list is updated weekly, according to HIMSS Analytics’ website. There are different capabilities associated with each stage, and all capabilities within each stage must be reached before moving to the next stage.
The website recognizes all provider organizations who have reached Stage 6 or Stage 7. Also on the website are tools that help hospitals and clinics climb up the scale by creating custom paths using an organization’s resources and timeline to help reach its specific goal. During the second quarter of 2015, only 3.7 percent of the more than 5,400 U.S. hospitals in the HIMSS Analytics database received the Stage 7 Award; however, nearly 60 percent of those hospitals are at least at Stage 5 on the EMRAM scale. On the ambulatory side, clinics are struggling to move up stages; nearly 75 percent of the more than 34,000 tracked by HIMSS are at Stage 3 or below.
So, to sum up, getting to Stage 7 isn’t easy. But with each passing year, patient care organizations are improving in becoming more electronic—the EMR Adoption Model shows that in 2011, the number of acute care hospitals achieving Stage 5 or Stage 6 increased by more than 80 percent. Meanwhile, the number of hospitals at Stages 0, 1, 2, and 3 has decreased in that time. From an industry standpoint, it’s great to have a scale that tracks that progress.
Similar to EMRs in 2005, when the rate of adoption of such technology was at least a third of what it is now, most hospitals and physician practices aren’t doing so hot when it comes to engaging patients. But in recent years, senior healthcare leaders are making patient engagement a real priority within their organizations. Indeed, according to findings of the 26th Annual HIMSS Leadership Survey released at the annual HIMSS conference this past April, “patient satisfaction, patient engagement, and quality of care improvement have raced to the top of healthcare CIOs’ and senior IT executives’ agendas in the past year, a stark change from previous years which found that health IT leaders were more focused on business and financial goals.
Enter the Scottsdale Institute, a not-for-profit membership organization of prominent healthcare systems, whose goal is to support its members on their journey to clinical integration and transformation through information technology. Last month, leaders at Scottsdale Institute announced the creation of the SI Patient/Consumer Engagement Adoption Model, which according to an announcement, “is an assessment tool and adoption model to help U.S. healthcare systems measure effectiveness in engaging patients and consumers in managing their own health and wellness.” According to senior officials at Scottsdale Institute who have spoken to HCI, the creation of the model was inspired by the widespread adoption of the HIMSS Analytics EMRAM Model.
Recently, HCI Editor-in-Chief Mark Hagland spoke with Stephen Sproul, M.D., medical director, EMR and clinical integration, at Chicago-based Advocate Physician Partners, and also one of a number of senior executives who were surveyed about the concepts embedded in the new patient/consumer engagement model, and whose participation as survey respondents helped shaped it.
The SI Patient/Consumer Engagement Adoption Model has five levels with Level 1 starting at “engagement services offered,” and Level 5 representing “full community engagement.” More details on the model can be seen in the above-mentioned Hagland article, but what struck me as particularly interesting is what Dr. Sproul said about the ability of models like this to spur activity, as Hagland specifically asked. Sproul said, “Yes, I do [think it will promote action], I think there’s a value in this. Healthcare organizations respond to this type of evaluation of how well they do a certain type of thing. They respond to it and improve. And giving them a framework for this process of engagement helps them determine where they are. I think that’s helpful.”
Much as EMR adoption has exploded in the last five years, I expect patient engagement strategies and results to improve significantly in the coming years, at a time when healthcare policymakers are pressuring hospitals and health systems to get patients more involved in their care in an overall effort to cut costs and improve outcomes. In its proposed Stage 3 rule, set to begin in 2018, the meaningful use program alone asks for providers to get 25 percent of patients to view/download/transmit the health data. Whether that threshold sticks or not is unclear; but what is clear is the growing push towards a patient-centered healthcare.
What’s more, Sproul admitted to Hagland that many healthcare organizations are only on the early levels of this scale, and that it’s the larger health systems that are further along. To this end, in February, at the iHT2 Health IT Summit in Miami, C. Martin Harris, M.D., Cleveland Clinic’s CIO, and the chairman of the organization’s IT division, gave a keynote speech on the advancement of technology at the Clinic, including the notion of getting its patients used to idea of driving their own healthcare team, rather than being constrained by organizational relationships going forward. Harris said in the presentation, “Patients are out in front now compared to the caregivers. We have an open medical records policy, and when the physician writes a note and signs it, it's instantly available to the patient. Certain things such as the first cancer diagnosis would obviously not be available, but we believe engaging patients and giving them knowledge through this tool is necessary. We wanted to create a virtual relationship rather than only what happens in the doctor's office.”
Obviously, Cleveland Clinic, an industry leader, is ahead of where much smaller organizations with fewer resources are at when it comes to this shifting technology-based culture that healthcare is going through. But the idea it has is the right one in the new healthcare, and one that can lead to full community engagement, as noted by Sproul who mentioned that Advocate is “very much aware that the social determinants of health are much more important in fact than the delivery of sick care, in determining the health of a population, and then supporting the primary care base in the community.” He added that Advocate is currently doing things that would qualify as between Level 3 and 5 on the patient engagement model, while most organizations are only at the Level 1 or 2 ranges.
It should be said that this isn’t the industry’s first attempt to track patient engagement in healthcare organizations. In 2013, Axial Exchange, a Raleigh, N.C.-based health IT software provider, began to rank U.S. hospitals state-by-state based on an analysis of publically available data in three categories: personal health management, patient satisfaction and social media engagement. Axial then constructed a Patient Engagement Index (PEI) starting in four states, Florida, Texas, New York and California, assessing points based on those three categories. It is unclear if this index has spanned across any other states, but it’s an important note that in recent years, patient engagement has become even more of a priority for healthcare organizations.
As the Scottsdale Institute announcement additionally notes, the model is “in response to the growing demand as well as necessity for patients and consumers to participate directly in their own care as the healthcare industry moves from a volume-based, fee-for-service model to one based on value, accountable care and population-health management.” It adds, “Studies have shown that clinical outcomes and health improve, and costs are reduced, when patients are actively involved in managing their own health and well-being. However, healthcare-provider organizations have lacked any clear consensus on practical steps to achieve that goal.” The question that remains is will the boost in EMR adoption serve as a precedent for a boost in getting patients more involved in their health? Of course, only time will tell, but there’s no doubt that this model is a step in the right direction.
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