EMR Adoption Model^SM

HIMSS Analytics, the authoritative source on EMR Adoption trends, devised the EMR Adoption Model to track EMR progress at hospitals and health systems.  The EMRAM scores hospitals in the HIMSS Analytics Database on their progress in completing the 8 stages to creating a paperless patient record environment. 

EMR Adoption Model Structure Ensures Objectivity

• All application capabilities within each stage must be operational before that stage can be achieved.
• All lower stages must have been achieved before a higher level will be considered as achieved. 
• A hospital can achieve Stages 3-6 if it has met all of the application requirements for a single patient care service (e.g. single nursing floor, cardiology service).   
• Using the rules above, additional points are given for the implementation of applications in stages higher than the one fully achieved by the healthcare organization. In this fashion, other implementation paths than those prescribed by the stages can be taken into consideration for correlation with quality and financial research. 

Read a detailed description of the stages

Please note that we have made important changes to the EMR Adoption Model which impacts the Stage 7 evaluations. These changes have been in place since September 14, 2009 and will effect EMRAM scoring moving forward. Minor clarifications were also made to Stages 2 and 3. The modifications are summarized here for your convenience.

EMR Scores by Hospital Type, 2nd Quarter 2010

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	3.9427	1.2060	7.0710	3.5100	263
NonAcademic	2.7919	0.0000	7.0710	3.1720	4,954
General Medical/Surgical	3.1428	0.0000	7.0710	3.2520	3,174
Others	2.3949	0.0000	7.0710	3.0790	2,043
Rural	1.9959	0.0000	6.0710	2.0870	1,200
Urban	3.1050	0.0000	7.0710	3.2550	4,017
IDS	3.1077	0.0000	7.0710	3.2600	3,136
Independent Hospital	2.4615	0.0000	7.0310	3.0800	2,081
Critical Access	1.9474	0.0000	6.0470	2.0865	1,286

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	2.0342	0.0000	4.3060	2.1510	74
NonAcademic	1.5770	0.0000	6.0230	2.0550	586
General Medical/Surgical	1.6100	0.0000	6.0230	2.0560	551
Others	1.7204	0.0000	4.3060	2.0470	109

EMR Scores by Bed Size, 2nd Quarter 2010

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	2.2774	0.0000	7.0550	3.0150	2,657
101-200 Beds	3.1936	0.0050	7.0710	3.2600	983
201-300 Beds	3.5046	0.0400	7.0710	3.3335	616
301-400 Beds	3.5189	0.0330	7.0710	3.3480	413
401-500 Beds	3.6047	2.0150	7.0470	3.3670	215
501-600 Beds	3.7291	1.2500	7.0710	3.3630	147
600+ Beds	3.9913	2.0710	7.0470	3.4825	186

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	1.4216	0.0000	6.0230	1.1150	449
101-200 Beds	1.9145	0.0000	4.2160	2.0950	79
201-300 Beds	1.7882	0.0000	3.2310	2.0790	44
301-400 Beds	2.1468	0.0000	4.1400	2.2300	41
401-500 Beds	2.2948	0.0050	4.3060	2.6235	18
501-600 Beds	2.6955	0.2350	4.2160	3.0790	11
600+ Beds	2.6366	1.0640	4.1950	3.0440	18

EMR Scores by Region, 2nd Quarter 2010

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Regions (U.S. Census Defined)	Mean	Min	Max	Median	Number
East North Central	3.1289	0.0050	7.0710	3.2435	812
East South Central	2.6495	0.0000	6.0710	3.1470	448
Middle Atlantic	3.1564	0.0050	7.0390	3.2320	487
Mountain	2.5071	0.0000	6.0710	3.1310	414
New England	3.5653	0.0700	6.0710	3.3020	204
Pacific	3.0307	0.0000	7.0630	3.1920	579
South Atlantic	3.1619	0.0000	7.0710	3.3200	782
West North Central	2.4942	0.0000	7.0310	3.0975	696
West South Central	2.3579	0.0000	7.0470	3.0640	795

All Hospitals, 2nd Quarter 2010

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All Hospitals	Mean	Min	Max	Median	Number
Total	2.8499	0.0000	7.0710	3.1920	5,217

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All Hospitals	Mean	Min	Max	Median	Number
Total	1.6283	0.0000	6.0230	2.0555	660

EMR Scores by State/Province, 2nd Quarter 2010

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United States	Mean	Min	Max	Median	Number
Alaska	2.6501	0.0050	4.1390	3.1920	17
Alabama	2.6907	0.0000	5.0960	3.1300	103
Arkansas	2.2224	0.0050	6.0710	2.0870	85
Arizona	2.7601	0.0050	6.0550	3.1790	79
California	3.1236	0.0000	7.0630	3.1760	385
Colorado	2.6426	0.0050	6.0710	3.2030	84
Connecticut	3.7821	1.0390	6.0710	3.3750	34
District of Columbia	2.1631	0.0000	4.2770	3.0950	11
Delaware	3.5296	2.1550	5.1270	3.3390	9
Florida	3.1410	0.0050	6.0560	3.3320	233
Georgia	2.8805	0.0000	6.0630	3.2630	156
Hawaii	1.9869	0.0050	6.0470	2.0940	25
Iowa	2.7879	0.0000	6.0710	3.1750	119
Idaho	2.3214	0.0000	5.0960	2.2395	42
Illinois	3.1615	0.0100	7.0710	3.2150	195
Indiana	3.2728	0.0050	6.0550	3.2910	127
Kansas	1.9559	0.0000	6.0710	2.0985	136
Kentucky	2.7243	0.0350	5.1030	3.1435	106
Louisiana	2.2779	0.0050	6.0710	2.2150	137
Massachusetts	3.6852	0.0700	6.0710	3.3000	81
Maryland	3.8195	1.0710	6.0630	3.4030	48
Maine	3.4873	0.2030	6.0390	3.3150	38
Michigan	2.9113	0.0050	6.0710	3.1995	158
Minnesota	2.8759	0.0000	6.0630	3.1965	134
Missouri	2.9644	0.0050	7.0310	3.2080	127
Mississippi	2.0846	0.0000	6.0710	2.0940	97
Montana	1.4152	0.0000	3.3270	1.0200	56
North Carolina	3.1067	0.0050	6.0560	3.3210	122
North Dakota	1.8113	0.0000	5.1350	2.0390	42
Nebraska	2.0936	0.0000	5.1350	2.1540	85
New Hampshire	3.0537	0.0960	4.3190	3.2515	26
New Jersey	3.3850	0.0100	6.0710	3.3350	84
New Mexico	2.5928	0.0000	6.0230	3.0710	37
Nevada	2.5668	0.0000	4.2670	3.1755	40
New York	3.1383	0.0050	6.0710	3.2085	208
Ohio	3.0554	0.0150	6.0710	3.2450	196
Oklahoma	2.2070	0.0000	6.0710	2.1550	119
Oregon	3.1376	0.0290	6.0560	3.2270	59
Pennsylvania	3.0773	0.0050	7.0390	3.2310	195
Rhode Island	3.7637	2.1030	6.0630	3.3130	11
South Carolina	3.2429	0.1540	6.0560	3.3360	68
South Dakota	2.3083	0.0000	6.0550	3.0600	53
Tennessee	2.9495	0.0000	6.0710	3.2130	142
Texas	2.4470	0.0000	7.0470	3.1335	454
Utah	3.1246	0.0000	6.0710	3.1930	49
Virginia	3.6635	0.0650	7.0710	3.4070	84
Vermont	3.3507	1.0710	6.0710	3.2615	14
Washington	2.9281	0.0050	6.0710	3.2360	93
Wisconsin	3.3063	0.0050	7.0630	3.2850	136
West Virginia	2.8481	0.0050	6.0470	3.1650	51
Wyoming	2.5720	0.0150	5.0850	3.1400	27
Proprietary & Confidential to HIMSS AnalyticsTM LLC

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Canada	Mean	Min	Max	Median	Number
Alberta	2.5762	1.1150	3.2120	3.0240	96
British Columbia	2.0533	0.0100	6.0230	2.0790	81
Manitoba	0.5654	0.0000	4.3060	0.0770	67
New Brunswick	3.0480	2.1230	4.2160	3.1420	20
Newfoundland and Labrador	2.7146	0.2010	3.2150	3.0950	30
Northwest Territories	0.1560	0.1540	0.1620	0.1540	4
Nova Scotia	2.5489	2.0560	3.2230	2.1550	33
Nunavut	1.0000	1.0000	1.0000	1.0000	1
Ontario	1.6948	0.0000	4.1950	2.0950	145
Prince Edward Island	2.0727	2.0150	2.1310	2.0710	7
Quebec	1.0351	0.0000	3.1920	0.0810	114
Saskatchewan	0.2771	0.0000	2.0920	0.0225	60
Yukon Territory	0.0650	0.0000	0.1300	0.0650	2
Proprietary & Confidential to HIMSS AnalyticsTM LLC

EMRAM Trended, Summary

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EMRAM Trended	Q1 2010	Q2 2010
Stage 7	0.7%	0.8%
Stage 6	1.8%	2.6%
Stage 5	5.0%	3.2%
Stage 4	7.7%	9.7%
Stage 3	50.0%	50.2%
Stage 2	16.5%	15.5%
Stage 1	6.9%	6.8%
Stage 0	11.4%	11.2%
Total Hospitals	n = 5223	n = 5217

EMRAM, Year Over Year

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EMRAM Trended	2008	2009
Stage 7	0.3%	0.7%
Stage 6	0.5%	1.6%
Stage 5	2.5%	3.8%
Stage 4	2.5%	7.4%
Stage 3	35.7%	50.9%
Stage 2	31.4%	16.9%
Stage 1	11.5%	7.2%
Stage 0	15.6%	11.5%
Total Hospitals	n = 5166	n = 5235