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, 4th Quarter 2009

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	3.7836	0.1650	7.0710	3.3770	296
NonAcademic	2.6903	0.0000	7.0630	3.1470	4,939
General Medical/Surgical	3.0282	0.0000	7.0630	3.2150	3,156
Others	2.3332	0.0000	7.0710	3.0550	2,079
Rural	1.8593	0.0000	6.0080	2.0710	1,171
Urban	3.0094	0.0000	7.0710	3.2150	4,064
IDS	3.0017	0.0000	7.0710	3.2160	3,134
Independent Hospital	2.3800	0.0000	7.0310	3.0640	2,101
Critical Access	1.8494	0.0000	6.0080	2.0630	1,291

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	1.9906	0.0000	4.3060	2.1390	74
NonAcademic	1.5066	0.0000	6.0230	2.0150	586
General Medical/Surgical	1.5358	0.0000	6.0230	2.0470	551
Others	1.6876	0.0000	4.3060	2.0150	109

EMR Scores by Bed Size, 4th Quarter 2009

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	2.1999	0.0000	7.0310	2.2070	2,675
101-200 Beds	3.0949	0.0050	7.0630	3.2170	986
201-300 Beds	3.3780	0.0400	7.0630	3.3070	624
301-400 Beds	3.4009	0.0330	7.0710	3.3040	397
401-500 Beds	3.5128	0.1750	7.0470	3.3320	227
501-600 Beds	3.6051	3.6051	7.0310	3.3480	141
600+ Beds	3.8236	2.0550	7.0310	3.3630	185

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	1.3720	0.0000	6.0230	1.0640	449
101-200 Beds	1.7738	0.0000	3.2070	2.0950	79
201-300 Beds	1.7133	0.0000	3.2230	2.0595	44
301-400 Beds	2.0367	0.0000	4.1400	2.1550	41
401-500 Beds	2.2904	0.0050	4.3060	2.6235	18
501-600 Beds	2.4115	0.2350	3.2120	3.0320	11
600+ Beds	2.6321	1.0640	4.1950	3.0440	18

EMR Scores by Region, 4th Quarter 2009

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Regions (U.S. Census Defined)	Mean	Min	Max	Median	Number
East North Central	2.9981	0.0050	7.0710	3.2135	816
East South Central	2.5713	0.0000	6.0710	3.0960	448
Middle Atlantic	3.0805	0.0050	7.0390	3.2080	493
Mountain	2.3731	0.0000	6.0230	3.0880	417
New England	3.4212	0.1110	6.0710	3.2920	203
Pacific	2.9186	0.0000	7.0630	3.1400	583
South Atlantic	3.0769	0.0000	7.0310	3.3040	781
West North Central	2.3753	0.0000	7.0310	3.0615	698
West South Central	2.3163	0.0000	6.0560	3.0150	796

All Hospitals, 4th Quarter 2009

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All Hospitals	Mean	Min	Max	Median	Number
Total	2.7522	0.0000	7.0710	3.1560	5,235

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All Hospitals	Mean	Min	Max	Median	Number
Total	1.5609	0.0000	6.0230	2.0470	660

EMR Scores by State/Province, 4th Quarter 2009

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United States	Mean	Min	Max	Median	Number
Alaska	2.4579	0.0050	4.1390	3.1240	17
Alabama	2.6135	0.0000	5.0960	3.0800	103
Arkansas	2.2418	0.0050	6.0550	2.0870	85
Arizona	2.7355	0.0050	5.1650	3.1560	80
California	3.0028	0.0000	7.0630	3.1320	386
Colorado	2.6307	0.0050	5.1490	3.1855	84
Connecticut	3.8377	1.0390	6.0630	3.4150	33
District of Columbia	2.1558	0.0000	4.2770	3.1640	11
Delaware	3.4942	2.1550	5.1120	3.3390	9
Florida	3.0890	0.0050	6.0560	3.3240	234
Georgia	2.7965	0.0000	6.0630	3.2070	155
Hawaii	1.9702	0.0050	6.0470	2.0940	25
Iowa	2.7058	0.0000	5.1490	3.1115	118
Idaho	2.2698	0.0000	5.0480	2.1790	43
Illinois	3.1618	0.0100	7.0710	3.1840	197
Indiana	3.0953	0.0050	6.0550	3.2390	129
Kansas	1.8145	0.0000	6.0310	2.0850	137
Kentucky	2.6456	0.0350	5.1490	3.0815	106
Louisiana	2.2656	0.0000	6.0560	2.1620	139
Massachusetts	3.3802	0.2100	6.0710	3.2670	81
Maryland	3.5229	0.0100	6.0630	3.3190	49
Maine	3.4549	0.2030	6.0390	3.3175	38
Michigan	2.8805	0.0050	6.0710	3.1840	159
Minnesota	2.7241	0.0000	6.0630	3.1390	133
Missouri	2.8590	0.0050	7.0310	3.1800	127
Mississippi	2.0463	0.0000	6.0710	2.0860	97
Montana	1.2831	0.0000	3.3270	1.0040	56
North Carolina	3.1242	0.0050	5.1350	3.3210	120
North Dakota	1.8347	0.0000	5.1490	2.0150	43
Nebraska	1.9567	0.0000	5.1350	2.0860	87
New Hampshire	3.0317	0.1110	5.0790	3.1910	26
New Jersey	3.1583	0.0100	5.1490	3.2715	86
New Mexico	2.5575	0.0000	6.0230	2.1280	40
Nevada	2.4574	0.0000	4.2670	3.1560	40
New York	3.0951	0.0050	6.0710	3.1570	209
Ohio	2.9304	0.0150	5.1490	3.2270	195
Oklahoma	2.0420	0.0000	6.0470	2.1150	119
Oregon	3.0582	0.0290	6.0560	3.1720	62
Pennsylvania	3.0314	0.0050	7.0390	3.2190	198
Rhode Island	3.7207	0.1650	6.0550	3.3210	11
South Carolina	3.0945	0.0450	5.1490	3.3200	67
South Dakota	2.1805	0.0000	5.0950	3.0000	53
Tennessee	2.8440	0.0000	6.0710	3.1560	142
Texas	2.4180	0.0000	6.0550	3.0750	453
Utah	2.3375	0.0000	3.4230	2.2900	47
Virginia	3.5291	0.0650	7.0310	3.3350	85
Vermont	3.0729	1.0710	5.1490	3.1755	14
Washington	2.8151	0.0000	6.0390	3.2030	93
Wisconsin	2.9036	0.0050	7.0310	3.2250	136
West Virginia	2.6827	0.0050	5.0640	3.1310	51
Wyoming	2.5865	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	0.5619	0.0000	4.3060	0.0770	67
New Brunswick	2.4125	0.1320	3.1560	3.0560	20
Newfoundland and Labrador	2.7527	0.2690	4.1840	3.0800	30
Northwest Territories	0.1560	0.1540	0.1620	0.1540	4
Nova Scotia	2.5404	2.0560	3.2230	2.1550	33
Nunavut	1.0000	1.0000	1.0000	1.0000	1
Ontario	1.4730	0.0000	4.1950	1.1200	145
Prince Edward Island	2.0727	2.0150	2.1310	2.0710	7
Quebec	1.0331	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	Q3 2009	Q4 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

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