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, 3rd Quarter 2011

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	4.2111	1.2860	7.0710	4.2470	221
NonAcademic	3.0901	0.0000	7.0710	3.2600	5,078
General Medical/Surgical	3.4286	0.0000	7.0710	3.3310	3,161
Others	2.7056	0.0000	7.0710	3.1350	2,138
Rural	2.3608	0.0000	7.0390	3.0400	1,251
Urban	3.3767	0.0000	7.0710	3.3200	4,048
IDS	3.3029	0.0000	7.0710	3.3030	3,306
Independent Hospital	2.8615	0.0000	7.0630	3.1990	1,993
Critical Access	2.3872	0.0000	6.0550	3.0720	1,323

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Hospital Type Segment	Mean	Min	Max	Median	Number
Academic/Teaching	2.3081	0.0200	6.0550	2.3080	73
NonAcademic	1.7854	0.0000	6.0320	2.0950	568
General Medical/Surgical	1.7746	0.0000	6.0320	2.0950	551
Others	2.2750	0.0200	6.0550	2.2845	90

EMR Scores by Bed Size, 3rd Quarter 2011

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	2.6328	0.0000	7.0630	3.1200	2,759
101-200 Beds	3.3981	0.0000	7.0710	3.3150	973
201-300 Beds	3.7498	0.0100	7.0710	3.4080	610
301-400 Beds	3.8064	0.1900	7.0710	3.4150	405
401-500 Beds	3.8185	2.0150	7.0390	3.4410	215
501-600 Beds	4.0942	2.1700	7.0710	3.5090	149
600+ Beds	4.2120	2.1020	7.0710	4.2235	188

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Bed Segment	Mean	Min	Max	Median	Number
0-100 Beds	1.5817	0.0000	6.0080	2.0550	440
101-200 Beds	2.2001	0.0000	4.2160	2.1910	79
201-300 Beds	2.2012	0.0200	5.1810	2.2470	41
301-400 Beds	2.7577	0.1300	6.0320	3.0880	37
401-500 Beds	2.6634	0.0720	6.0550	2.6530	16
501-600 Beds	2.7317	1.2230	4.2160	3.0520	12
600+ Beds	2.8208	1.0720	4.3700	3.2100	16

EMR Scores by Region, 3rd Quarter 2011

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Regions (U.S. Census Defined)	Mean	Min	Max	Median	Number
East North Central	3.3991	0.0000	7.0710	3.3160	839
East South Central	2.8580	0.0000	6.0710	3.2000	442
Middle Atlantic	3.4383	0.0050	7.0390	3.3150	486
Mountain	2.7394	0.0000	7.0630	3.1560	419
New England	3.8923	0.1110	7.0630	3.4595	200
Pacific	3.3311	0.0000	7.0710	3.2710	584
South Atlantic	3.3794	0.0000	7.0710	3.3350	787
West North Central	2.9378	0.0000	7.0630	3.2350	708
West South Central	2.6678	0.0000	7.0390	3.1390	834

All Hospitals, 3rd Quarter 2011

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All Hospitals	Mean	Min	Max	Median	Number
Total	3.1369	0.0000	7.0710	3.2750	5,299

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All Hospitals	Mean	Min	Max	Median	Number
Total	1.8449	0.0000	6.0550	2.1040	641

EMR Scores by State/Province, 3rd Quarter 2011

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United States	Mean	Min	Max	Median	Number
Alaska	3.3329	0.0050	6.0710	3.2750	17
Alabama	2.9664	0.0000	5.1190	3.2520	99
Arkansas	2.6313	0.0050	6.0710	3.0750	86
Arizona	3.1642	0.0250	7.0630	3.2615	82
California	3.3571	0.0000	7.0710	3.2305	388
Colorado	2.7713	0.0150	6.0470	3.2495	84
Connecticut	3.9343	1.0790	6.0710	4.0960	34
District of Columbia	2.4858	0.0050	4.2770	3.0970	10
Delaware	4.1829	2.4580	7.0470	3.6050	9
Florida	3.2695	0.0000	6.0710	3.3320	239
Georgia	3.1888	0.0000	6.0710	3.3350	155
Hawaii	2.5397	0.0050	6.0480	2.1510	25
Iowa	3.4053	0.0050	6.0710	3.3680	121
Idaho	2.7576	0.0000	6.0150	3.1840	43
Illinois	3.5352	0.0450	7.0710	3.3600	199
Indiana	3.4674	0.0050	6.0710	3.3390	137
Kansas	2.2425	0.0000	6.0480	3.0750	137
Kentucky	3.0084	0.0580	6.0710	3.2350	104
Louisiana	2.5083	0.0050	6.0710	3.1395	144
Massachusetts	4.0049	0.1250	7.0630	3.4870	81
Maryland	3.8939	1.0710	6.0630	3.4155	48
Maine	3.9510	2.0950	6.0480	4.1550	35
Michigan	3.2511	0.0050	6.0710	3.2195	160
Minnesota	3.4272	0.0000	7.0630	3.2980	133
Missouri	3.4470	0.0050	7.0310	3.4000	133
Mississippi	2.3038	0.0050	6.0710	2.1620	99
Montana	1.7363	0.0000	6.0240	1.7300	56
North Carolina	3.3421	0.0100	6.0710	3.3220	122
North Dakota	2.0412	0.0000	5.1350	2.1470	45
Nebraska	2.5447	0.0000	6.0550	3.1240	87
New Hampshire	3.1196	0.1110	6.0470	3.2600	25
New Jersey	3.4309	0.0550	6.0710	3.3150	85
New Mexico	2.8459	0.0000	6.0310	3.1240	37
Nevada	2.4048	0.0000	4.2670	3.1550	41
New York	3.4579	0.0050	6.0710	3.2870	203
Ohio	3.2535	0.0000	6.0710	3.3120	207
Oklahoma	2.4634	0.0000	6.0710	3.0750	118
Oregon	3.3854	0.0420	7.0230	3.3350	61
Pennsylvania	3.4214	0.0050	7.0390	3.3350	198
Rhode Island	4.3605	1.3230	6.0710	4.2610	11
South Carolina	3.4575	0.1300	6.0710	3.3910	71
South Dakota	2.5621	0.0000	6.0470	3.1435	52
Tennessee	3.0614	0.0000	6.0710	3.2720	140
Texas	2.7711	0.0000	7.0390	3.1870	486
Utah	3.2554	0.0000	6.0710	3.3750	49
Virginia	3.9711	0.0790	7.0710	3.4190	84
Vermont	4.0035	1.0710	6.0710	3.5250	14
Washington	3.3992	0.0050	6.0710	3.3590	93
Wisconsin	3.5267	0.0000	7.0710	3.3250	136
West Virginia	3.0150	0.0100	6.0470	3.2000	49
Wyoming	2.8278	0.0150	6.0310	3.1470	27
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Canada	Mean	Min	Max	Median	Number
Alberta	2.5762	1.1150	3.2120	3.0240	96
British Columbia	2.4670	0.0180	6.0080	3.0600	81
Manitoba	0.6043	0.0000	4.3220	0.0770	67
New Brunswick	3.0480	2.1230	4.2160	3.1420	20
Newfoundland and Labrador	2.4825	0.0550	3.2150	3.0950	30
Northwest Territories	0.1560	0.1540	0.1620	0.1540	4
Nova Scotia	2.5603	2.0560	3.2230	2.1710	33
Nunavut	0.5025	0.0050	1.0000	0.5025	2
Ontario	2.3229	0.0000	6.0550	2.2775	124
Prince Edward Island	2.2530	2.2050	2.2610	2.2610	7
Quebec	1.2535	0.0000	4.2000	1.0760	116
Saskatchewan	0.3223	0.0000	2.1040	0.0300	59
Yukon Territory	2.5855	2.0630	3.1080	2.5855	2
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EMRAM Trended, Summary

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EMRAM Trended	2011 Q2	2011 Q3
Stage 7	1.1%	1.1%
Stage 6	4.0%	4.4%
Stage 5	6.1%	7.1%
Stage 4	12.3%	13.2%
Stage 3	46.3%	46.1%
Stage 2	13.7%	12.6%
Stage 1	6.6%	5.9%
Stage 0	10.0%	9.6%
Total Hospitals	n = 5310	n = 5299

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EMRAM Trended	2011 Q2	2011 Q3
Stage 7	0.0%	0.0%
Stage 6	0.5%	0.5%
Stage 5	0.2%	0.2%
Stage 4	1.7%	2.3%
Stage 3	33.2%	34.5%
Stage 2	23.9%	22.0%
Stage 1	12.2%	14.4%
Stage 0	28.3%	26.2%
Total Hospitals	n = 639	n = 641

EMRAM, Year Over Year

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EMRAM Trended	2009	2010
Stage 7	1.0%	1.0%
Stage 6	2.8%	3.2%
Stage 5	3.7%	4.5%
Stage 4	10.3%	10.5%
Stage 3	49.7%	49.0%
Stage 2	15.4%	14.6%
Stage 1	6.7%	7.1%
Stage 0	10.5%	10.1%
Total Hospitals	n = 5233	n = 5281