1. TREND OF DIGITAL HOSPITALS
DRIVING PATIENT‟S SAFETY AND
QUALITY OF CARE THROUGH IT
STEVEN YEO
GENERAL MANAGER,
HIMSS ANALYTICS ASIA PACIFIC & MIDDLE EAST
6th September 2013

2. CONTENT
• Asia Pacific EMRAM Trend
• Key challenges for hospitals in adopting EMR
• Values
• Summary

3. 3 FUNDAMENTAL HEALTHCARE ISSUES
• Cost
• Quality of Care
• Access to care

4. A COMMON GLOBAL PROBLEM
• Safety
• Privacy
• Engagement
»Clinicians
»“Consumers”
• Maturity
• Paper
„Management‟

5. THIS LOOKS FAMILIAR?

6. HIMSS ANALYTICS ASIA PACIFIC
EMR ADOPTION MODELSM

7. EMR ADOPTION IN THE U.S. MARKET TRENDED
2006 – 2012 (% OF U.S. HOSPITALS)
Tracking EMR adoption assists in the creation of policies and strategies that
drive EMR adoption and improve patient care
Source: HIMSS Analytics ® Database

8. Data from HIMSS Analytics® Database ©
Cross Country EMRAM Score Distribution (2013 Q2)
Stage
United
States*
Canada* Australia Malaysia Singapore
United
Arab
Emirates
Saudi
Arabia
Germany* Italy* Poland* Portugal* Spain*
Nether-
lands*
Stage
7
1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.3% 0.0% 0.0% 0.0% 0.5% 0.0%
Stage
6
9.1% 0.5% 0.0% 0.5% 57.1% 12.8% 2.9% 0.0% 0.6% 0.0% 0.0% 4.3% 3.8%
Stage
5
16.3% 0.3% 3.5% 4.7% 14.3% 14.9% 14.7% 8.3% 6.6% 0.0% 26.1% 40.9% 34.6%
Stage
4
14.4% 2.2% 0.9% 2.8% 14.3% 4.3% 5.9% 1.9% 1.8% 0.7% 4.3% 6.7% 3.8%
Stage
3
36.3% 33.6% 0.4% 0.5% 0.0% 6.4% 27.9% 8.3% 3.4% 0.0% 21.7% 1.9% 1.9%
Stage
2
10.1% 26.9% 52.0% 1.9% 14.3% 25.5% 14.7% 34.9% 26.7% 10.3% 4.3% 18.8% 55.8%
Stage
1
4.2% 14.8% 4.4% 1.4% 0.0% 21.3% 8.9% 0.6% 41.4% 13.0% 4.3% 9.6% 0.0%
Stage
0
7.8% 21.7% 38.9% 88.2% 0.0% 14.9% 25.0% 45.7% 19.5% 76.0% 39.1% 17.3% 0.0%
N =
5,441
N = 640 N = 229 N = 212 N = 7 N = 47 N = 68 N = 324 N = 498 N = 146 N = 23 N = 208 N = 52

9. Data from HIMSS Analytics® Database ©
Cross Regional EMRAM Score Distribution
Stage Asia Pacific Middle East United States * Canada* Europe*
Stage 7 0.2% 0.0% 1.9% 0.0% 0.1%
Stage 6 2.3% 7.0% 9.1% 0.5% 1.4%
Stage 5 4.5% 14.8% 16.3% 0.3% 14.9%
Stage 4 2.5% 5.2% 14.4% 2.2% 2.8%
Stage 3 0.5% 19.1% 36.3% 33.6% 4.0%
Stage 2 28.0% 19.1% 10.1% 26.9% 27.2%
Stage 1 6.2% 13.9% 4.2% 14.8% 18.8%
Stage 0 55.8% 20.9% 7.8% 21.7% 30.7%
N = 600 N = 115 N = 5,441 N = 640 N = 1,354
EMR Adoption Model Scores, % of Hospitals, Q2 2013
* Data Retrieved: Q1, 2013

10. Stage Short Description 2012 Q4 2013 Q1 2013 Q2
Stage 7
Complete EMR; CCD transactions to share data; Data
warehousing; Data continuity with ED, ambulatory, OP
0.2% 0.2% 0.2%
Stage 6
Physician documentation (structured templates), full CDSS
(variance & compliance), closed loop medication administration
2.6% 2.2% 2.3%
Stage 5 Full complement of R-PACS displaces all film-based images 4.1% 5.3% 4.5%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 3.0% 3.0% 2.5%
Stage 3
Nursing/clinical documentation (flow sheets), CDSS (error
checking), PACS available outside Radiology
0.4% 0.4% 0.5%
Stage 2
Clinical Data Repository (CDR), Controlled Medical
Vocabulary, CDS, may have Document Imaging; HIE capable
27.5% 26.0% 28.0%
Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed 3.8% 6.1% 6.2%
Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 58.4% 56.9% 55.8%
N= 469 N= 508 N= 600
Data from HIMSS Analytics® Database © 2013 HIMSS Analytics
Asia Pacific EMR Adoption ModelSM

11. Cross Country EMRAM Score Distribution (2013 Q2)
Stage Australia New Zealand Singapore Malaysia Thailand
Stage 7 0.0% 0.0% 0.0% 0.0% 0.0%
Stage 6 0.0% 0.0% 57.1% 0.5% 0.0%
Stage 5 3.5% 5.6% 14.3% 4.7% 6.2%
Stage 4 0.9% 0.0% 14.3% 2.8% 0.0%
Stage 3 0.4% 0.0% 0.0% 0.5% 1.5%
Stage 2 52.0% 91.7% 14.3% 1.9% 9.2%
Stage 1 4.4% 2.8% 0.0% 1.4% 32.3%
Stage 0 38.9% 0.0% 0.0% 88.2% 50.8%
N = 229 N = 36 N = 7 N = 212 N = 65
Data from HIMSS Analytics® Database ©
Data Retrieved: 2013 Q2

12. Stage Short Description
Small
(≤ 100 beds)
Medium
(101-200 beds)
Large
(>200 beds)
Stage 7
Complete EMR; CCD transactions to share data; Data
warehousing; Data continuity with ED, ambulatory, OP
0.0% 0.0% 0.0%
Stage 6
Physician documentation (structured templates), full CDSS
(variance & compliance), closed loop medication administration
0.0% 0.0% 6.7%
Stage 5 Full complement of R-PACS displaces all film-based images 7.1% 12.5% 20.0%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 0.0% 12.5% 3.3%
Stage 3
Nursing/clinical documentation (flow sheets), CDSS (error
checking), PACS available outside Radiology
28.6% 20.8% 33.3%
Stage 2
Clinical Data Repository (CDR), Controlled Medical
Vocabulary, CDS, may have Document Imaging; HIE capable
7.1% 16.7% 16.7%
Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed 0.0% 8.3% 13.3%
Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 57.1% 29.2% 6.7%
N=14 N= 24 N= 30
Data from HIMSS Analytics® Database © 2013 HIMSS Analytics
australiaKSA EMR Adoption ModelSM (2013 Q2)

13. CONTENT
• Asia Pacific EMRAM Trend
• Key challenges for hospitals in adopting EMR
• Values
• Summary

14. CHALLENGES FOR ADOPTION IN HEALTHCARE
ORGANIZATIONS
• Lack of financial resources
• Lack of basic IT infrastructure
• Use of open-source technology in developing countries
• Lack of professional healthcare IT Staff
• Lack of incentives for private hospitals to adopt EMR E.g. Raffles
Hospital
• Nursing documentation not considered a priority
• Unable to justify the Returns of Investments (ROIs)
• Managing competing priorities to meet organisational budget and
goals

15. KEY ISSUES IN ACHIEVING STAGE 6 & 7
• Nursing functions not a priority; unable to move past Stage
2 of the EMRAM
• No pre-packaged unit dose medications for closed loop
medication administration

16. CONTENT
• Asia Pacific EMRAM Trend
• Key challenges for hospitals in adopting EMR
• Values
• Summary

17. 9/20/2013 17©2011 Healthcare Information and Management Systems Society
Reasons for Adopting HIMSS EMRAM Benchmark
Stage Capabilities Benefit
Stage 7 Medical record Fully
electronic, Able to
contribute CCD as by
product of EHR/EMR,
Data Warehousing
Paperless environment for better care & medical outcomes .
Clinical analytics derived from EMR data used to improve
outcomes by inputs back to operational EMR. Rich analytics
due to ability to capture data at every point.
Stage 6 Physician Documentation,
Full CDSS
Higher level of Patient Safety, Patient Care,
Enhanced Effectiveness of Care
Stage 5 Closed Loop Medication
Administration
Patient Safety, 5 Rights
Stage 4 CPOE, CDSS Patient Safety
Stage 3 Clinical Documentation
(Flow sheets), CDSS
Allow Team-Based Care
Stage 2 Clinical Data Repository Force Standardisation. Single source of Truth
Stage 1 Ancillaries Automation of Departmental Workflow.
Basis for Electronic Orders
Stage 0 -- --

18. CONTENT
• Asia Pacific EMRAM Trend
• Key challenges for hospitals in adopting EMR
• Values
• Summary

19. IN SUMMARY
• Government and hospitals are investing in IT to deliver
better patient care – safety, quality and access.
• HIMSS Analytics EMRAM (EMR Adoption Model)
provide a good framework for government to baseline
and track hospital‟s IT capability.
» Creation of policy and strategy
» Drive EMR adoption and patient care
• Hospitals can learn from other hospitals that had
successfully achieved the stages and getting the ROI.
• Management needs to have clear strategy for building
its EMR environment to meet its corporate objectives
with its investment and outcome.

20. IN SUMMARY
• Government and hospitals are investing in IT to
deliver better patient care – safety, quality and
access.
• HIMSS Analytics EMRAM (EMR Adoption Model)
provide a good framework for government to
baseline and track hospital‟s IT capability.
» Creation of policy and strategy
» Drive EMR adoption and patient care
• Vendor needs to continue to invest in R&D on
capabilities in their solutions to meet customer‟s
needs.
Steven Yeo
syeo@himss.org
Tel : +65-98485259