12 Chapter 1 hospitals, with all their key organizational figures, are measured, whichmakes it possible to compare hospitals with each other. At the lowest level, the hospital is at the beginning and has not even automated the ancillary departments like the pharmacy, radiology, or laboratory. At the highest level, the hospital no longer uses physical paper or images, but has everything stored and encoded electronically. Clinical Decision Support Systems (CDSS) are used to analyze clinical information and thus improve the quality of care and patient safety. Clinical data are exchanged electronically between all parts of the hospital. Computerized Provider Order Entry (CPOE) systems are used and refer to the process of providers entering and sending treatment instructions, including medication, laboratory, and radiology orders, via a computer application rather than paper, fax, or telephone. Physician orders are standardized across the organization and maybe individualized for each doctor or specialty by using order sets. Orders are communicated to all departments and involved caregivers, improving response time and avoiding scheduling problems and conflicts with existing orders. And the hospital uses analytic tools and thus also has, from a management perspective, a view of all parts of the hospital. Only hospitals on the highest level (stage 7) are ready to communicate fully digitally with other healthcare providers, the patient, insurers, and other stakeholders. The scoring process is done by identifying the software used in the different functional areas of the hospital. Depending on the level of maturity, each hospital is presented with approximately 150 questions to focus on varied issues to include demographics, software functionalities, processes, integration standards, and usage in percentage by physicians and nurses. In order to monitor the quality of the scoring process, site visits or telephone interviews are conducted on selected hospitals. Validation is done by the quality assurance department of HIMSS Analytics Europe and the scoring by a proprietary scoring algorithm (HIMSS Analytics North America). If a hospital receives an EMRAM Stage 6 score, an additional 59 questions are asked by a validation team of international peer inspectors mostly from Stage 6 or 7 hospitals in the EU (see appendix 2 for example of results). Stage 6 hospitals can apply for a Stage 7 validation, consisting of a 2-day visit of peer inspectors (see appendix 3 for example of results). EMRAM scores lower than Stage 6 are not publicly shared by HIMSS Analytics and are confidential. See chapter 2 for more details of the model. Quality of healthcare The World Health Organization (WHO) definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health
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