28 Chapter 2 TABLE 2: Frequency Distribution of EMRAM Scores (Q2 2015) HIMSS level Frequency Percent Characteristics (EU model) Stage 7 0 0 Complete EMR; CCD transactions to share data; Data warehousing feeding outcomes reports, quality assurance, and business intelligence. 6 11 15.3 Physician documentation interaction with full CDSS (structured templates related to clinical protocols trigger variance & compliance alerts) and Closed loop medication administration. 5 31 43.1 Full complement of PACS displaces all filmbased images. 4 2 2.8 CPOE in at least one clinical service area and/or for medication (i.e., e-Prescribing); may have Clinical Decision Support based on clinical protocols. 3 0 0 Nursing/clinical documentation (flow sheets); may have Clinical Decision Support for error checking during order entry and/or PACS available outside Radiology 2 27 37.5 Clinical Data Repository (CDR) / Electronic Patient Record; may have Controlled Medical Vocabulary, Clinical Decision Support (CDSS) for rudimentary conflict checking, 1 1 1.4 Major ancillary clinical systems are installed (pharmacy, laboratory, radiology) or laboratory, pharmacy, radiology information system data output is delivered to the hospital for online access and processing if the ancillary service is not provided inhouse, but by external service providers 0 0 0 All Three Ancillaries (Laboratory, Radiology and Pharmacy) not Installed OR not processing Laboratory, Radiology and Pharmacy data output online from external service providers. Total 72 100 Stage 3, Stage 6, and Stage 7 requirements present as challenges for NL hospitals. The distribution profile is significant in that it suggests some EMRAM requirements are more challenging for NL hospitals than others. EMRAM Stage 3 presents as the first notable challenge to NL hospitals, as 37.5% of the hospitals in this study have yet to satisfy the requirements of this stage. Once EMRAM Stage 3 requirements are met, the EMRAM profile then suggests NL hospitals are likely to be challenged in meeting the requirements of EMRAM Stage 6 (Closed loop medication administration [CLMA] and
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