43 The Association between eHealth Capabilities and the Quality and Safety of Health Care INTRODUCTION Implementations of potentially transformative information technologies are currently underway internationally, often with significant impact on national expenditure.1,2 Such large-scale efforts and expenditures have been justified on the grounds that EMR, picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerized provider (or physician) order entry systems (CPOE), and computerized decision support systems (CDSS) are supposed to help to address the problems of variable quality and safety in modern health care .3 However, the scientific basis of such claims, which are repeatedly made and seemingly uncritically accepted, remains to be firmly established. 4–10 This paper has the objective to contribute to the scientific discourse on the relationship between the digitalization of hospital care and quality and safety of such care by exploring the experience in one European country with fairly advanced EMR capabilities: The Netherlands. The hypothesis to be tested is: advanced electronic medical record (EMR) capabilities are positively associated with quality and safety of hospital care. METHODS For the measurement of the level of implementation of information systems the concept of maturity of information systems has been developed. There are a large number of methods or models available to measure the level of implementation of information technology.11 This study will use the so-called Electronic Medical Record Adoption Model (EMRAM) scoring approach developed by Healthcare Information and Management Systems Society (HIMSS) Analytics.12 EMRAM is an eight-stage maturation model reflecting the EMR capabilities in hospitals, ranging from a completely paperbased environment (Stage 0) to a highly advanced digital patient record environment (Stage 7). The EMRAMmodel is perhaps one of themost commonly cited EMRmaturation models in the world as its scoring approach has been applied to over 10.000 hospitals in the U.S., Canada, Europe, the Middle and Far-East and Australia. For a more detailed description of the HIMSS Analytics EMR Adoption Model, see.13 To adjudicate a hospital’s EMR maturation, the CEOs of every non-academic hospital in the Netherlands (84) were invited to participate in the EMRAM study. In the beginning of 2014, 67 hospitals (80%) joined the program. The scoring process was done by identifying the software used in the different functional areas of the hospital. At least 150 questions 3
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