55 Patient safety outcomes and their association with the level of digitization in Dutch hospitals INTRODUCTION Implementations of potentially transformative eHealth technologies throughout the world frequently have a significant impact on national health expenditures. Such largescale efforts and investments have been justified on the grounds that the electronic medical record (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.1–5 However, the scientific basis of such claims, which are repeatedly made and seemingly uncritically accepted, remains to be firmly established. For the measurement of the level of implementation of information systems a concept of maturity of these systems has been developed. There is a number of methods or models available to measure the level of implementation of information technology.6 One of these methods is the so-called Electronic Medical Record Adoption Model (EMRAM) scoring approach developed by Healthcare Information and Management Systems Society (HIMSS) Analytics. 7 This model is distinguished from other models that it also surveys the actual use of the available software and not only the available functionality. EMRAM is an eight-stage maturation model reflecting the EMR capabilities in hospitals, ranging from a completely paper-based environment (Stage 0) to a highly advanced near paperless and digital patient record environment (Stage 7). Previous studies on this model in the Netherlands show that EMRAM stage 3, the first stage in which clinical functionalities (nursing) become available, presents as the first notable challenge to Dutch hospitals; 37.5% of the hospitals in this study (Q2-2015) have yet to satisfy the requirements of this stage. The basic and more advanced clinical capabilities are expected to help to increase the quality, safety and efficiency of the treatment of patients in the hospital.8 4
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