56 Chapter 4 Table 1 - Frequency distribution of EMRAM scores (Q2 2015) in the Netherlands HIMSS level Frequency Percent Characteristics Stage 7 0 0 Complete EMR; data analytics to improve care 6 11 15.3 Physician documentation (templates); full CDSS; Closed loop medication administration 5 31 43.1 Full R-PACS 4 2 2.8 CPOE; Clinical Decision Support (clinical protocols) 3 0 0 Clinical documentation; Clinical Decision Support (error checking) 2 27 37.5 Clinical Data Repository (CDR); Controlled Medical Vocabulary; CDS; HIE (internal) 1 1 1.4 All three ancillaries installed – Lab, Rad, Pharmacy 0 0 0 All three ancillaries not Installed Total 72 100 Patient safety has been high on the international agenda for several decades since the 1999 Institute of Medicine report ‘To Err Is Human’.9 Many retrospective patient record review studies in various countries have followed this Harvard Medical Practice Study HMPS in an attempt to evaluate patient safety. 10–14 To keep track of changes in patient safety at a national level, three patient safety measurements with patient records from 2004, 2008 and 2011/2012 have been carried out by the Netherlands by Netherlands Institute for Health Services Research (NIVEL).11,15–17 These studies demonstrated significant overall improvement of the years, but also showed that differences in patient safety outcomes exist between hospitals. Since EMRs may lead to better hospital performance and outcomes, hospitals may use EMRs to improve the quality of care. The key assumption to be explored in this study is that when basic clinical functionalities are available in a hospital (EMRAM>=3), patients will have a more effective and safe hospitalization compared to hospitals with lesser capabilities. Effective communication through EMRs could prevent medical or organizational mistakes. From this concept, we deducted the following expected associations for our study.
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