88 Chapter 6 INTRODUCTION Inmodern-day hospitals, information technology is present inmany forms. Among these are information systems, networks, databases, and websites. An electronic medical record (EMR) comprehensively includes all information to support medical diagnosis and treatment within the same institution or health system. Various authors agree that EMRs can offer an important contribution to increasing the quality of care. 1,2. However, how are electronic medical record use and quality of medical care related in a hospital context? In previous studies, the two authors of this paper have attempted to establish links between the extent of EMR use and the quality of medical care3–5. In those previous quantitative studies, they used a specially developed tool to measure the degree of EMR use in Dutch hospitals. These eight stages (0 - 7) measurement tool, the so-called EMR Adoption Model (EMRAM) fromHIMSS analytics, aims to encourage hospitals to use EMR in a higher stage. 6 The HIMSS definition of an environment with a complete EMR (stage 7) is “an environment that is composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized practitioner order entry, and clinical and physician documentation applications”.7 Ultimately, the model should lead to the use of EMR systems so that the hospital no longer uses paper charts. The findings of the quantitative analysis in the previous studies 3–5 show Dutch hospitals in 2014 particularly struggled with the electronic nursing documentation. In 2012/2014, 37.5 percent of Dutch hospitals were unable to upload this information in the EMR. Once this challenge is met, the next challenge for Dutch hospitals will be to equip the EMR with a Closed Loop Medication Administration (CLMA) and advanced Clinical Decision Support System (CDSS). A 2015 study 4 tried to find a correlation between the EMRAM score and the Elsevier performance indicators. This yearly Elsevier publication is a Dutch nationwide publication of quality indicators for hospitals. No statistically significant correlations were found. In the 2017 study 5, a positive association between the use of EMRs and patient quality outcomes was found for the ‘length of stay’ (LOS) for patients with colorectal cancer in Dutch hospitals as measured by DSCA audits. In a third study (2018, not yet published, available from the first author), we did not find a significant relation between the EMRAM score and the number of patients with adverse
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