How the HIMSS EMRAM model helps advance healthcare through digital maturity

by April Armitage, Chris Clark and Tracy McClelland

There is a growing push, globally, to improve the adoption of electronic medical records (EMR) and other digital technologies in hospitals. With more and more evidence that digitally advanced hospitals provide a safer environment and improved outcomes for patients, the advantages of digital maturity are compelling.

Indeed, a large proportion of medication errors can be attributed to poor reconciliation across the patient’s healthcare journey. There’s also evidence that a digital environment improves the patient experience, for example, through clear interfaces for scheduling, education and feedback.

But exactly what is digital maturity, and how should it be measured?

To help achieve consistency around this question, the Healthcare Information and Management Systems Society (HIMSS) created an eight-stage model to help hospitals track their digital progress. This model, the EMR Adoption Model (EMRAM) is an international standard that determines digital maturity in hospitals based on an EMRAM score of 0 to 7. The higher the number, the further along an organization is in its digital maturity.

While EMRAM is an international standard, progress has varied across different countries and regions. EMRAM originated in the United States, where its pervasiveness increased due to the “meaningful use” program focused on creating health IT to improve care. Unsurprisingly, therefore, healthcare organizations in North America have a high level of maturity. Turkey is also well-advanced with the EMRAM model, thanks to a national directive requiring healthcare organizations to increase their maturity.

Elsewhere in Europe, Spain has made huge strides in its EMRAM progress, with several organizations already scoring the optimum global digital exemplar (GDE) rating of 7. In the United Kingdom, some organizations are starting to push into those higher numbers, with expectations that at least one UK hospital will be at Stage 7 by the end of 2019.

The regional score variations can be attributed to the fact that some regions, such as the United Kingdom, had been following different models until quite recently. Further, hospitals apply to be regraded every 3 years to make sure they are meeting current best practices, so a direct comparison is neither fair nor accurate. What matters is that healthcare organizations are making strong progress.

A smarter hospital

In addition to the potential safety and patient interface benefits of a digitally mature hospital, there are persuasive staffing and financial reasons to aspire to a high EMRAM rating.

Staffing remains a perpetual problem for the United Kingdom’s National Health Service, with experienced nurses and clinicians leaving for many reasons, including being overburdened, duplication of efforts, and the stress of not having the right information to do their jobs efficiently and productively. Receiving the globally recognized EMRAM Stage 6 or 7 award can help hospitals to attract and retain top clinical professionals.

There are potential financial benefits, of course, depending on the country’s healthcare system. For example, in Saudi Arabia, several hospitals within a larger healthcare network have been able to charge more for their services because they have been recognized with an EMRAM Stage 6 award.

The EMRAM evaluation model benefits healthcare organizations across the board, but taking the necessary steps to EMRAM maturity requires hospitals to be ready for the cultural change needed. And that cultural change requires commitment from the top. Of course, funding for such programs is always an issue, but often it’s less about the amount of money spent and more about how and where those funds are directed.

Without leadership commitment to cultural change, though, no amount of investment in digital technologies will help a hospital achieve EMRAM or digital maturity. Time and effort need to be invested in engaging staff, developing their digital knowledge and understanding, and training them in the use of advanced technologies.


April Armitage is principal medical expert in the DXC global healthcare advisory group. Her role involves supporting and advising healthcare providers and organizations along their digital transformation journeys, promoting clinical innovation and latest trends in health technology. April has wide ranging clinical and consulting experience. She holds a Master of Pharmacy and is also a certified HIMSS Consultant for DXC Technology.


Chris Clark is a senior business analyst within the DXC HCLS Advisory Team, now specializing in digital transformation for the healthcare provider sector. He has 25 years of experience working in the healthcare IT industry for organizations including the NHS, EMR Product Vendors and System Integrators, with previous roles including EMR Product Manager, EMR Design Team Lead and Technical Lead for several EMR deployments. Chris is a HIMSS Analytics Certified Consultant.



Tracy McClelland has 20 years of experience in oncology and haematology nursing and clinical management.  She worked in the NHS and 10 years within private and public sector acute hospitals in Australia managing a large oncology and haematology service and multi-unit transformation. Tracy has worked on service design for multi-disciplinary care coordination delivery and clinical strategic planning for a private healthcare provider. She has a master’s degree in advanced nursing practice and a post graduate certificate in cancer nursing, and she has certified as a HIMSS Assessor Consultant.




Speak Your Mind


This site uses Akismet to reduce spam. Learn how your comment data is processed.