We live in a digital age. We connect with others, entertain ourselves, and compare the quality of myriad goods and services through digital networks.
Yet within the walls of many hospitals, doctors and nurses still rely on bulging folders, clipboards, and stickies to track patient health, order tests and treatments, and perform other essential duties. If smartly implemented, a suite of technologies broadly known as electronic medical records, or EMRs, could make patients safer and care more efficient.
Hospitals are moving in that direction, in part because of a federal push to reward hospitals that adopt EMRs and penalize hospitals that don’t. Eager to lower costs and improve healthcare quality, the Department of Health and Human Services has up to $27 billion in funding at its disposal to entice hospitals to adopt EMRs that allow drugs to be prescribed electronically (e-prescribing), health records to be exchanged electronically, and quality-related clinical data to be captured for analysis that will lead to better care. Each hospital that meets these and other requirements, collectively known as the criteria for “meaningful use” of EMRs, receives a base payment of $2 million, which can grow as hospitals expand their digital capabilities. Hospitals that do not meet the meaningful use requirements for EMRs by 2015 will see their Medicare payments shrink.
Just buying an electronic medical record package from a technology vendor isn’t good enough to get the incentive payment, says Elizabeth Holland, who leads the health information techology group at the DHHS Office of E-Health Standards and Services. “You have to use it meaningfully: for electronic prescribing, exchanging health information and improving coordination of care.”
Several hundred hospitals have begun to adopt EMRs. An even smaller subset of those hospitals also deliver the superior care that U.S. News recognizes in its Best Hospitals.
U.S. News developed Most Connected Hospitals to highlight that doubly unique group of institutions, which are both digitally forward and clinically excellent. We began with a list of all the institutions we have ranked among the best in the nation or have identified as high-performing in at least one medical specialty in the 2012-13 Best Hospitals and Best Children’s Hospitals rankings.
We compared that roster of top hospitals with institutions that as of July 10, 2012, had achieved two other milestones. First, they met the federal government’s current meaningful use criteria. Second, they have been recognized as early adopters of EMR technology by HIMSS Analytics, a division of the non-profit Healthcare Information and Management Systems Society. Through surveys of hospital executives and, in some cases, site visits, HIMSS Analytics evaluates how far hospitals have progressed toward fully incorporating health information technology into every aspect of clinical care. A Stage 7 hospital has gone all the way. A Stage 0 hospital has yet to start.
At Stage 7, a hospital no longer uses paper charts to deliver and manage patient care. At this level, the hospital also has the ability to analyze electronic data to assess quality of care, potentially leading to improvement, and patients typically can look at their own medical records on a restricted web page.
At Stage 6 hospitals, doctors in at least one inpatient unit enter medical orders into a computer system that offers them real-time guidance—by calling their attention to a potentially dangerous drug combination, perhaps. Doctors also electronically document their clinical interactions with patients. And EMRs are used in the hospital’s nursing, pharmacy, laboratory, and radiology services. But the majority of doctors at some Stage 6 hospitals may continue to rely on paper records.
Only about 1.2 percent of U.S. hospitals are at Stage 7 and 5.2 percent are at Stage 6, according to HIMSS, leaving the other 90-plus percent with catching up to do.
U.S. News defines a hospital as Most Connected if that hospital, or a major unit of it such as a children’s hospital within the larger institution, has met all three standards: qualifying for federal meaningful use funding, achieving HIMSS Analytic’s top grades for EMR adoption, and earning either a national Best Hospital or Best Children’s Hospital ranking or a high-performing designation in one or more medical specialties.