Aug 18

Advancing EMR Adoption

8/18/13 | Create Innovations, Newsroom

Primary Goal:  Maximize quality

Primary Goal: Maximize quality

At University of Missouri Health System, we strive to maximize quality by using technology as a strategic enabler.Thus, our health information technology system helps us deliver the highest level of quality and safety of care.This approach helped us earn recognition from the Health Information Management Systems Society (HIMSS) Analytics as a Stage 7 facility on November 2012 — an honor received by the top 2% of all U.S. hospitals.


HIMSS Analytics focuses on recognizing health care providers for their level of EMR adoption.

Currently, there are eight defined stages of recognition (0-7) with each stage being cumulative and Stage 7 being the highest. (Please refer to the appendix for details of both the inpatient and ambulatory models.)

The HIMSS Electronic Medical Record Adoption Model (EMRAM) evaluation process allows us to showcase UMHS hospitals’ accomplishments.


HIMSS GraphicMUHC began the EMR journey in 1996, when we signed on with Cerner Millennium.

In 2009, we were at HIMSS Stage 2. After the Tiger Institute was formed in late 2009, we accelerated our adoption of technology and implemented computerized physician order entry (CPOE) system-wide in 2010.

Some of the steps taken in our journey through the EMRAM progression have included:

  1. Using computers to reduce the potential for error by eliminating hand-written doctors’ orders and medication prescriptions
  2. Using computerized systems to alert medical professionals to potential problems, such as a patient’s allergy to a medication
  3. Giving all of a patient’s caregivers, such as physicians, nurses, pharmacists, and others, immediate access to their patient’s up-to-date medical information
  4. Allowing faster ordering of laboratory tests and quicker access to those tests by caregivers

By May 2011, HIMSS Analytics certified the University Hospital at Stage 6 — significant progress in a short period of time.


MUHC hospitals then received HIMSS Stage 7 — currently the highest level of recognition for EMR adoption — on Nov. 19, 2012.

To qualify, hospitals must exhibit:

  1. Use of a complete EMR for a patient’s stay
  2. Shared data through continuity of care document transactions
  3. Electronic data warehousing
  4. Data continuity with the emergency department as well as ambulatory and outpatient sites

While reaching HIMSS Stage 7 was a monumental achievement, the collaborations and focus on continuous improvement was of equal benefit.

Stage 7 required an on-site visit from HIMSS reviewers. To prepare, we developed an inter-disciplinary workgroup, which also addressed other cross-organizational challenges. The team quickly developed a synergy and collaboration that continues to exist today.

For example, we needed to scan TPN orders (nutrients administered intravenously) within 24 hours of creation (following the HIMSS requirement that all clinically-relevant documents must be scanned within 24 hours of creation).

Leaders from our nursing community said they worried nurses would not be able to access the information once the document was scanned.

In response, our team pulled together the appropriate parties and developed a system to categorize the scanned forms so they are readily accessible through the chart.

This system helped us meet an objective for Stage 7 and ensured that key data is available online in the EMR — our source of truth for patient data.

When presenting the results of the on-site visit, the HIMSS reviewers stated that MU was “an excellent example of a paperless health care delivery system” and that we are “setting new standards in our use of data.”

The reviewers also were impressed with our use of decision support tools — taking things to a new level with the St. John Sepsis Alert, the Bili tool integration, the Grace Score integration, and many others.


MUHC achieved HIMSS Stage 7 for University Hospital, Women’s & Children’s Hospital, Missouri Orthopaedic Institute, Ellis Fischel Cancer Center, and the Missouri Psychiatric Center. These five hospitals are now ranked among the top 2% of health care organizations in the United States.

In 2012, HIMSS developed an EMRAM for ambulatory sites, also consisting of eight stages (0-7). And on Aug. 2, 2013, 44 MUHC clinics received Stage 6 Ambulatory EMRAM recognition — marking the first clinics in Missouri to receive this honor.


Reaching HIMSS Stage 7 in our hospitals and Stage 6 in the ambulatory setting shows we now have the information technology foundation we need to meet our strategic vision.

Through this foundation, our clinical data warehouse turns overwhelming amounts of data into information we can use to further improve the quality and efficiency of patient care.

Further, sharing up-to-date patient EMRs between our hospitals and physicians who work at other health care organizations in central Missouri gives our physicians a more complete picture of their patients’ health.

Reaching this milestone gave us the opportunity to reflect on how far we’ve come since 2009 — and how far we have to go.

Information technology will play an increasing role in the practice of medicine in the future, allowing better value through improved quality and efficiency.  The creativity and expertise of our medical, nursing, and health professions faculty has been invaluable in helping us reach this technology milestone.

— Harold Williamson Jr., MD | Vice Chancellor | UMHS



  • HIMSS Stage 7 visit for ambulatory
  • Stay at the forefront of health care information technology to be ready for HIMSS Stage 8 and beyond


Partner with HIMSS to help understand and define future EMRAM stages and requirements


Maintain our stake in the top 5%


Achieving HIMSS Stage 7 in our Hospitals and Stage 6 in our clinics shows the strength of adoption of technology across the continuum of care at MU Health Care.

— Bryan Bliven, CIO & Executive Director | MU Health Care & Tiger Institute