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Key differences are

Stage 1
can also be achieved if hospitals without own internal Laboratory, Radiology or Pharmacy are able to process orders and results delivered back to the hospital for online access by hospital clinicians.

Stage 2
can be achieved if the hospital has implemented an infrastructure that enables major ancillary clinical systems to feed data to a system that provides physician access for retrieving and reviewing patient-centered results. The system may be an Electronic Patient Record (EPR) system or a clinical data repository (CDR) fed by and feeding back into sub-systems.

Stage 3
can be achieved if nursing/clinical documentation and/or the electronic medication administration record (eMAR) system and Order Entry/Communications are implemented.

Stage 4 
can also be achieved by ePrescribing as a form of CPOE

Stage 5
can be achieved if full Radiology-PACS is implemented.

Stage 6
can be achieved with various alternative processes to achieve IT supported Closed Loop Medication Administration.

Stage 7
can be achieved when a hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images, and medical images within its EMR environment.

• Data collection, scoring and delivery of score and benchmarking reports is free of charge to healthcare provider organizations under HAE general terms and conditions.
• While the HAE team will contact every European CIO over time, please feel free to contact us directly to receive your EMRAM score and benefits.
• The survey can be conducted by phone, online or offline self-completion, and in any combination thereof.
• The input effort per hospital is between 1 and 3 hours. Sessions can be interrupted and continued.
• All data is reviewed by an in-house trained Quality Assurance team; in case of questions there will be follow-up communication with the CIO or other hospital staff.
• Personal respondent data are treated strictly confidential and are used solely for further contact by HAE (e.g. data collection, quality assurance, information about benefits); HAE ensures that the data is collected in accordance with the applicable data protection regulations.
• Organizational financial data collected are treated strictly confidential and are used solely for statistical purposes and to create peer benchmarking reports (NB: peers are anonymized).
• The individual EMRAM scores and benchmarking reports are confidential to the provider organizations; peers in the reports are anonymized.
• The CIO will receive notification of his FREE benefit package availability together with a login as soon as the internal QA process is completed and the data is submitted to the live database on which the EMRAM algorithm runs.

EMR Adoption Model Rules Ensure Objectivity:

• All application capabilities within each stage must be operational before that stage can be achieved.
• All lower stages must have been achieved before a higher level will be considered as achieved.
• A hospital can achieve Stages 3-6 if it has met all of the application requirements for a single patient care service (e.g. single nursing floor, cardiology service).
• Using the rules above, additional points are given for the implementation of applications in stages higher than the one fully achieved by the healthcare organization. In this fashion, other implementation paths than those prescribed by the stages can be taken into consideration for correlation with quality and financial research.