1. Measurements and indicators for healthcare IT
Leif Panduro Jensen, MD, MHM
Director of Centre, Rigshospitalet, Copenhagen, DK

2. Measurements and indicators for healthcare IT
Working group from January to December 2014
Representation by all 5 Danish regions
Overall aims:
Establish a national objective for the clinical IT workplace
Prepare a first set of indicators for monitoring of health IT.

3. The vision
The project's vision is aimed at making IT support for clinical work ambitious and measurable In order to carry out the vision, the project would:
1. Provide a basis for consistent patient care by identifying the regions' current level of healthcare IT and propose a roadmap forward for the five regions
2. Develop and test indicators for the regions' use of healthcare IT solutions
3. Underpin the regional ambitions for improved operational efficiency, patient quality and safety, and increased patient satisfaction on the basis of data and timely measurements and measurement concepts

4. From availability to effect of HIT – a journey
Structure
Process
Outcome
Professional quality
Organisational quality
Patient-perceived quality
In hospitals the framework for improving quality is well known, originally proposed by Donabedian as ”structure – process – Outcome”, and later subdivided in the three perspectives of professional, organisational and patient percieved quality. This framework is very useful when discussing indicators in the health sector. In the case of health IT it also seems relevant to divide a view on maturity into availability (is the HIT service available at all, and to how many), usage (is it used or are the health professional prone to use non-IT tools instead) and Effect (what is the impact of HIT on all the above quality perspectives)
Availability Usage Effect

5. EMR Adoption in Europe ... based on HIMSS European EMR Adoption Model
EMR Adoption Model Scores, Mean per Country, Q2/2014
(based on data from the last 24 months, no weighting applied)
Denmark1 (24)
Austria (39)
Germany (311)
Italy (447)
Netherlands (71)
Spain (211)
Turkey1 (143)
Global Best Practice for Closed Loop Medication Administration (CLMA) – Global best practice includes • Bar code scanning of the patient and unit dose medication at the bed side, integrated with the EMAR (electronic medicine administration and recording) to update the EMAR in real-time and trigger alerts
Europe2 (1,321)
EMRAM Score (Means)
Only public hospitals
Excl. Denmark; incl. Austria (39), Belgium (2), Finland (3), France (18), Germany (311), Ireland (2), Italy (447), Netherlands (71), Norway (3), Poland (20), Portugal (18), Slovenia (2), Spain (211), Sweden (1), Turkey (143), Switzerland (7), UK (29)
There are now two hospitals in Europe that have implemented the global best practice for CLMA – Galway Clinic in Ireland and Radboudumc in the Netherlands
Source: HIMSS Europe Database, 07/25/2014

6. EMR Adoption in Europe ... based on HIMSS European EMR Adoption Model
EMRAM Scores, % of Hospitals, Q2/2014 (based on data from the last 24 months, no weighting etc. applied)
Stage
Denmark
Austria
Germany
Italy
Netherlands
Spain
Turkey
Europe*
Stage 7
0.0%
0.3%
0.5%
0.2%
Stage 6
0.7%
14.1%
4.7%
4.9%
2.6%
Stage 5
100.0%
33.3%
9.6%
8.9%
42.3%
31.8%
7.7%
17.0%
Stage 4
3.5%
1.6%
2.8%
6.2%
23.8%
5.6%
Stage 3
3.4%
1.9%
4.2%
3.7%
Stage 2
38.5%
33.1%
33.6%
39.4%
25.6%
50.3%
33.4%
Stage 1
1.4%
9.5%
13.8%
Stage 0
23.1%
45.3%
18.8%
19.9%
8.4% N 24 39
311
447 71
211
143
1,321
Mean
5.3
2.9
1.8
4.2
3.1
2.4
Median
2.5
2.1
1.3
2.2 X
* Excl. Denmark,; incl. countries listed in the table above, plus: Belgium (2), Finland (3), France (18), Ireland (2), Norway (3), Poland (20), Portugal (18), Slovenia (2), Sweden (1), Switzerland (7), Turkey (143), United Kingdom (29)
Source: HIMSS Europe Database, Q2/2014 (data from 7/2012 – 6/2014)
Status as of 7/1/2014

7. EMR Adoption World-Wide
... based on HIMSS European EMR Adoption Model
EMR Adoption Model Scores, Means per Segment, Q2/2014
(based on data from the last 24 months, no weighting applied)
In North America Closed Loop Medication Administration (CLMA) is a requirement of Stage 5, and PACS is a requirement of Stage 6
Denmark (24)
Europe1 (1,321)
US2 (5,447)
Canada2 (640)
Middle East (123)
Singapore (7) X
Australia (271)
EMRAM Score (Means)
Excl. Denmark; incl. Austria (39), Belgium (2), Finland (3), France (18), Germany (311), Ireland (2), Italy (447), Netherlands (71), Norway (3), Poland (20), Portugal (18), Slovenia (2), Spain (211), Sweden (1), Turkey (143), Switzerland (7), UK (29)
The EMRAM algorithm differs from the European countries, United Arab Emirates, Saudi Arabia and Australia
Source: HIMSS Europe Database, 07/25/2014

8. EMR Adoption World-Wide
... based on HIMSS European EMR Adoption Model
EMRAM Scores, % of Hospitals, Q2/2014 (based on data from the last 24 months, no weighting applied)
Stage
Denmark
Europe*
US**
Canada**
Middle East
Singapore
Australia
Stage 7
0.0%
0.2%
3.2%
Stage 6
2.6%
15.0%
0.6%
13.6%
85.7%
Stage 5
100.0%
17.0%
27.5%
0.5%
16.7%
5.9%
Stage 4
5.6%
15.3%
3.6%
3.7%
14.3%
0.7%
Stage 3
25.4%
32.5%
0.4%
Stage 2
33.4%
28.9%
19.7%
58.3%
Stage 1
13.8%
2.8%
14.5%
Stage 0
23.8%
4.9%
19.4%
15.2%
31.0% N 24
1,321
5,447
640
123 7
271
Mean
5.3
2.4
4.3
2.0
3,1
5.7
1.8
Median
2.2
2.1
2.9
6.1 X
* Excl. Denmark,; incl. countries listed in the table above, plus: Belgium (2), Finland (3), France (18), Ireland (2), Norway (3), Poland (20), Portugal (18), Slovenia (2), Sweden (1), Switzerland (7), Turkey (143), United Kingdom (29)
** The EMRAM algorithm differs from the European countries, United Arab Emirates, Saudi Arabia and Australia
Source: HIMSS Europe Database, Q2/2014 (data from 7/2012 – 6/2014)
Status as of 7/1/2014

9. EMR Adoption in Denmark
... based on HIMSS European EMR Adoption Model
EMR Adoption Model Scores, Means per Bed Size Segment
Denmark1 (24)
Important Deficiencies:
CLMA
Decision support
System integration
Small (1 – 199 beds) (2)
Medium (200 – 499 beds) (9)
Large (>500 beds) (13) X
EMRAM Score (Means)
Only public hospitals
Source: HIMSS Europe Database, 07/25/2014

10. Deliverables from the project
Functionality available
IT support of core processes
(User satisfaction)
EMRAM-measurement of availability of IT at all Danish hospitals
17 proposals to immediately implementable indicators
A large number of immature indicators
A set of indicators for internal performance management as well as for governmental monitoring
Concept for development of indicators
Report on data-driven management and benefit realization
Analysis of the future organization of indicator management
Three reports on data-driven management

11. How useful was the EMRAM assessment?
The EMRAM assessment was very useful !
Creating a baseline assessment for further improvement
Revealing our strenghts and ”weak spots”
But it could be more consistent and comprehensive
One model for USA+Cananda, another for the rest of the world
On the 4 stages of introducing EMR-functionality only the first is measured
available at all
widespread available
adopted in clinical practice
documented clinical impact on effectiveness, quality and safety
End-user experience is not part of the EMRAM evaluation

12. Director of Centre, MD, MHM
Thank you
Leif Panduro Jensen
Director of Centre, MD, MHM