The updated HIMSS model and the possibilities of the cloud

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Back in 2005, an American IT society launched a means for assessing hospitals’ progress towards going paperless. It was an important step in the world of healthcare; a sign of the growing importance of IT in delivering excellent care. And yet there was no YouTube video created to promote the launch; no Twitter or Facebook account which offered more information; and no iPhone-friendly web page to browse.

It is a promotional campaign, or lack thereof, which now seems like madness. And yet there is a very simple explanation for it. When HIMSS launched its Electronic Medical Record Adoption Model (EMRAM), Twitter and Facebook didn’t exist. Nor did the iPhone. YouTube did… just. It had been unleashed on the world in February of 2005.

Today, HIMSS’ eight-stage EMRAM model is one of the most commonly accepted means of assessing a hospital’s digital maturity. That includes in Europe. Indeed, the NHS’s global digital exemplars – considered the most digitally advanced in England – are explicitly expected to achieve HIMSS Stage 7, the highest level in the model.

From early next year, though, the criteria by which EMRAM assesses digital maturity is to change. There have been tweaks before, in 2014 and 2015. But the fundamental aspects have remained the same since the model was first launched.

The updates to the assessment criteria aim, HIMSS says, to “better reflect the current state of an advanced EMR environment”. That makes good sense. Just as we now live in a society in which technology is ubiquitous in our home lives, so too has it become increasingly central to the delivery of healthcare.

But leaders at the body have another aim in refreshing the criteria. They say they want to shift the focus onto what hospitals are doing with digital technology rather than with which digital technology they are doing it.

That also appears to make good sense. As a patient, you’re not likely to care about which specific computer system is being used to review your x-rays – you just care that one of them is.

On the other hand, if you’re an NHS chief information officer (CIO) or chief clinical information officer (CCIO), then precisely which technology could help you meet the updated HIMSS criteria will be a key consideration.

Take the second level of the model, for example. To reach it, organisations will now be required to have a system which provides digital access to 95% of radiology and cardiology images. That includes remote access, so that clinicians can review information even when they are outside a hospital’s walls.

If you’re a CIO or CCIO, that leaves you with a couple of choices to make. The most obvious is which picture archiving and communication system (PACS) and/or radiology information system (RIS) you buy. But there is also a decision to be taken over how to store the images – which are growing in both number and size – such that they can be quickly and reliably accessed.

Those sort of decisions have to be taken against the backdrop of constrained NHS finances which, in many instances, leave little room for investment in IT infrastructure. They also have to be taken in an era when cyber attacks are on the increase, and when a significant proportion of NHS trusts were affected by ransomware earlier in the year. Little wonder that the refresh of EMRAM sees six out of eight stages gain specific requirements around security.

Some argue that balancing these competing demands will necessitate an exploration of more flexible technological setups. That might include doing away with traditional understandings of infrastructure – the server which sits in the corner of the room consuming floor space and energy – and opting instead for a cloud-based approach. This will have the benefit of greater cost efficiency, support easier shared access to growing banks of data, and bring reassurance over security.

In navigating such discussions, it’s perhaps worth considering that 12 years ago – back when the EMRAM model was first launched – many of us had CDs which we copied to our computer and then to our iPod. Today, most of us have smartphones and our music sits in the cloud or is streamed. It could be that EMRAM version two will involve a similar shift for hospitals.

Claire Read is a freelance writer and editor. She has specialised in healthcare throughout her 17 year career, and has a particular interest in technology. Claire is on Twitter @readthewriter.