Lydia Lee
COACH President and Board Chair
Canada’s Health Informatics Association

Dear Lydia, I am writing to you in hope that you will utilize your national leadership to help educate our members on the proper use of the HIMSS EMR Adoption Model. Over the last few years I have observed on many occasions organizational leaders in Canada, including hospital CIOs who have mistakenly communicated that their organization is at a much higher level on the HIMSS EMR Adoption Model than has actually been achieved. Here is one example from recent national newspaper article:

“St. Michael's, North York General and South Okanagan have all achieved Stage 6 status, which means a significant portion of hospital records are electronic. As of yet, no Canadian hospital is meeting the highest standard of Stage 7.”

The Globe and Mail Wed Apr 13 2011 Page: A15 Byline: Tamara Baluja

The instructions for the use of the HIMSS EMR Adoption Model specifically state that:

  • “All application capabilities within each stage must be operational before that stage can be achieved (and)
  • All lower stages must have been achieved before a higher level will be considered as achieved.”

https://www.himssanalytics.org/hc_providers/emr_adoption.asp

An essential capability within Stage 2 is an operational “controlled medical vocabulary”. This capability is critical to achieve the resulting benefit that allows clinical data to be captured once and coded and then used many times to support both direct patient care and population-based analytics including clinical outcomes reporting and performance measurement. Not only is “codifiable data” a fundamental concept in the field of informatics it is a critical component of the value of any EMR. Without coded data we cannot perform the data analysis required to determine how good the care delivered actually is. Unfortunately, most Canadian hospitals have bypassed this foundational building block as they have pursued higher level capabilities such as CPOE. The absence of operational controlled medical vocabularies severely weakens the “value for money” proposition of EMRs and denies users of EMRs an important capability essential to the practice of quality care.

Lydia, as a national leader in health informatics, I would encourage you to take the opportunity to remind all of us that without an operational controlled medical vocabulary we can not provide our patients with best care because we cannot use the clinical data captured within our EMRs to answer fundamental questions about the care we deliver to all our patients. With an operational controlled medical vocabulary, EMRs can be used to ask questions such as:

  • How many of my patients have been appropriately offered screening for colon cancer?
  • How many of my patients with diabetes have their blood sugars well controlled and how many do not?
  • How many of my patients will require influenza vaccine this year?

We must advance EMR adoption in a way that provides our physicians, other clinicians, managers, funders and patients with new insights into the care delivered. In order to practice high quality care we must leverage our EMR investments for population-based data analytics, performance measurement and outcome reporting. If EMR users in hospitals and offices across Canada cannot leverage their EMR to answer questions like those posed above then they most likely remain at HIMSS EMR Adoption Level 2. As a nation, we must increase our efforts and leverage our extensive experience, expertise and commitment to deliver better care enabled by EMRs that include controlled medical vocabularies and the essential benefits they offer to our patients.

Sincerely,
Matthew W. Morgan, MD, MSc, FRCP(C), FACP

Cc: Richard Alvarez, President and CEO, Canada Health Infoway
Cc: John Wright President & CEO Canada. CIHI
Cc: Tom Closson President and CEO of the Ontario Hospital Association
Cc: Jeff Turnbull PRESIDENT Canadian Medical Association