9 April 2024 Articles

Opinion -Navigating the HIMSS EMRAM Framework: Transforming Healthcare


Healthcare Transformation – Why Every Trust Should Take Notice


The digital revolution in healthcare has brought forth a multitude of opportunities to enhance patient care, streamline operations, and improve clinical outcomes. One notable framework that has gained significant attention globally, including in the UK, is the HIMSS EMRAM (Electronic Medical Record Adoption Model). This model serves as a valuable guide for healthcare organisations, outlining a roadmap to achieving higher levels of digital maturity. This opinion piece written by Kiran Dave, Apira Managing Consultant and HIMSS Maturity Assessment lead, will delve into the significance of the HIMSS EMRAM framework in the healthcare landscape and explore its impact on modernising healthcare practices.

In the realm of healthcare, where technology is reshaping the landscape, the Healthcare Information and Management Systems Society (HIMSS) emerges as a guiding force. For healthcare trusts, HIMSS is not just an acronym but a roadmap to navigate the digital revolution. This opinion piece elucidates what HIMSS entails and why it should be at the forefront of every Trusts strategic consideration.

Understanding HIMSS EMRAM:

The HIMSS EMRAM framework is a recognised global standard for evaluating the adoption and maturity of electronic medical record systems within healthcare organisations. It comprises eight stages, ranging from Stage 0 (no electronic records) to Stage 7 (complete digitalisation and paperless environment). Each stage signifies a higher level of integration and sophistication in using technology to support clinical processes and patient care.


The NHS has been on a transformative journey to digitise healthcare processes and improve patient outcomes. The adoption of the HIMSS EMRAM framework aligns with these goals by providing a structured approach to digital maturity. NHS Trusts and healthcare providers have been actively working to ascend the EMRAM stages, aiming to provide more efficient, patient-centric care.

Key Benefits:

  1. Enhanced Clinical Decision-Making: Advancing through the HIMSS EMRAM stages enables healthcare professionals to access comprehensive patient data in real-time. This empowers more informed and timely clinical decision-making, leading to improved patient outcomes.
  2. Interoperability and Data Sharing: Achieving higher EMRAM stages necessitates better data integration and interoperability between different systems. This facilitates seamless data sharing across care settings and enhances care coordination.
  3. Patient Engagement and Empowerment: Higher EMRAM stages often involve patient portals and electronic communication channels, enabling patients to actively engage with their healthcare journey. This fosters a sense of ownership and improves patient satisfaction.
  4. Efficiency and Cost Reduction: As healthcare processes become more digitised and streamlined, administrative burdens are reduced, allowing healthcare providers to allocate more time to patient care. This can lead to cost savings and resource optimisation.


  1. Structured Digital Maturity: HIMSS offers a range of frameworks, with the EMRAM (Electronic Medical Record Adoption Model) being a flagship model. Where healthcare trusts exhibit varied levels of digital maturity, HIMSS provides a structured path, helping trusts progress from basic digital adoption to advanced integration.
  2. Patient-Centric Care: Patient engagement is the cornerstone of modern healthcare. HIMSS empowers Trusts to embrace patient portals, telehealth solutions, and electronic health records, promoting active participation and collaboration between patients and healthcare providers.
  3. Leveraging Data Insights: The healthcare landscape generates vast amounts of data. HIMSS equips Trusts with tools to harness data for actionable insights, predictive analytics, and evidence-based decision-making, thereby enhancing patient outcomes and optimising resource allocation.
  4. Interoperability and Integration: In a complex healthcare environment, seamless data exchange is imperative. HIMSS underscores interoperability, ensuring that different systems and departments within Trusts communicate effectively, leading to holistic patient care.
  5. Benchmarking and Global Standards: HIMSS allows Trusts to benchmark their progress against international standards. This aids in identifying areas of improvement and adapting best practices from around the world, thereby accelerating transformation.
  6. Efficiency and Resource Optimization: The adoption of HIMSS principles often streamlines processes, reduces administrative burden, and maximises resource utilisation. In the long run, this can translate into cost savings while enhancing care quality.
  7. Resilience in Healthcare: Recent global healthcare challenges underscore the need for resilient systems. HIMSS equips Trusts with tools to enhance their preparedness and adaptability, ensuring consistent care even during crises.

Getting Started

The HIMSS EMRAM model assesses the whole hospital and as mentioned above is an eight-stage model, ranging from Stage 0 (no electronic records) to Stage 7 (complete digitalisation and paperless environment).

Hospitals usually initiate the HIMSS EMRAM process by assessing their current state of electronic patient record (EPR) adoption and identify areas for improvement. Typically, a HIMSS Partner can help with this process.  The general principles are as follows:

1 – Assessment of Current State: Assess current level of adoption and maturity across various areas, such as clinical documentation, order entry, decision support, patient engagement, interoperability, and analytics. This will draw out the strengths, weaknesses and areas of improvement.

2  – Engagement for Leadership: Ensure executives, clinical leaders, IT leaders, and other stakeholders are engaged in the EMRAM process. Leadership commitment is essential for driving organisational change, securing resources and prioritising initiatives to enhance adoption.

3 – Formulate EMRAM Steering Committee: The hospital establishes an EMRAM steering committee comprising of representatives from various departments, including clinical, IT quality, and operations. This committee will be responsible for setting goals, identify prioritises and coordinate efforts across the organisation.

4 – Gap Analysis and Roadmap Development: Based on the assessment of the current state and HIMSS EMRAM framework, the hospital conducts a gap analysis to identify areas where it falls short of meeting the criteria for higher EMRAM stages. The roadmap is developed to outline the steps, initiatives and investment required to higher EMRAM stages.

5 – Implementation of initiatives: The hospital implements the initiatives and projects aimed at advancing their adoption and maturity. These may include optimising existing EPR functionalities, implementing new technologies and modules, enhancing interoperability with other systems, improving clinical workflows, and promoting user adoption and engagement.

6 – Measurement and Monitoring: Key performance indicators (KPIs) are established to measure progress and track outcomes related to adoption and maturity.

7 – Documentation and Submission: Once the hospital believes it has met the criteria for a particular EMRAM stage, it documents its achievements and prepares to submit the required documentation for validation.

8 – Validation by HIMSS and HIMSS Partner: Documentation is reviewed and validated to assign EMRAM stage.

9 – Continuous Improvements: Even after achieving a specific EMRAM stage, the hospital continues to focus on continuous improvements, innovation and optimisation of it EPR capabilities to provide high quality patient care, enhance efficiency, and achieve organisational goals.

Challenges and Considerations:

While the benefits of advancing through the HIMSS EMRAM stages are evident, the journey is not without challenges. Implementation costs, data privacy and security concerns, resistance to change among healthcare staff, and the need for comprehensive training against a backdrop of increased demands on clinical and operational teams, are among the obstacles that healthcare organisations must address.

Embracing HIMSS requires a comprehensive approach. Trusts need to allocate resources for staff training, system integration, and addressing potential resistance to change. Furthermore, data security and privacy must remain at the forefront as digital systems evolve.

Looking Ahead:

As Trusts continue to grapple with evolving healthcare needs, the HIMSS EMRAM framework offers a clear path to harnessing the potential of digital technology. NHS Trusts and healthcare providers must move ahead, addressing challenges head-on and embracing a culture of innovation. The goal is not just achieving higher EMRAM stages, but also ensuring that the technology is effectively leveraged to deliver the best possible care to patients.

Conclusion: The HIMSS EMRAM framework serves as a beacon of transformation for the healthcare sector. By adopting this framework, healthcare organisations can systematically enhance their digital capabilities, ultimately resulting in improved patient care, streamlined operations, and a more resilient healthcare system.

In an era of digital innovation, NHS Trusts need a clear roadmap to guide their digital transformation efforts. The HIMSS EMRAM framework offers a valuable benchmark for measuring digital maturity, fostering quality improvement, enhancing patient engagement, and driving operational excellence.

Apira Services

Apira are a HIMSS Digital Heath Technology (DHT) partner and are able to provide a range of HIMSS assessments including EMRAM and AMAM, and where required, to combine these with other frameworks such as NHS England’s What Good Looks Like framework.

With 25 years experience of supporting NHS Trusts and other health and care providers to procure, implement and drive out the benefits from digital, data and technology, and having conducted assessments across multiple care settings, we are well placed as a HIMSS assessment partner for providers and at ICS level.

For more information please contact Kiran Dave, Apira’s HIMSS Assessment Lead kiran.dave@apira.co.uk

Author: Kiran Dave

Kiran Dave has been with Apira for nearly 9 years and is an experienced and knowledgeable consultant with a proven track record of navigating rapidly changing and complex projects. Her career trajectory has evolved seamlessly from software development to project management, program management, and line management. Kiran effortlessly adapts to change and embraces new challenges, consistently maintaining a laser focus on business objectives and successfully achieving them.