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With EMRAM (Electronic Medical Record Adoption Model), the digital level of hospitals is rated at an international level. In this process, the level of using information technologies in the functioning of the health institution is audited and accredited. HIMSS uses EMRAM, the globally accepted accreditation and standard model, to evaluate the digital processes of applicant hospitals and determine their levels. With this model, hospitals are levelled between 1 and 7. The hospitals that have completed their digital process up to the sixth and seventh levels are documented. HIMSS EMRAM levelling makes it easier for hospitals to adapt to the ever-evolving health informatics technologies at international standards.

EMRAM evaluates hospitals according to the following criteria.

• Level 7- The hospital no longer uses paper to provide and manage patient care, and all patient data, medical images and other documents are included in the patient record (EMR) environment. The data warehouse is used to analyze patterns of clinical data to improve healthcare quality, patient safety, and efficiency. Clinical information can be easily shared with all units authorized to treat patients through standardized electronic procedures (i.e. CCD) or a health information exchange. The hospital demonstrates summary data continuity for all hospital services (e.g., inpatient, outpatient, emergency medical service documents, and inpatient clinics that are owned or managed in any way). Physician documentation and electronic orders are used at a rate of ninety per cent (emergency services are not included in this percentile), and closed-loop processes are used at a rate of ninety-five per cent (emergency departments are not included in this percentile).

Artech Operating Room Integration System and Process and Queue Management Kiosks are used safely in Yozgat City Hospital and Istanbul Bahçelievler State Hospital, among the 4 Hospitals at EMRAM Level 7 in Turkey.

• Level 6 - Technology is used to implement the closed-loop process, medicine, blood products and breast milk management, blood sample collection and follow-up. Closed-loop functions are fully implemented in fifty per cent of hospitals. This competence should also be applied in emergency services, but emergency services are excluded from the 50% rule. Electronic drug management records (eMAR) and technology are integrated with electronic ordering systems (CPOE), pharmacy and laboratory systems to maximize secure point-of-care processes and outcomes. A further level of my clinical decision support system provides the "rule of five" and other "rules" for medication management, blood products, breast milk management, and blood sample handling. The advanced clinical decision support system provides, for example, guidance initiated by the physician documentation associated with the protocol and outcomes, at least in the form of variance and compliance alerts. Mobile/portable device security policy and practices have been applied to user-owned devices. The hospital submits an annual safety risk assessment report to the managing authority for action.

Artech Operating Room Integration System is safely used in Adana City Hospital at EMRAM Level 6 in Turkey.

• Level 5 - All physician documentation (e.g. progress reports, opinion reports, discharge summaries, problem/diagnosis list, etc.) with structured templates and discrete data is implemented in at least fifty per cent of the hospital. Physician documentation should be operated under the fifty per cent rule; however, electronic data processing in emergency services is excluded from the fifty per cent rule. Nursing work plans can be edited, and task time and completion can be tracked and reported. There should be an intrusion prevention system (IPS- Intrusion Prevention System), and it is used not only to detect possible attacks but also to prevent attacks. Portable devices defined and authorized to work in the hospital's network can be remotely wiped if lost or stolen.

• Level 4 - Fifty per cent of all medical orders (orders) are made through the electronic order system (CPOE) by any clinician authorized to create the order. The CPOE is powered by the clinical decision support system (CDS) for primary conflict control and prompts added to the nursing and clinical repository environment. CPOE was used in the emergency department, but it was not included in the percentage rule determined for the hospital within the scope of the digitalization process. At least ninety per cent of clinical documents used by nurses and allied health personnel should be in electronic form. Except for the 90% rule, it should be ensured that nursing documents are in electronic form in emergency services. Physicians may access a national or regional patient database to support decision-making (e.g., medication, imaging, vaccination, laboratory results, etc.) unless restricted in terms of privacy. During the use of the electronic drug management record (eMAR), clinicians can access patient allergies, problem/diagnosis list, drug therapy and laboratory results. A potential network attack detection system must be in place to detect network attacks. (IDS- Intrusion Detection System). Nurses are supported by second-level clinical decision support systems when completing documents related to evidence-based medicine protocols (e.g., risk assessment scores that trigger recommended caregiver duties).

• Level 3 - Fifty per cent of the nursing documents (e.g. vital signs, flowcharts, caregiver notes, caregiver duties, care schedules) within the hospital (the hospital defines the formula) has been created and integrated into the clinical data pool. Fifty per cent of the integration of nursing documents with the data repository should be provided through electronic data. All electronic data within the hospital should be recorded in the clinical data repository. Technology should also be used in emergency services, but emergency services are excluded from the 50% rule. An electronic drug management record (eMAR) application was implemented. Role-based access control (RBAC) is implemented.

• Level 2 - Hospitals where the central ancillary clinical systems are activated with data fed from a single clinical data repository (CDR) or fully integrated data stores for all orders, results, radiology and cardiology images examined. Where the clinician can access this data seamlessly from a single user interface.

• Level 1 - Hospitals where pharmacy, laboratory and radiology information systems are all located together. As a complete complement to radiology and cardiology, PACS systems provide medical images to physicians via the intranet. Images delivered via PACS systems have replaced all film-based images. Patient-centred storage of non-DICOM images is also available.

• Level 0 – Refers to hospitals where even the most basic auxiliary medical systems (pharmacy, laboratory and radiology) and processes are not included in the digital environment.

Contact us for detailed information about which Artech digital solutions you will need to raise the EMRAM level of your hospital.