HIMMS Stage 5… but still using paper? A human-centered workflow approach to assessing digital maturity

The Healthcare Management and Information Systems Society Electronic Medical Record Adoption Model (HIMSS EMRAM) score is a widely-used metric of digital maturity. In this single-centre study, we explore how a hospital can have a high formal HIMSS EMRAM score, despite clinicians reporting poor real-world digital maturity. Using a workflow analysis approach, we examine pain points and physician tasks to develop novel metrics of true digital maturity, which better capture clinician experience. In addition to developing a quantitative approach to digital maturity that may be of use at other sites, this approach reveals key limitations of the HIMSS EMRAM score. These include its inability to account for clinician preference for non-EMR workarounds when electronic medical record configurations are available but impractical, and its inability to account for key clinical workflows not captured in the predefined HIMSS scoring system.