In this new blog penned by our own Brendan O’Leary, EMEA Solutions Engineer – HealthStore®, he explores the integral role of the Clinical Data Repository (CDR) within the HIMSS Electronic Medical Record Adoption Model (EMRAM) framework and underscores the urgency for healthcare organizations to implement a CDR at the earliest stages of their digital transformation.
Understanding the HIMSS Electronic Medical Record Adoption Model (EMRAM)
In the rapidly evolving landscape of healthcare technology, the HIMSS Electronic Medical Record Adoption Model (EMRAM) serves as a critical framework guiding hospitals and healthcare organizations through their digital transformation journey.
EMRAM assesses and benchmarks the digital maturity of healthcare organizations in relation to their use of electronic medical records (EMRs). It offers a comprehensive roadmap consisting of eight stages – each representing a milestone in the adoption and optimization of electronic medical records – starting with stage 0, generally defined as ‘paper-based systems’; all the way to stage 7, which are considered advanced, fully digital and mature environments. This model emphasizes a stepwise approach, ensuring that each stage builds upon the previous one, thereby enhancing digital capabilities, mitigating risks, and optimizing the benefits of technological advancements.
The Clinical Data Repository (CDR): a Cornerstone of EMRAM
As you can see in the diagram below, one of the pivotal components of the EMRAM model (introduced at stage 2) is the Clinical Data Repository.
A Clinical Data Repository or CDR is a centralized repository that stores patient-centric, clinical data sourced from multiple applications. It should have the ability to ingest an array of data types and formats – from discrete data values from a lab system through to an MRI study (featuring a series of DICOM images); and all in between. And, crucially, it must support interoperability standards, such as FHIR, HL7, DICOM etc. – allowing the data within the CDR to be accessed and shared with other systems; as well as receiving data from those systems. But unlike other systems that manipulate data or manage workflows, the CDR’s primary function is to manage data securely and efficiently. This distinction is crucial as it allows departmental applications to focus on their specific tasks while the CDR ensures that all data is stored in a unified, accessible manner.
Figure 1 – HIMSS EMRAM Model – Stage 2 Shows The Requirement For A Clinical Data Repository (CDR)
Why implement a CDR early in the EMRAM journey?
The CDR features early in the HIMSS EMRAM model as it allows healthcare organizations to take advantage of 3 key benefits that carry through and add value to the rest of the model’s stages:
1. Enhancing digital capabilities
For organizations with low levels of digital maturity, the implementation of a CDR at stage 2 of the EMRAM journey is transformative. It marks the first time clinicians can access patient data from various systems in one place. This integration includes data from laboratory information management systems (LIMS), pharmacy systems, PACS (Picture Archiving and Communication Systems), and radiology information systems (RIS). By consolidating this information, the CDR enables an holistic view of patient data that augments decision support. This is a significant step forward in clinical care.
2. Laying strong data foundations
Implementing a CDR early in the digital transformation process forces organizations to address any identified foundational issues, such as digital patient data management, correctly matching patient IDs, and discrepancies in clinical coding. While this may be a challenging task, it is far better to tackle these issues at the beginning of the EMRAM journey rather than at later stages. A robust foundation ensures that subsequent stages of digital transformation are built on solid ground, facilitating smoother transitions and more effective implementations of advanced technologies.
3. Risk mitigation
The CDR plays a critical role in mitigating risks associated with digital transformation. It also serves as the basis for a downtime system, providing a snapshot of patient data before any planned or unplanned downtime occurs. This ensures that clinicians have access to the most recent data, even if primary applications are temporarily unavailable. It also helps organizations to decommission vulnerable, ‘at risk’ legacy systems and preserve the data they contain for the long-term, which is essential for both clinical and legal reasons. Unlike primary clinical applications that are optimized for day-to-day workflows, the CDR ensures that data is stored securely for extended periods, meeting regulatory requirements and supporting long-term patient care.
The strategic value of a CDR
For healthcare organizations at the beginning of their digital transformation journey, adhering to the EMRAM stages and implementing a CDR at stage 2 is crucial for long-term success. The CDR not only enhances digital capabilities and mitigates risks but also lays the groundwork for future advancements – you just look need to look at the AI landscape in healthcare to appreciate the incredible value that large, structured clinical datasets can offer. Organizations that are more advanced in their journey, but have not yet implemented a CDR, should reconsider its value. The CDR’s ability to integrate data from various live and legacy systems, provide data for decision support, and ensure long-term data retention makes it an indispensable component of a comprehensive electronic medical record (EMR) system.
Conclusion
In conclusion, the Clinical Data Repository is a fundamental element of the HIMSS EMRAM framework. Its early implementation is essential for enhancing digital capabilities, laying strong foundations, and mitigating risks. Healthcare organizations embarking on their digital transformation journey should prioritize the integration of a CDR to ensure a successful transition to a fully digital environment. For those further along in their journey, revisiting the value of a CDR can provide significant benefits, reinforcing the importance of this critical component in achieving comprehensive, efficient, and secure patient care.
By following the EMRAM stages and prioritizing the implementation of a CDR, healthcare organizations can set themselves up for success, ensuring that they are well-equipped to navigate the complexities of digital transformation and deliver high-quality care in an increasingly digital world.
Brendan O’Leary joined BridgeHead Software in November 1998 and brings more than 25 years of experience in healthcare and data management. In his current role as EMEA Solutions Engineer – HealthStore®, he is entrusted with actively engaging with hospitals, listening to their unique challenges, and devising innovative solutions to address complex data management issues. His goal is to enhance healthcare delivery and positively impact people’s lives through his work.
Brendan is currently studying part-time in a post graduate course in Health Data Science at the University of Aberdeen. He is particularly interested in how healthcare data can be used to improve population health.
Prior to joining BridgeHead, Brendan was a control systems engineer supporting major electrical, transport and energy infrastructure in Australia, the Middle East and Ireland.
BridgeHead’s Clinical Data Repository, HealthStore®, enables you to meet the requirements for stage 2 of the HIMSS EMRAM maturity model – laying the foundations for your long-term data strategy. Interested in learning more?
