Turkey’s journey to becoming a hospital digitisation paradigm

Posted on: 24.04.2018
Award on stage

More than 150 Turkish public hospitals have reached Stage 6 in less than eight months.

Having one of its public hospitals among the EMRAM Stage 7 family of hospitals in Europe, Turkey now has more than 150 public hospitals having fulfilled the criteria to be validated as Stage 6 facilities1

What's the EMRAM model?

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) helps hospitals measure their adoption and utilisation of electronic medical record (EMR) functions, allocating different scores relative to their EMR capabilities. The eight-staged (0-7) model is usually referred to as a “strategic roadmap for effective EMR adoption and usage” and it was created by HIMSS Analytics to help healthcare facilities implement digital health and health IT solutions and track their progress against other healthcare organisations around Europe and across the world.

Currently, more than 2,500 hospitals in Europe have been assessed on EMRAM. However, achieving the biggest level of EMR capabilities is a rather demanding task given the strict criteria. Until today, only four (4) hospitals have been formally recognized at the Stage 7 level in Europe2.

What does it mean for a hospital to be at the Stage 6 & 7?

The different stages of the EMRAM, internationally recognised as the industry-standard, work as an indicator for healthcare facilities on their level of a near paperless environment where technology is used to support optimised patient care. Achieving Stages 6 and 7go far beyond just installing an EMR. In practical terms, a Stage 6 designation by HIMSS Analytics indicates that the hospital has made investments recognising the strategic value of improving patient care with the EMR including the adoption of a Closed Loop Medication Administration.

Among other qualifications, the facility must have achieved significant advancement in its IT capabilities, have almost fully automated/paperless medical records and IT applications across most of the inpatient care settings and has begun to create strategic alignments with their medical staff to effectively utilise information technology to improve the patient safety environment.

Following the same strategy, a Stage 7 certification is awarded to hospitals supporting the true sharing and use of patient data to improve process performance, quality of care, and patient safety. It requires hard work from all the relevant stakeholders as it showcases the hospital’s dedication to improve care for their patients, while the clinicians work towards the ideal paperless patient record environment and the use of the latest Information Technology, where clinical data is being used to improve the quality of care and patient safety3.

Dream big, aim high

In November 2016, the major Health IT event WoHIT (World of Health IT) opened with the recognition of the Turkish public hospital of Tire, in Izmir among the most digitally mature hospitals in Europe. 4 The public hospital of Tire, a province in western Turkey close to Izmir, was recognised to be EMRAM Stage 6 at the end of 2014 and achieved Stage 7 in less than two years. The Tire Devlet Hastanesi Izmir Hospital is the fourth hosptial in Europe and the only one in Turkey to be awarded the Stage 7 certification. Having implemented a variety of innovative solutions, the Tire Devlet Hastanesi has created a unique intelligent support decision system for healthcare professionals using artificial intelligence and machine learning. In particular, together with the software company, they built a system utilising the data of the hospital system to provide better care for the patient. The system offers clinical guidance to the doctors for predefined conditions, assisting especially in the interpretation and monitoring of patient data and offering guidance and assistance with making diagnosis and treatment

Since the beginning of the partnership between HIMSS Europe and Turkey, the country’s high number of Stage 6 awarded hospitals positioned it as a leading country in EMRAM. Until last May 2017, in Turkey, there were 16 hospitals at Stage 6. Expressing his will to establish the country as a European leader in use of information technologies in health services, the then Health Minister Akdag announced last May during the HIMSS Turkey conference, his intention to have more than 100 public hospitals accredited as Stage 6 in a year5.

The goal was set for more than 80 public hospitals across the country to work hard and meet the qualification requirements for the Stage 6 level in less than a year. There’s a very big increase in the hospitals’ use of information technologies between Stage 4 and then Stage 5, Stage 6, and 7, thus making that goal a very challenging task. For many hospitals reaching Stage 5 requires only a few changes, however Stage 6 is much more demanding. Many hospitals may take more than five years to reach that level as the necessary changes affect everyone involved in the care process.

To facilitate the procedure, the Turkish Ministry of Health organised workshops targeted at hospital managers throughout the country, offering them all the necessary information regarding the EMRAM model and its potential. The first of these workshops was organised in Izmir, where the management team of the Tire Devlet Hastanesi, Turkey’s Stage 7 hospital, showcased their work and their path to the accreditation6.

Today, less than a year since the Minister’s announcements, Turkey is preparing its dream team, consisting of the hospital managers of its 165 Stage 6 accredited public hospitals for something new; to attend the coming HIMSS Europe & Health 2.0 Conference, one of the most influential digital health conferences of 2018, organised this coming May, in the beautiful coastal Spanish town of Sitges, Barcelona to receive their awards!

Having achieved the goal to raise its number of Stage 6 accredited hospitals by more than 150 hospitals nation-wide, Turkey is now the only country outside North America to achieve the Stage 6 recognition for so many of its public hospitals.

We look forward to meeting the teams who achieved this astonishing result and learning more on their stunning journey to hospital digitisation! Until then, follow the discussion using #HIMSSEurope18! See you all in Sitges!

1 http://www.himss.eu/communities/himss-emram-stage-6-7-community
2 http://www.himss.eu/healthcare-providers/emram
3 http://www.himssanalyticsasia.org/docs/AAP_EMR_Adoption_Model_V1.1.pdf
4 http://www.ehealthnews.eu/wohit/5066-major-health-it-event-opens-with-re...
5 https://www.medimagazin.com.tr/guncel/genel/tr-recep-akdag-bu-sene-20-ha... 73811.html
6 http://www.horozmedya.com/guncel-2/dijital-hastane-toplantisi-yapildi-16...

Evangelia Stavropoulou

Strategic communication consultant focusing on digital health and patient advocacy, Greece/Turkey/UK