Electronic Medical Records Adoption Model

The Electronic Medical Records Adoption Model ( EMRAM ) is a model to describe the degree of digitization in hospitals. The model was created by the HIMSS Analytics Group in 2005 (Healthcare Information and Management Systems Society (HIMMS)). The model differentiates in 7 levels from limited, supplementary departmental systems to a completely paperless EMR environment. In total, EMRAM is used by more than 9,000 hospitals worldwide. The same requirements and prerequisites apply at international level. In Germany, the law for secure digital communication and applications in the health system as well as changes to other laws and the required electronic health record give it special importance.

Step model

step	criteria
Level 7	Complete electronic health record, CCD transactions for shared data use, data warehousing, reports on the result of data maintenance, quality assurance
Level 6	Interaction of the medical documentation with the complete clinical decision support system (CDSS) (structured templates with regard to clinical protocols trigger variance and conformity warnings) and closed medication management
Level 5	Complete PACS (Picture Archiving and Communication System) solution replaces all film-based images
Level 4	Computerized Physician Order Entry (CPOE, electronic drug prescription) at least in a clinical service area or for medication (i.e. prescribing ), there may be support in clinical decisions based on clinical protocols
level 3	Nursing / clinical documentation (flow chart), there may be support with clinical decisions to check for errors during prescription entry or PACS is also available outside of radiology.
Level 2	Storage for clinical data ( Clinical Data Repository ; CDR) / electronic patient record, possibly there is a controlled medical vocabulary, support with clinical decision-making (CDS) for elementary conflict checking, document mirroring and functions for the exchange of disease data Health information exchange (HIE)
step 1	Subdivisions such as laboratory, radiology and pharmacy are all installed OR the laboratory information and management system LIMS, radiology information system RIS, Pharma Intelligence Service PHIS data is output online via external service providers
Level 0	None of the three subdivisions (LIS, RIS, PHIS) is installed OR there is no laboratory, radiology or pharmacy data output online via external service providers

EMRAM levels from hospitals

In Europe there are a total of 66 hospitals with EMRAM level 6 or 7.

Hospitals in Germany

Level 7

University Medical Center Hamburg-Eppendorf

Level 6

Agaplesion Diakonieklinikum Rotenburg - Rotenburg
Nürtingen Clinic - Nürtingen

Hospitals in Switzerland

Level 7

no hospital

Level 6

Hôpitaux universitaires de Genève

Spital STS AG (Simmental-Thun-Saanenland)
at Inselspital Bern

Hospitals in Austria

Level 7

no hospital

Level 6

Ordensklinikum Linz Elisabethinen - Linz

rest of Europe

Level 7

Netherlands: Radboudumc. Nijmegen, Netherlands
Netherlands: Ziekenhuis St Jansdal - Harderwijk
Portugal: Hospital de Cascais - Cascais
Turkey: Izmir Tire Devlet Hastanesi - Izmir
Turkey: Yozgat Şehir Hastanesi - Yozgat

Level 6

Belgium: Center Hospitalier Universitaire de Liège - Liège
Belgium: UZ Leuven - Leuven
Denmark: Aarhus University Hospital - Aarhus
Ireland: Galway Clinic - Galway
Italy: Arcispedale Santa Maria Nuova - Reggio Emilia
Italy: COT Private Hospital - Messina
Italy: Candiolo Cancer Institute (IRCCS) - Candiolo
Italy: Fondazione Poliambulanza Istituto Ospedaliero - Brescia
Italy: Humanitas Research Hospital (IRCCS) - Rozzano
Italy: Vimercate Hospital - Vimercate
Netherlands: Medisch Centrum Leeuwarden - Leeurwarden
Netherlands: Onze Lieve Vrouwe Gasthuis (OLVG) - Amsterdam
Norway: Sykehuset Østfold - Grålum
Portugal: Hospital Lusíadas Lisboa - Lisbon
Portugal: Hospital Lusíadas Porto - Porto
Russia: Nikiforov Russian Center of Emergency and Radiation Medicine - St. Petersburg
Slovenia: University Children's Hospital - Ljubljana
Spain: Fundació Hospital Comarcal d'Inca - Tramuntana - Inca
Spain: Hospital de Dénia Marina Salud - Dénia
Spain: Hospital de Torrejón - Torrejón de Ardoz
Spain: Hospital Povisa - Vigo
Spain: Hospital Universitario 12 de Octubre - Madrid
Spain: Hospital Universitario Donostia - Donostia-San Sebastián
Turkey: Adana Şehir Eğitim ve Araştirma Hastanesi - Adana
Turkey: Adıyaman Besni Devlet Hastanesi - Adıyaman
Turkey: Adiyaman Çelikhan Devlet Hastanesi - Adiyaman
Turkey: Adıyaman Gölbaşı Devlet Hastanesi - Adıyaman
Turkey: Adıyaman Kahta Devlet Hastanesi - Kahta
Turkey: Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi - Adıyaman
Turkey: Akdeniz Üniversitesi Hastanesi - Antalya
Turkey: Alaplı Devlet Hastanesi - Zonguldak
Turkey: Amasya Gümüşhacıköy Devlet Hastanesi - Amasya
Turkey: Amasya Üniversitesi Sabuncuoğlu Şerefeddin Eğitim ve Araştırma Hastanesi - Amasya
Turkey: Ankara Nallıhan Devlet Hastanesi - Ankara
Turkey: Antalya Eğitim Araştırma Hastanesi - Antalya
Turkey: Antalya Kemer Devlet Hastanesi - Antalya
Turkey: Antalya Kumluca Devlet Hastanesi - Antalya
Turkey: Avcılar Murat Kölük Devlet Hastanesi - Avcılar
Turkey: Aydin Didim Devlet Hastanesi - Didim / Aydin
Turkey: Aydın Kadın Doğum ve Çocuk Hastalıkları Hastanesi - Aydın
Turkey: Aydın Nazilli Devlet Hastanesi - Aydın
Turkey: Bahçelievler Devlet Hastanesi - Istanbul
Turkey: Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: Bartın Devlet Hastanesi - Bartın
Turkey: Beyhekim Devlet Hastanesi - Konya
Turkey: Beyşehir Devlet Hastanesi - Beysehir
Turkey: Bingöl Genç Devlet Hastanesi - Bingöl
Turkey: Bolu Gerede Devlet Hastanesi - Bolu
Turkey: Bolu Izzet Baysal Devlet Hastanesi - Bolu
Turkey: Bolu İzzet Baysal Eğitim Araştırma Hastanesi - Bolu
Turkey: Bolu İzzet Baysal Ruh Sağlığı ve Hastalıkları Eğitim Araştırma Hastanesi - Bolu
Turkey: Bursa İnegöl Devlet Hastanesi - Bursa
Turkey: Bursa Mudanya Devlet Hastanesi - Bursa
Turkey: Çaycuma Devlet Hastanesi - Zonguldak
Turkey: Çorum Alaca Devlet Hastanesi - Çorum
Turkey: Çorum Göğüs Hastalıkları Hastanesi - Çorum
Turkey: Darıca Farabi Devlet Hastanesi - Kocaeli
Turkey: Denizli Acıpayam Devlet Hastanesi - Denizli
Turkey: Denizli Buldan Göğüs Hastalıkları Hastanemize - Denizli
Turkey: Denizli Çal Devlet Hastanesi - Denizli
Turkey: Denizli Çameli Devlet Hastanesi - Denizli
Turkey: Denizli Çivril Devlet Hastanesi - Denizli
Turkey: Denizli Devlet Hastanesi - Denizli
Turkey: Denizli Honaz Devlet Hastanesi - Denizli
Turkey: Denizli Kale Devlet Hastanesi - Denizli
Turkey: Denizli Servergazi Devlet Hastanesi - Denizli
Turkey: Denizli Tavas Devlet Hastanesi - Denizli
Turkey: Dr. Nafiz Körez Sincan Devlet Hastanesi - Ankara
Turkey: Esenler Kadın Doğum ve Çocuk Hastalıkları Hastanesi - Esenler
Turkey: Esenyurt Necmi Kadıoğlu Devlet Hastanesi - Istanbul
Turkey: Etimesgut Şehit Sait Ertürk Devlet Hastanesi - Ankara
Turkey: Eyüp Devlet Hastanesi - Istanbul
Turkey: Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi - Ankara
Turkey: Hakkari Devlet Hastanesi - Hakkari
Turkey: Hatay Altınözü Devlet Hastanesi - Hatay
Turkey: Hatay Devlet Hastanesi - Hatay
Turkey: Hatay Dörtyol Devlet Hastanesi - Hatay
Turkey: Hatay Erzin Devlet Hastanesi - Hatay
Turkey: Hatay Hassa Devlet Hastanesi - Hatay
Turkey: Hatay İskenderun Devlet Hastanesi - Hatay
Turkey: Hatay Kırıkhan Devlet Hastanesi - Hatay
Turkey: Hatay Reyhanlı Devlet Hastanesi - Hatay
Turkey: Hatay Samandağ Devlet Hastanesi - Hatay
Turkey: Hatay Yayladağı Devlet Hastanesi - Hatay
Turkey: Isparta Eğirdir Kemik Eklem Hastalıkları Tedavi ve Rehabilitasyon Hastanesi - Isparta
Turkey: Isparta Şarkikaraağaç Dr Sadettin Bilgiç Devlet Hastanesi - Isparta
Turkey: Isparta Şehir Hastanesi - Isparta
Turkey: Isparta Şehit Yunus Emre Devlet Hastanesi - Isparta
Turkey: Isparta Yalvaç Devlet Hastanesi - Isparta
Turkey: İstanbul Bağcılar Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: Istanbul Beykoz Devlet Hastanesi - Istanbul
Turkey: İstanbul Çatalca İlyas Çokay Devlet Hastanesi - Istanbul
Turkey: Istanbul Dr Siyami Ersek Gögüs Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Istanbul
Turkey: İstanbul Erenköy Fizik Tedavi ve Rehabilitasyon Hastanesi - Kadiköy
Turkey: Istanbul Haseki Egitim Ve Arastirma Hastanesi - Istanbul
Turkey: Izmir Bergama Dr. Faruk Ilker Devlet Hastanesi - Izmir
Turkey: Izmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Hastanesi - Izmir
Turkey: Izmir Gaziemir Nevvar Salih Isgören Devlet Hastanesi - Izmir
Turkey: Izmir Katip Çelebi Üniversitesi Ataturk Eğitim ve Araştırma Hastanesi - Izmir
Turkey: Izmir Menemen Devlet Hastanesi - Menemen
Turkey: Izmir Torbalı Devlet Hastanesi - Izmir
Turkey: Izmir Urla Devlet Hastanesi - Izmir
Turkey: Kaçkar Devlet Hastanesi - Rize
Turkey: Kadınhanı Refik Saime Koyuncu Devlet Hastanesi - Konya
Turkey: Kağıthane Devlet Hastanesi - Istanbul
Turkey: Kahramanmaraş Andırın Devlet Hastanesi - Andırın
Turkey: Kahramanmaraş Çağlayancerit Devlet Hastanesi - Çağlayancerit
Turkey: Kahramanmaraş Türkoğlu Dr. Kemal Beyazı Devlet Hastanesi - Türkoğlu
Turkey: Karadeniz Ereğli Devlet Hastanesi - Zonguldak
Turkey: Kartal Koşuyolu Yüksek İhtisas Eğitim Ve Araştırma Hastanesi - Istanbul
Turkey: Kastamonu Tosya Devlet Hastanesi - Kastamonu
Turkey: Kırklareli Vice Devlet Hastanesi - Kırklareli
Turkey: Kızılcahamam Devlet Hastanesi - Ankara
Turkey: Kocaeli Gebze Fatih Devlet Hastanesi - Kocaeli
Turkey: Kocaeli Gölcük Necati Çelik Devlet Hastanesi - Kocaeli Gölcük
Turkey: Kocaeli İzmit Seka Devlet Hastanesi - Kocaeli Izmit
Turkey: Kocaeli Karamürsel Devlet Hastanesi - Kocaeli
Turkey: Kocaeli Korfez Devlet Hastanesi - Kocaeli
Turkey: Kocaeli Üniversitesi Araştırma ve Uygulama Hastanesi - Kocaeli
Turkey: Konya Akşehir Devlet Hastanesi - Konya
Turkey: Konya Dr. Vefa Tanır Ilgın Devlet Hastanesi - Konya
Turkey: Konya Eğitim ve ARaştırma Hastanesi - Konya
Turkey: Konya Karapınar Devlet Hastanesi - Konya
Turkey: Malatya Akçadağ Şehit Gökhan Aslan Devlet Hastanesi - Malatya
Turkey: Malatya Darende Hulusi Efendi Devlet Hastanesi - Malatya
Turkey: Malatya Eğitim ve Araştırma Hastanesi - Malatya
Turkey: Malatya Hekimhan Devlet Hastanesi - Malatya
Turkey: Manisa Akhisar Mustafa Kirazoğlu Devlet Hastanesi - Akhisar
Turkey: Manisa Alaşehir Devlet Hastanesi - Alasehir
Turkey: Manisa Soma Devlet Hastanesi - Manisa
Turkey: Manisa Turgutlu Devlet Hastanesi - Manisa
Turkey: Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: Medipol Mega University Hastanesi - Istanbul
Turkey: Mersin Şehir Hastanesi - Mersin
Turkey: Muğla Bodrum Devlet Hastanesi - Muğla
Turkey: Muğla Datça Devlet Hastanesi - Muğla
Turkey: Muğla Köyceğiz Devlet Hastanesi - Muğla
Turkey: Muğla Marmaris Devlet Hastanesi - Muğla
Turkey: Muğla Yatağan Devlet Hastanesi - Yatağan
Turkey: Ödemiş Devlet Hastanesi - Izmir
Turkey: Pendik Devlet Hastanesi - Istanbul
Turkey: Polatlı Devlet Hastanesi - Ankara
Turkey: Recep Tayyip Erdoğan Üniversitesi Eğitim ve Araştırma Hastanesi - Rize
Turkey: Rize Çayeli İshakoğlu Devlet Hastanesi - Rize
Turkey: Rize Devlet Hastanesi - Rize Merkez
Turkey: Rize Fındıklı Bölge Guatr Araştırma ve Tedavi Merkezi - Fındıklı
Turkey: SBÜ Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Haydarpaşa Numune Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ İstanbul Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: SBÜ Sultan Abdülhamid Han Eğitim ve Araştırma Hastanesi - Üsküdar
Turkey: SBÜ Ümraniye Eğitim ve Araştırma Hastanesi - Ümraniye
Turkey: SBÜ Van Eğitim ve Araştırma Hastanesi - Van
Turkey: SBÜ Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: Samsun Gazi Devlet Hastanesi - Samsun
Turkey: Siirt Kurtalan Devlet Hastanesi - Siirt
Turkey: Şile Devlet Hastanesi - Istanbul
Turkey: Silivri Devlet Hastanesi - Istanbul
Turkey: Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi - Istanbul
Turkey: Tekirdağ Çerkezköy Devlet Hastanesi - Tekirdağ
Turkey: Tekirdağ Çorlu Devlet Hastanesi - Çorlu
Turkey: Tekirdağ Devlet Hastanesi - Tekirdağ
Turkey: Tekirdağ Marmaraereğlisi Devlet Hastanesi - Tekirdağ
Turkey: Tekirdağ Saray Devlet Hastanesi - Tekirdağ
Turkey: Tekirdağ Şarköy Devlet Hastanesi - Tekirdağ
Turkey: Tokat Almus Devlet Hastanesi - Almus
Turkey: Tokat Devlet Hastanesi - Tokat
Turkey: Tokat Dr. Cevdet Aykan Ruh Sağlığı ve Hastalıkları Hastanesi - Tokat
Turkey: Tokat Erbaa Devlet Hastanesi - Tokat
Turkey: Tokat Niksar Devlet Hastanesi - Tokat
Turkey: Tokat Reşadiye Devlet Hastanesi - Tokat
Turkey: Tokat Turhal Devlet Hastanesi - Tokat
Turkey: Tokat Zile Devlet Hastanesi - Zile
Turkey: Trabzon Sürmene Devlet Hastanesi - Sürmene / Trabzon
Turkey: Üsküdar Devlet Hastanesi - Istanbul
Turkey: Van Çatak Devlet Hastanesi - Van
Turkey: Van Erciş Devlet Hastanesi - Van
Turkey: Van Gevaş Devlet Hastanesi - Van
Turkey: Van Muradiye Devlet Hastanesi - Van
Turkey: Yalova Devlet Hastanesi - Yalova
Turkey: Yıldırım Beyazıt Üniversitesi Yenimahalle Eğitim ve Araştırma Hastanesi - Ankara
Turkey: Yozgat Sorgun Devlet Hastanesi - Yozgat
Turkey: Zonguldak Ataturk Devlet Hastanesi - Zonguldak
Turkey: Zonguldak Kadın Doğum Ve Çocuk Hastalıkları Hastanesi - Zonguldak
United Kingdom: Cambridge University Hospitals NHS Foundation Trust - Cambridge
United Kingdom: Kingston Hospital NHS Trust - Kingston upon Thames

literature

H. Kharrazi, CP Gonzalez, et al. a .: Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model. In: Journal of medical Internet research. Volume 20, number 8, August 2018, p. E10458, doi : 10.2196 / 10458 , PMID 30087090 , PMC 6104443 (free full text).
Morgan Price, Francis Lau: The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems. In: BMC Medical Informatics and Decision Making. 14, 2014, doi : 10.1186 / 1472-6947-14-43 .
Denis Protti: Missed Connections: The Adoption of Information Technology in Canadian Healthcare. In: SSRN Electronic Journal. , doi : 10.2139 / ssrn.2587406 .
Dhillon K, Tan E, Akseer R, Alhosani MS, H. o. GF, Lim SHE, Jamaludin ANSJ: EMR Access and Confidentiality Based on Patient and Hospital Staff Perspectives. In: The Open Public Health Journal. 11, 2018, p. 533, doi : 10.2174 / 1874944501811010533 .
IT development in radiology - an ESR update on the Digital Imaging Adoption Model (DIAM). In: Insights into Imaging. 10, 2019, doi : 10.1186 / s13244-019-0712-z .

Individual evidence

^ Electronic Medical Record Adoption Model. January 24, 2017, accessed April 28, 2019 .
↑ ^a ^b ^c ^d Only three Swiss hospitals have achieved a higher EMRAM ranking | qhit blog: Medical Process Management & Digital Health. Retrieved April 28, 2019 (German).
↑ Electronic patient files: What is Germany really doing forwards? , Healthcare in Europe, April 29, 2016. Retrieved April 29, 2019.
↑ ^a ^b ^c HIMSS Track: EMRAM - Consistent digitization - added value for hospital management. September 20, 2016, accessed April 28, 2019 .
↑ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az ^ba ^bb ^bc ^bd ^be ^bf ^bg ^bh ^bi ^bj ^bk ^bl ^bm ^bn ^bo ^bp ^bq ^br ^bs ^bt ^bu ^bv ^bw ^bx ^by ^bz ^ca ^cb ^cc ^cd ^ce ^cf ^cg ^ch ^ci ^cj ^ck ^cl ^cm ^cn ^co ^cp ^cq ^cr ^cs ^ct ^cu ^cv ^cw ^cx ^cy ^cz ^da ^db ^dc ^dd ^de ^df ^dg ^dh ^di ^dj ^dk ^dl ^dm ^dn ^do ^dp ^dq ^dr ^ds ^dt ^du ^dv ^dw ^dx ^dy ^dz ^ea ^eb ^ec ^ed ^ee ^ef ^eg ^eh ^ei ^ej ^ek ^el ^em ^en ^eo ^ep ^eq ^er ^es ^et ^eu ^ev ^ew ^ex ^ey ^ez ^fa ^fb ^fc ^fd ^fe ^ff ^fg ^fh ^fi ^fj ^fk ^fl ^fm ^fn ^fo ^fp ^fq ^fr ^fs ^ft ^fu ^fv ^fw ^fx ^fy ^fz ^ga ^gb ^gc ^gd ^ge ^gf ^gg ^gh ^gi ^gj ^gk ^gl ^gm ^gn ^go ^gp HIMSS EMRAM Stage 6 & 7 Community | HIMSS Europe. Retrieved April 28, 2019 .

[1] Electronic Medical Record Adoption Model. January 24, 2017, accessed April 28, 2019 .

[:0-2] Only three Swiss hospitals have achieved a higher EMRAM ranking | qhit blog: Medical Process Management & Digital Health. Retrieved April 28, 2019 (German).

[3] Electronic patient files: What is Germany really doing forwards? , Healthcare in Europe, April 29, 2016. Retrieved April 29, 2019.

[:1-4] HIMSS Track: EMRAM - Consistent digitization - added value for hospital management. September 20, 2016, accessed April 28, 2019 .

[:2-5] ↑ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az ^ba ^bb ^bc ^bd ^be ^bf ^bg ^bh ^bi ^bj ^bk ^bl ^bm ^bn ^bo ^bp ^bq ^br ^bs ^bt ^bu ^bv ^bw ^bx ^by ^bz ^ca ^cb ^cc ^cd ^ce ^cf ^cg ^ch ^ci ^cj ^ck ^cl ^cm ^cn ^co ^cp ^cq ^cr ^cs ^ct ^cu ^cv ^cw ^cx ^cy ^cz ^da ^db ^dc ^dd ^de ^df ^dg ^dh ^di ^dj ^dk ^dl ^dm ^dn ^do ^dp ^dq ^dr ^ds ^dt ^du ^dv ^dw ^dx ^dy ^dz ^ea ^eb ^ec ^ed ^ee ^ef ^eg ^eh ^ei ^ej ^ek ^el ^em ^en ^eo ^ep ^eq ^er ^es ^et ^eu ^ev ^ew ^ex ^ey ^ez ^fa ^fb ^fc ^fd ^fe ^ff ^fg ^fh ^fi ^fj ^fk ^fl ^fm ^fn ^fo ^fp ^fq ^fr ^fs ^ft ^fu ^fv ^fw ^fx ^fy ^fz ^ga ^gb ^gc ^gd ^ge ^gf ^gg ^gh ^gi ^gj ^gk ^gl ^gm ^gn ^go ^gp HIMSS EMRAM Stage 6 & 7 Community | HIMSS Europe. Retrieved April 28, 2019 .