RESULTS
NON-RESPONSE ANALYSIS
A profile of the 21 Dutch hospitals that did
not participate in the study is reflected in
Table 1. Representing approximately 21.5%
of all Dutch acute-care hospitals, perhaps
the most remarkable characteristic differentiating survey participates was hospital
size. Over 57% of non-participants were
small hospital providers as defined by the
number of physicians associated with the
hospital (see Table 1). Hospital size as an
influencer on survey participation is not
unique to this survey effort and may be the
result of a multiplicity of factors (e.g., limited staff availability to complete the survey).
Regional variances also seemed to play a
factor in survey participation as hospital
non-participation rates ranged from 4.8%
in the southern part of the Netherlands, to
36.8% in northern NL. The remarkably high
non-participation rate in the northern part
of the country maybe due to the relatively
high concentration of smaller hospitals in
this region compared to other regions.
EMRAM SCORES OF DUTCH HOSPITALS
Table 2 describes the different EMRAM
stages and profiles of the EMRAM distribution of NL hospitals. The distribution
profile is significant in that it suggests some
EMRAM requirements are more challenging for NL hospitals than others.
EMRAM Stage 3 presents as the first
notable challenge to NL hospitals, as 37.5%
of the hospitals in this study have yet to
satisfy the requirements of this stage. Once
EMRAM Stage 3 requirements are met, the
EMRAM profile then suggests NL hospitals are likely to be challenged in meet-
HIMSS level Frequency Percent Characteristics (EU model)
Stage
70 0
Complete EMR; CCD transactions to share
data; Data warehousing feeding outcomes
reports, quality assurance, and business
intelligence.
6 11 15. 3
Physician documentation interaction with
full CDSS (structured templates related
to clinical protocols trigger variance
& compliance alerts) and Closed loop
medication administration.
5 32 43.1 Full complement of PACS displaces all film- based images.
4 2 2. 8
CPOE in at least one clinical service area
and/or for medication (i.e., e-Prescribing);
may have Clinical Decision Support based
on clinical protocols.
30 0
Nursing/clinical documentation (flow sheets);
may have Clinical Decision Support for error
checking during order entry and/or PACS
available outside Radiology
2 28 37. 5
Clinical Data Repository (CDR) / Electronic
Patient Record; may have Controlled
Medical Vocabulary, Clinical Decision
Support (CDSS) for rudimentary conflict
checking,
1 1 1.4
Major ancillary clinical systems are installed
(pharmacy, laboratory, radiology) or
laboratory, pharmacy, radiology information
system data output is delivered to the
hospital for online access and processing
if the ancillary service is not provided in-house, but by external service providers
00 0
All Three Ancillaries (Laboratory, Radiology
and Pharmacy) not Installed OR not
processing Laboratory, Radiology and
Pharmacy data output online from external
service providers.
Total 73 100
Stage 3, Stage 6, and Stage 7 requirements present as challenges for NL hospitals.
Stage 0-2 Stage 3-5 Stage 6 and 7 Total
populationdensitykm2 populationdensitykm2 populationdensitykm2 populationdensitykm2
Mean Count Row N Mean Count Row N Mean Count Row N Mean Count Row N
non-Randstad 951 13 30.2% 1215 25 58.1% 1649 5 11.6% 1186 43 100%
Randstad 3534 12 52.2% 3021 8 34.8% 2859 3 13.0% 3267 23 100%
The Randstad region has the highest population density, but the lowest EMRAM score.
