DETROIT – Detroit Medical Center's chief medical information officer says the system, which has 2,000 beds, is working on "filling the gaps" in its electronic documentation as it strives to meet meaningful use and become paper free.

DMC recently reached HIMSS Analytics Stage 6 of seven stages for EMR adoption and use.

“Reaching Stage 6 EMR adoption is a great accomplishment, but was not an easy task and quite a journey,” said Mike LeRoy, DMC’s senior vice president and chief information officer.

According to HIMSS Analytics, DMC is the largest U.S. healthcare system to reach Stage 6 of the EMR Adoption Model.

It is DMC’s intent to reach Stage 7 sometime in the next calendar year, says Leland A. Babitch, MD, the system’s CMIO.

“We are talking about eight hospitals here,” said Babitch. “So this has to be a system-wide change, and it could take a little longer.”

Babitch said DMC began rolling out a clinical documentation system last December and only a couple months into it 25 percent of its inpatient base is already receiving electronic notes. He says they are seeing a 20-30 percent increase in electronic documentation month over month.

However, getting everyone on board will be the greatest challenge due to the number of specialists and private doctors. It is even tougher than CPOE because notes are done so frequently, he said.

"There is so much nuance in notes because there is no standardization and that makes it a bigger leap," Babitch said

In DMC's ICU, nursing documentation is still paper-based, and a successful move to an electronic system, "will hinge on the ease of getting that highly technical vital sign data from the monitor and onto the computer." He says this is not only time consuming for nurses but can increase the likelihood of transcription errors.

"I think it is a bigger step to get from Stage 6 to 7 than from Stage 4 to 5, or Stage 5 to 6,” he said.

Although Babitch views the HIMSS Analytics EMR Model as a good standard, he says requirements for meaningful use could "muddy the waters a little."

"They are mutually exclusive so it is going to make it harder to pick one versus the other. It falls down to what is right for the system or the patient instead of trying to meet one single goal," he said.

David Garets, former president and CEO of HIMSS Analytics, now with consulting firm The Advisory Board Company, figures healthcare systems will have to be Stage 4 to meet the meaningful use specifications for 2011. “For 2013, you'll need to be at Stage 5, and you need to be at Stage 7 by 2015,” he said.