Adoption of Electronic Medical Records in Healthcare Facilities in the Emirate of Dubai

Article information

Healthc Inform Res. 2024;30(2):154-161
Publication date (electronic) : 2024 April 30
doi :
1Health Informatics & Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, UAE
2Department of Public Health, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
3Health Informatics Department, College of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
Corresponding Author: Mahera Abdulrahman, Health Informatics & Smart Health Department, Health Regulation Sector, Dubai Health Authority, Sheikh Ahmed Square, Al Jaddaf, Dubai, United Arab Emirates. Tel: +971-4-502-2991, E-mail: (
Received 2023 December 15; Revised 2024 April 11; Accepted 2024 April 23.



This paper aimed to assess the adoption of electronic medical records (EMRs) in healthcare facilities in Dubai, the largest city in the United Arab Emirates (UAE) and a location where extensive healthcare services are provided. It explored the challenges, milestones, and accomplishments associated with this process.


A situation analysis was conducted by contacting 2,089 healthcare facilities in Dubai to determine whether they had implemented EMR in their medical practices and to identify the challenges they faced during this process. Additionally, the Electronic Medical Record Adoption Model (EMRAM) was utilized to measure the maturity level of hospitals in terms of EMR adoption. The EMRAM stages were rated on a scale from 0 to 7, with 0 representing the least mature stage and 7 the most mature.


By September 2023, all hospitals (100%, n = 54) and 75% of private clinics (n = 1,460) in Dubai had implemented EMRs. Several challenges were identified, including the absence of EMRs within the healthcare facility, having an EMR with a low EMRAM score, or the lack of a unified interoperability standard. Additionally, the absence of a clear licensing program for EMR vendors, whether standalone or cloud-based, was among the other challenges noted.


EMR implementation in healthcare facilities in Dubai is at a mature stage. However, further efforts are required at both the decision-making and technical levels. We believe that our experience can benefit other countries in the region in implementing EMRs and using EMRAM to assess their health information systems.

I. Introduction

An electronic medical record (EMR) is a digital version of a patient’s paper medical chart and personal information. It includes the patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, laboratory test results, and more. EMRs adhere to nationally recognized interoperability standards and enable the secure use and sharing of information across networks [1].

The adoption of EMRs is a high priority in many countries because of their potential to enhance the security, effectiveness, and efficiency of healthcare delivery [2]. EMRs facilitate healthcare delivery at various stages by allowing clinicians access to previous laboratory and radiology investigations, medication orders, and comprehensive patient histories, including comorbidities [3,4]. Additionally, EMRs improve clinical performance by supporting clinical decision-making. This support includes access to updated clinical guidelines, alerts for abnormal test results, and notifications of drug allergies and interactions [5]. Implementing EMRs has been shown to reduce medical errors, enable more effective communication and information sharing among clinicians, decrease national healthcare costs, and improve the quality of healthcare [2]. The adoption of EMRs in hospitals is increasing globally [6]. In the Gulf Cooperation countries region, the adoption of EMRs has begun, though progress has been slow [3,4].

In healthcare, digital maturity refers to the extent to which digital systems are utilized to deliver high-quality care, thereby enhancing services and improving the patient experience [7]. Assessing digital maturity is especially critical in hospital settings due to the complexity and cost associated with delivering multidisciplinary healthcare for both acute and chronic cases [8]. To evaluate digital maturity, organizations can use a maturity model that assesses their current digital status across various dimensions [9]. However, current methods for assessing digital maturity in hospitals face challenges due to a lack of consensus on which capabilities should be evaluated [10]. Several adoption and maturity models exist to measure the level of health information exchange (HIE) implementation [11,12]. We have employed the Healthcare Information and Management Systems Society (HIMSS) maturity model, which defines various stages of EMR adoption by healthcare providers. These stages are rated on a scale from 0 to 7, with 0 representing the least mature stage and 7 the most mature. The EMR Adoption Model (EMRAM) uses over 100 indicators across several focus areas, including software applications, software consumption, IT security, and closed-loop administration procedures [13].

EMRs have been in use at the Dubai Health Authority (DHA) since 1998. However, in January 2021, a policy was introduced that required the implementation of EMR in all healthcare facilities, including hospitals, outpatient clinics, dental clinics, pharmacies, labs, and rehabilitation facilities. One of the primary motivations for this initiative was the coronavirus disease 2019 (COVID-19) pandemic [14]. The United Arab Emirates (UAE) health sector faced significant challenges in managing COVID-19 patient data, which involved tracking cases, admissions, treatments, transfers, and ultimately, discharges or deaths [15]. The pandemic placed an enormous burden on already overstretched healthcare systems, especially in managing patients with chronic conditions [14]. It also impacted doctors’ ability to access information timely and make accurate diagnoses.

Another key reason for this push was the implementation of the HIE in Dubai, known as Nabidh. The Nabidh HIE is a healthcare platform designed to securely exchange trusted healthcare information across both public and private facilities in Dubai. The goal of Nabidh is to facilitate the seamless and secure sharing of patient health information and EMR across various healthcare sectors. It utilizes International Classification of Diseases (ICD) and Current Procedural Terminology codes along with HL7 Standards. The rollout of Nabidh faced several hurdles, primarily because many healthcare facilities either lacked an EMR system or had EMRs that did not meet the standards required by Nabidh.

The purpose of this paper was to evaluate the implementation of EMRs in healthcare facilities within the Emirate of Dubai, focusing on the challenges, milestones, and achievements. We believe that our experiences can provide valuable insights to other neighboring countries that are considering the adoption of EMR systems in their health sectors.

II. Methods

A situation analysis was conducted to explore the current state of health informatics records management in healthcare facilities. The DHA contacted approximately 2089 healthcare facilities in Dubai to determine whether they had implemented EMRs in their medical practices and to identify any challenges they faced during this process. Additionally, a benchmark analysis of the current EMR situation in major hospitals was performed. The primary aim of this methodology was to assess the readiness of healthcare facilities to adopt the Nabidh HIE in Dubai. There were a total of 3,670 healthcare facilities actively operating in Dubai, of which 1,581 were facilities without a physician, such as drugstores and school clinics. The study included the remaining 2,089 healthcare facilities, spanning both governmental and private sectors and regulated by the DHA (Table 1).

Type and number of healthcare facilities in Dubai included in this study (n = 2,089)

Since 2011, the EMRAM has been utilized to assess the maturity level of healthcare facilities in terms of EMR adoption among hospitals in Dubai. This includes inquiries about current EMR systems, requirements, provider names, and applications. The EMRAM survey is conducted annually from September to November via email and telephone calls. In-person meetings are also held to verify the survey results with the facilities. According to institutional policies, no ethics committee approval was required to conduct the survey, as it was not a human research study and all data were handled confidentially. All hospitals (healthcare facilities that include an inpatient setup) were included. HIMSS uses proprietary software with a survey tool to collect, validate, and assess responses from the hospitals. The survey includes criteria corresponding to seven stages as detailed in Table 2.

Situational analysis of the EMR maturity model within hospitals in Dubai, from 2011 to 2022

If the hospital successfully completes stage 6 according to the EMRAM scoring system, further validation measures, such as onsite visits, will be undertaken. The reliability and precision of the data presented, along with the findings in this evaluation, were primarily the responsibility of representatives from the participating hospitals.

III. Results

1. EMR Adoption in Dubai

All healthcare facilities in the Emirate of Dubai were contacted via email and phone to gather information about their EMR implementation, if any, and their plans to integrate it into their services. Our findings indicated that all governmental healthcare facilities, including five major hospitals, 14 primary healthcare centers, and five specialized centers—specifically, an infertility center, a diabetes center, a thalassemia center, a cord blood center, and a rehabilitation center—had implemented EMRs. In the private sector, all hospitals and some clinics were utilizing EMRs. In total, 54 (100%) of hospitals and 1,460 (75%) clinics had implemented EMR in their practice (Table 3).

Situational analysis of EMR accessibility in hospital and other healthcare facilities in Dubai

2. EMRAM Maturity Level of Hospitals in Dubai

Between 2011 and 2017, the average EMRAM score among Dubai hospitals continuously increased from 1.9 in 2011 to 4.0 in 2017. However, following a major update to the EMRAM criteria in January 2018, HIMSS Analytics reclassified some existing technologies and practices, moving them down its seven-stage ladder, and introduced significant new material focusing on security. From 2019 to 2021, the average EMRAM scores of Dubai hospitals rose from 2.2 in 2019 to 2.6 in 2022, as shown in Table 2. However, it is not feasible to directly compare the current EMRAM scores with those from the previous year (average 3.0) due to the modified criteria. More than 50% of hospitals in Dubai met or exceeded the standards for EMRAM stage 4, as shown in Table 2. These hospitals utilize Computerized Provider Order Entry and Electronic Medicines Administration Records; they maintain robust clinical and information governance, and monitor both clinical outcomes and patient satisfaction goals. Conversely, approximately 42% of the hospitals surveyed at EMRAM stage 0 need to enhance their digital transformation efforts to improve organizational performance and patient health outcomes. About 7% of the hospitals, as noted in Table 2, achieved stage 2 or stage 3 on the EMRAM, indicating that they have begun their digital transformation journey.

In 2011, the vast majority of hospitals in Dubai were at EMRAM stages 0, 1, or 2, with 21 out of 23 hospitals (91%) falling into these categories at the onset of the survey. Over time, participation in our survey increased, with 43 hospitals participating in 2022 compared to 23 in 2011. We observed that the hospitals’ EMRs were becoming more advanced. Between 2020 and 2022, 19 healthcare facilities improved their compliance with EMRAM criteria and achieved a higher EMRAM score. Specifically, improvements in seven Dubai hospitals resulted in advancement to higher EMRAM stages. In total, nine hospitals have met all the criteria required to achieve stage 5. To assess IT spending, hospitals in Dubai are required to report their expenditures. Of the 36 hospitals in Dubai, only 16 provided their IT spending figures. Among these 16, seven hospitals (44%) reported operational IT expenditures of less than 1%. This figure is comparable to that of 2020, where 40% (6 out of 15) reported similarly low expenditures, and is significantly lower than typically observed in hospitals that achieve EMRAM stages 6 and 7.

3. Adoption Rate of EMR by Physicians, Nurses, and Allied Health Professionals

The data indicated that an increasing number of hospitals in Dubai have been participating in EMRAM’s Annual Study since 2011, as detailed in Table 4. This rise in adoption was observed across all healthcare providers: the percentage of physicians with 95%–100% adoption increased from 35% in 2020 to 42% in 2021. Similarly, nursing usage rose from 41% to 47%, and documentation by allied health professionals increased from 41% to 44%.

Adoption rate of EMRs by physicians, nurses, and allied health professionals in hospitals that responded to the EMRAM survey, 2011–2022

IV. Discussion

In the present study, we chronicled the journey of EMR adoption and the transition from paper to electronic data in Dubai since 2011. The adoption of an EMR was evaluated based on its ability to support specific tasks, such as integrating clinical decision support into clinical platforms, automating the collection of patient-reported outcomes, and incorporating population health management initiatives as the adoption of a basic EMR became standard. Consequently, EMRAM was utilized to measure the maturity level of EMR implementation in the UAE. The average EMRAM score for Dubai hospitals was 2.6, slightly lower than the previous year’s score of 3.0. This decline can be attributed to model adjustments made between 2018 and 2022, as well as changes in the composition of the sample from 2021 to 2022. One of the significant challenges was that many hospitals in Dubai lacked EMRs. For those hospitals that did have EMRs, they were only at stage 0 or 1 according to the EMRAM assessment. Another issue was the lack of sufficient funds for hospitals without EMRs. Consequently, the experts in DHA health informatics decided to meet with the top executives and leaders of these healthcare facilities to encourage them to either purchase an EMR system or, if they already had one, to upgrade it to at least EMRAM stage 2. Additionally, there was a lack of awareness about vendors and interoperability standards. Therefore, DHA also decided to support these facilities by helping them identify suitable vendors and providing them with the necessary information and guidance on interoperability standards to employ.

The implementation of EMR systems was challenging, and their success heavily depended on healthcare providers’ willingness to integrate EMR into their daily practices. Another challenge involved finding qualified personnel to train medical professionals and clinicians in the use of EMR. This aligns with other studies that have reported similar obstacles and challenges in implementing EMR within the health sector [16,17]. DHA overcame this obstacle with the aid of training materials such as videos and virtual events. There were also technological challenges, including varying interoperability standards for data exchange. In 2017, different EMR vendors used different interoperability standards. Therefore, DHA worked to gradually unify these standards through various regulatory actions, initially offering options and eventually making it mandatory to use DHA-approved standards. In addition, to address this issue, DHA introduced the option of using cloud-based EMR. Cloud-based EMR is a software program that maintains health records data on remote servers, also known as the cloud, rather than on servers located within the premises of a medical clinic or facility [18]. It offers simplified operations, reduced costs, and enhanced data sharing with security for its users. Cloud EMR provides a comprehensive suite of essential features, facilitating easy storage, creation, sharing, and tracking of digital patient data for small clinics and practices. It is also accessible to both single-physician clinics and large, multi-location, multi-specialty practices. This approach enabled DHA to maintain EMR across various facilities in Dubai without incurring high costs.

Governmental hospitals in the Emirate of Dubai serve as an exemplary case of how healthcare providers can leverage technology to enhance patient care, minimize medical errors, and boost operational efficiency. These facilities have consistently advanced their digital maturity from 2012 to 2017, with further improvements following the introduction of new EMRAM criteria in 2018. One of the primary challenges in EMRAM stages 1 and 2 is the management of basic security and privacy requirements. Technological and functional deficiencies in EMRs, particularly in cardiology, along with inadequate annual reviews of physical access, acceptable use, and data destruction policies, prevent many hospitals in Dubai from advancing to EMRAM stage 2. While high levels of EMR maturity generally correlate with substantial IT investments, the amount of spending is less critical than its strategic application. It is often the strategic nature of the investment—allocating the right amount of funds to the right areas at the right time—that is crucial for achieving high levels of EMR maturity and adoption. This strategic approach complicates the implementation of investment projects.

Achieving EMRAM’s stage 2 or higher for EMRs was another significant milestone. This advancement promotes the uniformity of EMR interoperability among healthcare providers and supports the future integration of EMRs with local and regional HIEs. The DHA has actively encouraged healthcare providers to adopt interoperability by providing roadmaps and facilitating the development and adoption of new information exchange standards. However, achieving full interoperability will require more time. The ongoing lack of interoperability could negatively impact patient safety, clinical outcomes, and efforts in population health management [15]. Additionally, hospitals vary in their levels of capital assets, resources, and IT-oriented mindsets, which can result in different patterns of adopting EMR functionalities. Despite these challenges, our healthcare reform project has reached many milestones related to the use of information and technology standards, including the ICD, 10th Revision (ICD-10) [19], Health Level Seven International (HL7) [20], health insurance and claims management system, and telehealth systems.

In the Emirate of Dubai, the implementation of EMRs in healthcare facilities is advancing in maturity. The study explored the current state and challenges associated with EMR implementation. Several challenges were identified, including the absence of an EMR system in healthcare facilities, the presence of an EMR with a low EMRAM score, or an EMR that fails to meet the necessary standards for HIE due to a lack of awareness about available vendors and relevant interoperability standards. Funding, policymaking, and organizational resistance can significantly hinder the implementation of EMRs. However, evidence suggests that governmental support and national standards are the most critical factors influencing EMR adoption in hospitals [21]. Therefore, programs promoting interoperability and relevant policies and standards have been implemented in Dubai. Nevertheless, the lack of EMR incentives by the DHA may discourage hospitals from adopting EMRs and realizing their benefits. We believe that other Gulf countries can learn from our experience with EMR technologies and EMRAM to improve the maturity level of their health information systems.

This study has several limitations. Firstly, it was conducted in health facilities under the jurisdiction of the DHA, which is limited to the Emirate of Dubai. A more comprehensive study would include all health facilities across the UAE. Additionally, at the onset of the EMRAM assessment in 2011, only 23 hospitals participated; by 2022, this number had increased to 43. Furthermore, the period from 2011 to 2022 saw significant advancements in health informatics and technology. However, the impact of these technological advancements was not included in our assessment due to feasibility constraints.


Conflict of Interest

No potential conflict of interest relevant to this article was reported.


The authors would like to thank all healthcare facilities in the Emirate of Dubai who participated in implementing the EMR.


1. The Office of the National Coordinator for Health Information Technology (ONC). What is an electronic health record (EHR)? [Internet] Washington (DC):; 2019. [cited at 2024 Apr 25]. Available from:
2. Kharrazi H, Gonzalez CP, Lowe KB, Huerta TR, Ford EW. Forecasting the maturation of electronic health record functions among US hospitals: retrospective analysis and predictive model. J Med Internet Res 2018;20(8):e10458.
3. AlSadrah SA. Electronic medical records and health care promotion in Saudi Arabia. Saudi Med J 2020;41(6):583–9.
4. Musa S, Dergaa I, Al Shekh Yasin R, Singh R. The impact of training on electronic health records related knowledge, practical competencies, and staff satisfaction: a pre-post intervention study among wellness center providers in a primary health-care facility. J Multidiscip Healthc 2023;16:1551–63.
5. Menachemi N, Collum TH. Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy 2011;4:47–55.
6. Kanakubo T, Kharrazi H. Comparing the trends of electronic health record adoption among hospitals of the United States and Japan. J Med Syst 2019;43(7):224.
7. Martin G, Clarke J, Liew F, Arora S, King D, Aylin P, et al. Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England. NPJ Digit Med 2019;2:41.
8. Eden R, Burton-Jones A, Grant J, Collins R, Staib A, Sullivan C. Digitising an Australian university hospital: qualitative analysis of staff-reported impacts. Aust Health Rev 2020;44(5):677–89.
9. Johnston DS. Digital maturity: are we ready to use technology in the NHS? Future Healthc J 2017;4(3):189–92.
10. Krasuska M, Williams R, Sheikh A, Franklin BD, Heeney C, Lane W, et al. Technological capabilities to assess digital excellence in hospitals in high performing health care systems: international eDelphi exercise. J Med Internet Res 2020;22(8):e17022.
11. Carvalho JV, Rocha A, Abreu A. Maturity models of healthcare information systems and technologies: a literature review. J Med Syst 2016;40(6):131.
12. Duncan R, Eden R, Woods L, Wong I, Sullivan C. Synthesizing dimensions of digital maturity in hospitals: systematic review. J Med Internet Res 2022;24(3):e32994.
13. Healthcare Information and Management Systems Society Inc. (HIMSS). Digital health transformation: Electronic Medical Record Adoption Model (EMRAM) [Internet] Chicago (IL): HIMSS; c2024. [cited at 2024 Apr 25]. Available from:
14. Levene LS, Seidu S, Greenhalgh T, Khunti K. Pandemic threatens primary care for long term conditions. BMJ 2020;371:m3793.
15. AbdulRahman M, Al-Tahri F, AlMehairi MK, Carrick FR, Aldallal AM. Digital health technology for remote care in primary care during the COVID-19 pandemic: experience from Dubai. Telemed J E Health 2022;28(8):1100–8.
16. Ellingsen G, Christensen B, Hertzum M. Persuasion tactics in the implementation of large-scale EHR suites in public healthcare. Stud Health Technol Inform 2021;286:33–7.
17. Ellingsen G, Hertzum M, Christensen B, Wynn R. National integration components challenge the epic implementation in Central Norway. Stud Health Technol Inform 2022;294:500–4.
18. Wu Z, Xuan S, Xie J, Lin C, Lu C. How to ensure the confidentiality of electronic medical records on the cloud: a technical perspective. Comput Biol Med 2022;147:105726.
19. Kharrazi H, Lasser EC, Yasnoff WA, Loonsk J, Advani A, Lehmann HP, et al. A proposed national research and development agenda for population health informatics: summary recommendations from a national expert workshop. J Am Med Inform Assoc 2017;24(1):2–12.
20. World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD) [Internet] Geneva, Switzerland: World Health Organization; 2021. [cited at 2024 Apr 25]. Available from:
21. Health Level Seven International. HL7 Standards [Internet] Ann Arbor (MI): Health Level Seven International; c2024. [cited at 2024 Apr 25]. Available from:
22. Liang J, Li Y, Zhang Z, Shen D, Xu J, Zheng X, et al. Adoption of electronic health records (EHRs) in China during the past 10 years: consecutive survey data analysis and comparison of Sino-American challenges and experiences. J Med Internet Res 2021;23(2):e24813.

Article information Continued

Table 1

Type and number of healthcare facilities in Dubai included in this study (n = 2,089)

Main category n
Outpatient Clinic 1,626
Home Healthcare Agency 150
Dental General Clinic 77
Diagnostic Center 59
Day Surgery Center 58
Hospital 54
Special Need Center 22
Telehealth 20
Fertility Center 10
Renal Dialysis Centre 6
Cord Blood & Stem Cell Center 4
Rehabilitation Center (outpatient) 3

Table 2

Situational analysis of the EMR maturity model within hospitals in Dubai, from 2011 to 2022

EMRAM Cumulative capabilities 2011 2012 2013 2014 2015 2016 2017 2019a) 2020 2021 2022
Stage 7 Complete EMR, external HIE, data analytics, governance, disaster recovery, privacy and security 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Stage 6 Technology-enabled medication, blood products & human milk administration, risk reporting, full CDS 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 2 (6) 4 (12) 4 (10) 6 (15) 0 (0)
Stage 5 Full physician documentation, using structured templates, intrusion/device protection. 0 (0) 2 (7.5) 6 (21) 6 (21) 10 (31) 11 (33) 14 (42) 6 (18) 11 (28) 11 (28) 9 (21)
Stage 4 50% of all medical orders are placed using CPOE and is supported by a CDS, nursing/allied health professional documentation has reached 90%, basic business continuity. 1 (4) 2 (7.5) 1 (3.5) 1 (3.5) 1 (3) 1 (3) 0 (0) 1 (3) 3 (8) 5 (13) 13 (30)
Stage 3 50% of nursing and allied health documentation. The eMAR application is implemented, role-based security. 1 (4) 1 (4) 2 (7) 1 (3.5) 1 (3) 1 (3) 1 (3) 0 (0) 0 (0) 0 (0) 1 (2)
Stage 2 Major ancillary clinical systems are enabled with internal interoperability feeding data to a single CDR, basic security. 7 (30) 10 (37) 10 (36) 12 (41) 12 (38) 17 (52) 15(46) 0 (0) 0 (0) 0 (0) 2 (5)
Stage 1 All major ancillary clinical systems are installed (laboratory, pharmacy, radiology and cardiology). 9 (39) 9 (33) 8 (29) 6 (21) 6 (19) 1 (3) 0 (0) 10 (29) 7 (18) 5 (13) 0 (0)
Stage 0 All three ancillaries are not installed. 5 (22) 3 (11) 1 (3.5) 3 (10) 2 (6) 2 (6) 1 (3) 13 (38) 14 (36) 12 (31) 18 (42)
Number of participated hospitals 23 27 28 29 32 33 33 34 39 39 43b)

Values are presented as number (%).

EMRAM: Electronic Medical Record Adoption Model, EMR: electronic medical record, HIE: health information exchange, CDS: clinical decision support, CPOE: Computerized Provider Order Entry, eMAR: Electronic Medication Administration Record, CDR: clinical data repository.


In year 2018, the EMRAM criteria was updated. This is the reason of slip of EMRAM stage we are observing above.


Not all hospitals responded to EMRAM survey.

Table 3

Situational analysis of EMR accessibility in hospital and other healthcare facilities in Dubai

Yes No Total
Hospitals 54 (100) 0 54
Other facilities 1,460 (72) 583 (28) 2,043

Values are presented as number (%).

EMR: electronic health record.

Table 4

Adoption rate of EMRs by physicians, nurses, and allied health professionals in hospitals that responded to the EMRAM survey, 2011–2022

Share Adoption rate (%)

Physician documentation Nursing documentation Allied health professionals documentation

2020 (n = 34) 2021 (n = 36) 2020 (n = 34) 2021 (n = 36) 2020 (n = 34) 2021 (n = 36)
1%–25% 3 3 0 0 3 0

26%–49% 6 3 0 0 0 0

50%–75% 26 22 18 11 18 11

76%–89% 3 6 9 8 9 8

90%–94% 26 25 32 33 29 36

95%–100% 35 42 41 47 41 44

EMRAM: Electronic Medical Record Adoption Model, EMR: electronic medical record.