The Electronic Medical Record Adoption Model (EMRAM) score provides peer comparisons for hospitals relative to the implementation of an electronic health record (EHR). Holland Bloorview’s current Healthcare Information & Management Systems Society Analytics(HIMSS)EMRAM ranking of 4.228 is significantly higher than the Ontario Provincial average of 2.5397. Holland Bloorview has had an electronic health record (EHR) on all inpatient units since 2009 and successfully leveraged the EHR implementation across the organization in 2012, to redesign and dramatically improve documentation practices and facilitate improved team, client and family collaboration.

Four innovative strategies were used to expand the EHR to outpatient and community services; address variation in documentation practices/standards; and improve health literacy of the health record for clients and families.

The implementation team:
1. Established a governance structure to steward the project including Executive Steering Committee, EHR Project Team, and Clinical Documentation Change Team which engaged clinicians and family representatives.
2. Completed a systematic review of documentation practices through questionnaires, user knowledge quiz, focus groups and a chart audit.
3. Redesigned documentation practices to establish standards across disciplines/programs; this included a forum of Professional College representatives to ensure new documentation standards met expectations of regulatory bodies.
4. Implemented a rigourous education strategy and evaluation plan with mandatory e-learning modules, in class clinically based instruction, and peer super–user support model. Simulation events were used to facilitate adoption of point of care technology.

The implementation of an organization-wide electronic health record was an important corporate and strategic goal for Holland Bloorview; and as a result dedicated resources were provided through Information Systems, Programs and Services and Collaborative Practice to ensure the successful implementation and sustainability of the initiative. Collaborative Practice holds a significant role and accountability for the electronic health record, as the design of the build enables documentation to reflect current standards of practice (e.g., all physiotherapists, occupational therapists, orthotists and prosthetists use the same tools for assessing range of motion, strength and tone). As practice changes and new standards become known, an on line process is in place to capture change requests and ensure that these are discussed, reviewed and approved by the relevant parties (Collaborative Practice leads, Practice Councils, Medical Advisory Council, Forms Committee).

Contact Information:

Contact Title: Project Manager, Clinical Adoption
Contact Email:

← Back to Search Results

Leading Practices are submitted by health organizations from around the world. The contents of the Leading Practices library do not reflect opinions or views of HSO or its affiliates. If you have questions, concerns or suggestions please email us at