Cisco Canada Blog

What the heck is the INFRAM, and why should I care about it?

July 25, 2018

If you work in healthcare and your organization considers itself to have an appetite for digitization and innovation in any way, you will care about INFRAM – even if you don’t know what it is…. yet.

Those of us who work in the healthcare IT space know the organization HIMSS; it’s only just the largest health informatics organization you’ve ever seen. At its annual conference (which can only be held in less than a handful of locations because it is so huge), just shy of 44,000 attendees participate in countless sessions, culminating in closing keynote speeches from the likes of former U.S. presidents (Bill Clinton, George W. Bush Jr),  political notables such as Hillary Rodham Clinton, former General Colin Powell, and Dr. Eric Topol, and high profile athletes like Peyton Manning and Magic Johnson. Suffice it to say the HIMSS conference is not to be missed if you work in this space.

HIMSS Analytics is a supporting arm of HIMSS, whose mission “is to provide the highest quality data and analytical expertise to support improved decision-making for healthcare providers, healthcare information and technology companies and consulting firms”. Over the past several months Cisco has worked closely with HIMSS Analytics to share a transformational model, initially developed by the Cisco healthcare team in Australia and New Zealand, which has been officially adopted by HIMSS Analytics as the global model all healthcare organizations should adopt and follow when creating architectural infrastructure to support their EMR and other technical rollouts.

Now, that might not sound like a big deal — BUT IT IS.

We hear about organizations all over the world making enormous investments in EMR implementations – we are talking about millions and millions of dollars here (sometimes even a billion or two). The EMR rollout, that’s the exciting part – the opportunity for a healthcare organization to move from paper charts to a digital modality that touts efficiency returns, broader access to patient data, comprehensive clinical workflows and more. But all too often, the infrastructure upon which these highly complex systems must ride on are neglected or even forgotten; and if it isn’t current (i.e. powerful enough to support the application), Day 1 of a new launch can be disastrous. And guess who/what the clinicians blame? The application they are using, when perhaps it is the aging infrastructure it is riding on that is causing the issue…

One of the problems I frequently see is that the network ‘isn’t sexy enough’ to warrant upgrade investments … organizations want to be able to point to their shiny new EMR, not their shiny new switch, router or access point (never mind the security technology that keeps all the patient data safe).

But let me ask you this – if you had the opportunity to buy a Ferrari, would you ever choose to drive it on a logging road? My guess would be “heck no!” So why would healthcare organizations choose to run their high-end clinical applications on aging infrastructure?

The answers vary, but the one I’m going to go with is: they are not sure of the way forward. So instead of taking a forward-thinking, almost ‘preventative’ approach, I see organizations investing in technology that might do the bare minimum, instead of imagining the art of the possible and preparing for that. It might not be anyone’s fault, it might just be that they don’t know of any other way.

Enter INFRAM (the INFRastructure Adoption Model). This model guides organizations through a specific process and assessment, and at the end creates a bespoke infrastructure architecture roadmap. The organization can then use this to map out their specific technology requirements based on what they already have in place, and where they want to go. If you’ve heard of the HIMSS EMRAM (Electronic Medical Record Adoption Model), you will quickly realize that the INFRAM goes hand in hand with the EMRAM and its corresponding levels. So if you think your organization is an EMRAM level 4, you can verify this by undertaking the INFRAM assessment and then planning the strategic architecture to get to a level 6 or even 7 – also known to some as EMR nirvana…

I know I’ve simplified this quite a bit, but as a nurse I needed to understand what INFRAM might mean for clinicians and clinical leaders. What I can tell you is that IT folks who know about EMRAM comprehend the value of INFRAM almost before I can finish the sentence. But clinicians, well we need to understand how this is going to affect how we practice and care for our patients. And if the bottom line is as simple as this: your skookum clinical application won’t crash 15 times as you are charting; then that is equally as valuable as understanding the technical underpinnings of the detailed model.

But don’t take my word for it: check out this article written by Cisco’s Global Healthcare Leader, Barbara Casey, or this one from Healthcare IT News. And hopefully we can help you out; we’ve certainly been working hard on this for a few years to make this easier for you – because we don’t want your Ferrari to have a bumpy ride.





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  1. Thanks for sharing.