Form Appendix B Appendix B Physician Survey

Form Approved

OMB No. 0990-XXXX

Exp. Date 06/30/2008

APPENDIX B

A National Survey of Health Record Keeping among Physicians & Group Practices in the United States.

This survey asks about medical record keeping. Please return the survey with your answers in the enclosed postage-paid envelope.

• Answer the questions by putting an “X” in the appropriate answer box like this:

Have you taken a vacation in the past year?

[x] yes

[ ] no

• Some questions ask you to report a number, such as the number of patients you see in a given week. Please write your best estimate of the number in the space provided. For numbers less than 1, please use fractions, or percentages as appropriate.

Notice of respondent confidentiality.

All information that would permit identification of any person who is chosen for this survey will be kept under the strictest protections allowed by law. This information will be used only for the purposes of this study and will not be disclosed or released for any other purposes without your permission. None of the questions ask about the care you provide to individual patients. If you have questions concerning your rights as a research subject, please call the Office for Research Protection at RTI-International toll-free at 866-214-2043.

If you have any questions or want to know more about the study or to find out about reports that are generated from this data collection effort, please call RTI’s project director, Dr. John D. Loft, toll free at 800-EHR-0000.

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to HHS/OS Reports Clearance Officer, 200 Independence Ave. SW, Washington DC 20201; ATTN: PRA (0990-XXXX).

PHYSICIAN SURVEY

000. Practice Characteristics

001. At how many different office locations do you see ambulatory patients?

₁ One

₂ Two

₃ Three or more

₄ None, I do not see any outpatients

If you practice at more than one location, please keep in mind your main practice site for the remaining questions. By “main practice site” we mean the location at which you see the most ambulatory patients.

002. During a typical week, what percent of your patient visits are provided at your main practice site?

₁ Less than 25%

₂ 25%-49%

₃ 50% - 75%

₄ More than 75%

003. How many physicians are associated with you, at your main practice site? ____________.

004. Is your main practice site a single-specialty practice, or a multi-specialty practice?

₁ Single specialty group or partnership

₂ Multi-specialty group or partnership

005. What is the primary setting of your main practice site?

₁ Hospital, medical-center.

₂ Ambulatory surgical center.

₃ Urgent-care facility.

₄ Laboratory or imaging center, outside a hospital.

₅ An physician office not attached to a hospital, or on a medical center campus.

006. About what percentage of your patients in your main practice site:

	Less than 10%	10% to less than 25%	25% to less than 50%	50% or more
a. are uninsured (do not have health insurance coverage)?	1	2	3	4
b. are covered by Medicaid (including managed care)?	1	2	3	4
c. are African American or Black?	1	2	3	4
e. are Hispanic or Latino?	1	2	3	4
f. have a primary language other than English?	1	2	3	4

007. During your last full week of work, approximately how many patient visits did you personally have at your main practice site?

______________________.

100. Use of computers in your main practice site

101. Does your main practice site have a computerized system for any of the following? For those features that you have, indicate the extent to which you use them:

	Availability					Use
	Yes		No	Don’t Know		I do not use	I use some of the time	I use most or all of the time	Not applicable to my practice or specialty
a) Patient demographics	1		2	3		1	2	3	4
b) Patient problem lists	1		2	3		1	2	3	4
c) Orders for prescriptions?	1		2	3		1	2	3	4
d) If yes – are there warnings of drug interactions or contraindications provided	1		2	3		1	2	3	4
e) If yes - Are prescriptions set electronically to the pharmacy?	1		2	3		1	2	3	4
f) Orders for laboratory tests?	1		2	3		1	2	3	4
g) If yes – are orders sent electronically?	1		2	3		1	2	3	4
h) Orders for radiology tests?	1		2	3		1	2	3	4
i) If yes, Are orders sent electronically?	1		2	3		1	2	3	4
j) Viewing Lab results?	1		2	3		1	2	3	4
k) If yes – are out of range levels highlighted?	1		2	3		1	2	3	4
l) Viewing Imaging results	1		2	3		1	2	3	4
m) If yes – are electronic images returned?	1		2	3		1	2	3	4
n) Clinical notes?	1		2	3		1	2	3	4
o) If yes – do they include medical history and follow up notes?	1		2	3		1	2	3	4
p) Electronic lists of what medications each patient takes	1		2	3		1	2	3	4
q) Reminders for guideline-based interventions and/or screening tests?	1		2	3		1	2	3	4
r) Public health reporting?	1		2	3		1	2	3	4
s) If yes: Are notifiable diseases sent electronically?	1		2	3		1	2	3	4

200. Acquisition and Implementation of an EHR system

201. Does your main practice use an electronic health record (not including billing records)?

₁ Yes, all electronic

₂ Yes, part paper, part electronic

₃ No

₄ Don’t know

202. As of today, what is your degree of electronic health record acquisition or implementation at your main practice site [Choose one]

₁ We have no plans to acquire an EHR system (go to next page)

₂ Our EHR implementation is in process (go to next page)

₃ We have fully implemented our EHR system (go to next page)

₄ We plan to acquire an EHR system in the next 12 months (go to next page)

₅ We plan to acquire an EHR system in the next 13 – 24 months (go to next page)

₆ We have acquired an EHR system, but have not implemented it (go to Question 203)

203. If you have purchased and are in the process of implementing an EHR system, when do you expect to have completed implementation?

₁ in the next 12 months.

₂ in the next 13 to 24 months.

IF YOUR MAIN PRACTICE SITE USES PAPER RECORDS PLEASE GO TO SECTION 400. IF YOUR SITE USES ELECTRONIC HEALTH RECORDS OR IS IN TRANSITION TO AN EHR SYSTEM PLEASE COMPLETE THE FOLLOWING SECTION.

300. Experience with Electronic Health Records

301. How many years have you been using an EHR in your main practice site? _____________.

302. To what extent has the EHR system affected the following areas at your main practice site?

	Major positive impact	Positive impact	No impact	Negative impact	Major negative impact	Not applicable
a) The quality of clinical decisions	1	2	3	4	5	6
b) Communication with other providers	1	2	3	4	5	6
c) Communication with your patients	1	2	3	4	5	6
d) Prescription refills	1	2	3	4	5	6
e) Timely access to medical records	1	2	3	4	5	6
g) Avoiding medication errors	1	2	3	4	5	6
f) Delivery of preventive care that meets guidelines	1	2	3	4	5	6
g) Delivery of chronic illness care that meets guidelines	1	2	3	4	5	6

303. In providing patient care since adopting an EHR system at your main practice site, have you

	Yes		No	Not applicable
	In the last 6 months	Ever
a) Avoided a drug allergy because of an EHR?	1	2	3	4
b) Avoided a potentially dangerous medication interaction because of an EHR?	1	2	3	4
c) Been alerted to a critical lab value by an EHR?	1	2	3	4
d) Provided preventive care (e.g., vaccine, colonoscopy, mammogram) because you were prompted by an EHR?	1	2	3	4
e) Ordered a critical lab test (such as HbA1c or LDL) as a result of an electronic prompt from an EHR?	1	2	3	4

304. Overall, how satisfied are you with the EHR system at your main practice?

Very satisfied	Somewhat satisfied	Somewhat dissatisfied	Very dissatisfied
1	2	3	4

305. How satisfied are you with each of the following aspects of your EHR system

	Very satisfied	Somewhat satisfied	Somewhat dissatisfied	Very dissatisfied
a) Ease of use when providing direct care to a patient	1	2	3	4
b) Reliability of the system (i.e. frequency of system failures, system speed)	1	2	3	4
c) Sharing of medical information with hospitals and other health-care providers?	1	2	3	4

306. Please indicate whether the EHR system at your main practice site allows patients to…

	Yes	No	Don’t know
a. View their medical record online	1	2	3
b. Make changes to or update their medical record online	1	2	3
c. Request appointments online	1	2	3
d. Request referrals online	1	2	3
e. Request refills for prescriptions online	1	2	3

307. Is electronic health record system at your main practice site integrated with a hospital system where you admit patients (i.e. your patient’s ambulatory EHR is accessible through the hospital’s EHR system)?

Yes	No	Don’t know
1	2	3

400. Use of Email

401. Please indicate how frequently you communicate by email with each of the following

	Never	Rarely	Sometimes	Frequently
a) patients about medical issues	1	2	3	4
b) other physicians in your practice about patient care	1	2	3	4
c) other staff in your practice about patient care	1	2	3	4
d) other physicians who are not in your practice about patient issues	1	2	3	4

500. Barriers to EHR adoption

501. Please answer the next set of questions, regardless of whether your main practice site has acquired an EHR system or has not. If your practice site has acquired an EHR system, please tell us how much of a barrier each of the following was. If your practice has not acquired an EHR, please indicate how much of a barrier it is to adoption, even if you have no immediate plans to adopt.

	Major barrier	Minor barrier	Not a barrier
Financial Barriers
a. The amount of capital needed to acquire and implement an HER	1	2	3
b. Uncertainty about the return on investment (ROI) from an HER	1	2	3
Organizational Barriers
c. Resistance to adoption from practice physicians	1	2	3
d. Capacity to select, contract, install and implement an EHR	1	2	3
e. Concern about loss of productivity during transition to the EHR system	1	2	3
Legal or Regulatory Barriers
f. Concerns about inappropriate disclosure of patient information (i.e. breaches of patient confidentiality?)	1	2	3
g. Concerns about illegal record tampering or “hacking”	1	2	3
h. Concerns about the legality of accepting an EHR that is donated from a hospital	1	2	3
i. Concerns about physicians’ legal liability if patients have more access to information in their medical records	1	2	3
State of the Technology
j. Finding an EHR system that meets providers’ needs	1	2	3
k. Concerns that the system will become obsolete	1	2	3

600. Incentives for EHR adoption

601. Please rate the impact the following possible policy changes would have on your decision to adopt an EHR. If you have adopted an EHR, please rate the impact of the following possible policy changes on EHR adoption among physicians generally. Please indicate whether the impact was positive or negative.

	Major positive impact	Minor positive impact	No Impact	Minor negative impact	Major negative impact
Legal or Regulatory Barriers
a. Change the law to protect physicians from personal liability for record tampering by external parties or for privacy and security breaches	1	2	3	4	5
b. Concerns about legal liability as a result of NOT using the latest technology	1	2	3	4	5
State of the Technology
c. Published certification standards that indicate whether an EHR has the necessary capabilities and functions.	1	2	3	4	5
Financial Barriers
d. Incentives for the purchase of an EHR (e.g. tax credits, low interest loans, grants)	1	2	3	4	5
e. Additional payment for the use of an EHR (i.e. additional reimbursement for using an EHR).	1	2	3	4	5

602. Has your practice undertaken any of these capital investments in the last three years?

	Yes	No	Don’t know
Added new examining rooms.	1	2	3
Purchased an x-ray or imaging machine.	1	2	3
Acquired or opened another practice site	1	2	3
Purchased clinical laboratory equipment	1	2	3

900. Physician and practice characteristics

901. What is the year of your birth? 19________

902. What is your gender?

₁ Male ₂ Female

902. What is your ethnicity?

₁ Hispanic or Latino

₂ Not Hispanic or Latino

902. What is your race? (check all that apply)

₁ White

₂ Black/African American

₃ Asian

₄ Native Hawaiian/Other Pacific Islander

₅ American Indian/Alaska Native

902. What is your primary specialty? _____________________________________________________
     
     

903. What is your secondary specialty? ________________________________________________
     
     

904. In what year did you first practice medicine, after completing residency or fellowship? _________
     
     

Roughly, what percent of your patient care revenue comes from (note percentage to total to 100).

____ ____Medicare

____ ____Medicaid

____ ____Private insurance

____ ____Patient payments

____ ____Other ________________________.

IF YOU ARE KNOWLEDGABLE ABOUT DECISIONS REGARDING EHR ADOPTION IN YOUR PRACTICE, PLEASE COMPLETE THE SECOND HALF OF THIS FORM. IF NOT, PLEASE ASK THE MOST KNOWLEDGABLE PERSON AT YOUR MAIN PRACTICE SITE TO COMPLETE THE SECOND HALF OF THIS FORM AND TO RETURN IT IN THE POSTAGE-PAID ENVELOPE PROVIDED.

THANK YOU FOR COMPLETING THIS FORM. PLEASE RETURN IT IN THE ENCLOSED ENVELOPE.