Form #2 Form #2 Asthma questionnaire -- Nemours

Asthma Management and Clinical Decision Support

System Usability and User Satisfaction Survey

We are conducting a study to help us assess the usefulness of the Asthma SmartForm in the Electronic Medical Record. We are asking you to complete a brief survey that should take less than 10 minutes of your time. Your participation in this survey is completely voluntary and your answers will be anonymous. Thank you for helping us improve the design of clinical decision support tools for electronic health records.

We are interested in understanding how you utilize the Electronic Medical Record for your patients with asthma. For each question below, indicate how often the statement is true.
		Never	Sometimes	Often	Usually	Always
a.	I document the history of present illness in EPIC during the patient visit.
b.	I document the exam findings in EPIC during the patient visit.
c.	I document my assessment in EPIC during the patient visit.
d.	I document my plan in EPIC during the patient visit.
e.	I print an asthma action plan and give it to the patient, if the patient has asthma on the problem list.
f.	I print an asthma action plan and give it to the patient, if the patient is having asthma symptoms.
g.	I have used the Asthma SmartForm in EPIC.
h.	I complete the Asthma SmartForm during the patient visit.

The following questions are about your beliefs about guidelines and decision support systems. A decision support system compares patient characteristics with a knowledge base and then guides a health provider by offering patient-specific and situation-specific advice. Indicate the extent to which you agree or disagree with the following statements:
		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
a.	I am familiar with the recommendations for management of chronic asthma in the 2007 guidelines from the NIH/NHLBI.
b.	I agree with the recommendations for chronic asthma management in the 2007 guidelines from the NIH/NHLBI.
c.	I believe that reliance on practice guidelines leads to “cookbook medicine.”
d.	I know what a clinical decision support system is.
e.	I believe that clinical decision support systems have the capacity for improving patient care.

3. We are interested in your opinion of the Asthma SmartForm in EPIC. Indicate the extent to which you agree or disagree with the following statements:
		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
a.	The Asthma SmartForm helps me take better care of patients.
b.	The Asthma SmartForm is not worth the time it takes to use.
c.	The Asthma SmartForm has useful reminders about something I might have forgotten to do.
d.	The Asthma SmartForm is a useful tool to teach me about appropriate care for asthma.
e.	The way the Asthma SmartForm was designed fits efficiently into my workflow.
f.	I needed to learn a lot of things before I could get going with the Asthma SmartForm.
g.	The Asthma SmartForm was designed in a way that minimizes data input.
h.	The Asthma SmartForm note produces a satisfactory note to document progress..
i.	The Asthma SmartForm has too much inconsistency with the NIH/NHLBI guidelines.
j.	I would recommend the Asthma SmartForm to a colleague.
k.	The Asthma SmartForm was cumbersome to use.

4. How satisfied are you with the way the Asthma SmartForm performs the following functions?
		Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
a.	Helping me assess asthma severity.
b.	Helping me assess asthma control.
c.	Helping me to choose appropriate therapies.
d.	Generating the asthma action plan.
e.	Creating progress notes.
f.	Generating notes to the referring providers.

5. Do you have any other comments you would like to make regarding the Asthma SmartForm?

DEMOGRAPHICS AND BACKGROUND INFORMATION

1. How skilled are you in using the EPIC system?

Novice
Average User
Expert

2. In general, not just in terms of the EPIC system, how would you rate yourself as a computer user?

Novice
Average User
Expert

3. What is your profession?

MD/DO
Nurse Practitioner
Physician Assistant
APRN/ARNP
Other		Specify:

4. At what level of training are you? 5. What is your age?

Resident
Fellow
Attending
Not applicable

25-34
35-44
45-54
55-64
65 or older

Thank you for completing this survey!