Crosswalk_4192010

Comparison between Original Electronic Health Records Demonstration Paper Application and Revised, Online Updates to the Application Form

The proposed web-enabled physician practice application form will be used by primary care physician practices that have been selected for participation as treatment group practices in the Electronic Health Record (EHR) Demonstration to update key practice information contained in the originally-approved paper form. The web-based form that the practices will access is pre-filled to reflect practice information as represented on the original paper-based form that the practice completed to initially apply for the demonstration. Note that only certain aspects of the form may be modified/updated by the participating practices during the course of the demonstration, as follows (see accompanying proposed screens):

1. Certain “baseline” information, including the number of providers applying for the demonstration in the “Demographics Section” and the “EHR System Details” in the “EHR” tab, may be viewed but cannot be updated or changed in any way on this form. Information that is “view only” is greyed out on the screens.

2. Information included as part of the “Demographics” tab, including the description of the practice, as well as the Group PIN and/or Group NPI is pre-filled based on information in the original application, and may be updated as necessary.

3. Information included as part of the “Locations” tab is pre-filled and may be updated as necessary.

4. Information included as part of the “Contacts” tab is pre-filled and may be updated as necessary. Note that the proposed web-based form does include one modification to the currently-approved paper-based form. In the web-based form, we ask whether a practice contact is interested in sharing his/her contact information with other treatment group practices participating in the demonstration for purposes of having colleagues to contact and share information regarding EHRs and other issues related to the demonstration. This is simply a “Yes” or “NO” answer which defaults to “N/A” if not actively identified by the practice user.

5. Information included as part of the “Providers” tab is pre-filled and may be updated as necessary. Updates may include the addition of new participating providers and their associated information, and deletion of current providers and relevant effective/termination dates.