National Electronic Health Records Survey 2012

ATTACHMENT L - National Electronic Health Records Survey 01
OMB No. 0920-0234: Approval expires 02/28/2013
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National Electronic Health Records Survey 2012
The National Electronic Health Records Survey is affiliated with the National Ambulatory Medical Care Survey
(NAMCS). The purpose of the survey is to collect information about the adoption of electronic health
records/electronic medical records (EHRs/EMRs) in ambulatory care settings. Your participation is greatly
appreciated. Your answers are completely confidential. Participation in this survey is voluntary. If you have
questions or comments about this survey, please call 866-966-1473.
1. We have your specialty as
Is that correct?

□1
□2

Yes
No → What is your specialty?

_______________________________________

This survey asks about ambulatory care, that is, care for patients
receiving health services without admission to a hospital or other facility.
2. Do you directly care for any ambulatory patients in
your work?

□1
□2
□3

Yes
No
I am no longer
in practice

Continue to Question 3.

}

Please stop here and
return the questionnaire in
the envelope provided.
Thank you for your time.

3. In a typical year, about how many weeks do you NOT
see any ambulatory patients because of such events
as conferences, vacations, illness, etc.?

__________ weeks

The next set of questions asks about a normal week. We
define a normal week as a week with a normal case load, with
no holidays, vacations, or conferences.

4. Overall, at how many office locations do you see
ambulatory patients in a normal week?

__________ locations

6. Do you see ambulatory patients in any of the
following settings? CHECK ALL THAT APPLY.

□1
□2

Private solo or group practice
Freestanding clinic/urgicenter (not part of a
hospital outpatient department)

□3

Community Health Center (e.g., Federally
Qualified Health Center (FQHC), federally
funded clinics or “look alike” clinics)

□4
□5

Mental health center
Non-federal government clinic (e.g., state,
county, city, maternal and child health, etc.)

□6
□7

Family planning clinic (including Planned Parenthood)
Health maintenance organization or other
prepaid practice (e.g., Kaiser Permanente)

□8
□9

Faculty practice plan
None of the above

If you answered none of the above in question 6,
skip to question 26.
If you checked any of the boxes 1-8 in question 6,
continue to question 7.

5. During your last normal week of practice how many
patient visits did you have at all locations?

__________ visits

7. At which of the settings in question 6 do you see the
most ambulatory patients? WRITE THE NUMBER
NEXT TO THE BOX YOU CHECKED.

__________
1

National Electronic Health Records Survey
For the remaining questions, please answer regarding
the reporting location indicated in question 8 even if
it is not the location where this survey was sent.
8. What are the county, state, zip code and telephone
number of the reporting location?
Country

USA

State

□1
□2

Zip Code
(

)

-

9. During your last normal week of practice,
approximately how many office visits did you have at
the reporting location? Note: Please only include visits
where you personally saw the patient.

10. Is the reporting location a solo practice, or are you
associated with other physicians in a partnership, in a
group practice or in some other way?
Solo  Skip to Question 12
Associated with other physicians

10a. How many?

__________ physicians

11. Is the reporting location a single- or multi-specialty
(group) practice?

□1

Single

□2

Multi

12. How many mid-level providers (i.e., nurse
practitioners, physician assistants, and nurse
midwives) are associated with the reporting location?

__________ mid-level providers
13. At the reporting location, are you currently accepting
new patients?

□1Yes

□2 No

□3 Unknown

13a. If yes, from those new patients, which of the
following types of payment do you accept?
Yes
1. Private capitated
2. Private non-capitated
3. Medicare
4. Medicaid/CHIP
5. Worker’s compensation
6. Self pay
7. No charge

Yes
No
Unknown

□3
□4

}

Yes, all electronic
Yes, part paper and
part electronic

Go to Question 15a.

}

No
Unknown

Skip to Question 16.

15a. In which year did you install your EHR/EMR
system?

__________ office visits

□1
□2

□1
□2
□3

15. Does the reporting location use an electronic health
record (EHR) or electronic medical record (EMR)
system? Do not include billing record systems.

County

Telephone

14. Does the reporting location submit any claims
electronically (electronic billing)?

□1
□1
□1
□1
□1
□1
□1

No

□2
□2
□2
□2
□2
□2
□2

Unknown

□3
□3
□3
□3
□3
□3
□3

Year: ___________
15b. What is the name of your current EHR/EMR
system? CHECK ONLY ONE BOX. IF OTHER IS
CHECKED, PLEASE SPECIFY THE NAME.

□1 Allscripts □2 Cerner
□3 eClinicalWorks
□4 Epic
□5 GE/Centricity □6 Greenway Medical
□7 McKesson/ □8 NextGen □9 Sage
Practice Partner

□10 Other_________________

□11 Unknown

16. At the reporting location, are there plans for installing
a new EHR/EMR system within the next 18 months?

□1Yes

□2 No

□3 Maybe

□4 Unknown

17. Medicare and Medicaid offer incentives to practices
that demonstrate “meaningful use of health IT”. At
the reporting location, are there plans to apply for
these incentive payments?

□1 Yes, we already applied
When did you first apply?

□1

2011

□2

2012

□3

Unknown

□2 Yes, we intend to apply
When do you intend to first apply?

□1

2012

□2

2013 or later

□3

□3 Uncertain if we will apply
□4 No, we will not apply

2

Unknown

National Electronic Health Records Survey
18. Please indicate whether the reporting location has each of the computerized capabilities listed below
and how often these capabilities are used. CHECK NO MORE THAN ONE BOX PER ROW.
Yes,
used routinely

18a. Recording patient history and
demographic information?
18a1. If yes, does this include a patient
problem list?
18b. Recording and charting vital signs?
18c. Recording patient smoking status?
18d. Recording clinical notes?
18d1. If yes, do the notes include a list of the
patient’s medications and allergies?
18e. Ordering prescriptions?
18e1. If yes, are prescriptions sent
electronically to the pharmacy?
18e2. If yes, are warnings of drug interactions
or contraindications provided?
18f. Providing reminders for guideline-based
interventions or screening tests?
18g. Providing standard order sets related to a
particular condition or procedure?
18h. Ordering lab tests?
18h1. If yes, are orders sent electronically?
18i. Viewing lab results?
18i1. If yes, can the EHR/EMR automatically
graph a specific patient’s lab results over time?
18j. Viewing imaging results?
18k. Viewing data on quality of care measures?
18l. Reporting clinical quality measures to
federal or state agencies (such as CMS or
Medicaid)?
18m. Generating lists of patients with particular
health conditions?
18n. Electronic reporting to immunization
registries?
18n1. If yes, reported in standards specified by
Meaningful Use criteria?
18o. Providing patients with clinical summaries
for each visit?
18p. Exchanging secure messages with
patients?
18q. Providing patients with an electronic copy
of their health information?

□

1

□
1□
1□
1□
1

Yes,
Yes,
but not
but turned off
used routinely or not used

□

2

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1
1
1
1
1

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3□
3□
3□
3

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1

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3

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No

□

4
Skip to 18b

□
4□
4□
4□
4

Skip to 18e

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4

Skip to 18f

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Skip to 18b

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Skip to 18e

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5

Skip to 18f

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Skip to 18i

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Skip to 18j

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Unknown

□

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Skip to 18o

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5

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3

National Electronic Health Records Survey
The next questions are about sharing (either sending or receiving) patient health information.
19. Do you share any patient health information
electronically (not fax) with other providers,
including hospitals, ambulatory providers, or
labs?

□1
□2

19a. How do you electronically share patient health
information? CHECK ALL THAT APPLY.

□1
□2
□3

Yes  Go to Question 19a
No  Skip to Question 21

20. Please indicate which types of health data you share
electronically (not fax) with the health care providers
listed to the right. CHECK ALL THAT APPLY.

EHR/EMR
Web portal (separate from EHR/EMR)
Other electronic method: ________________

Hospitals
with which
you are
affiliated

Ambulatory
providers
inside your
office/ group

□
1□
1□
1□
1□

20a. Lab results

□
2□
2□
2□
2□

1

20b. Imaging reports
20c. Patient problem lists
20d. Medication lists
20e. Medication allergy lists

Hospitals
with which
you are
not affiliated

Ambulatory
providers
outside your
office/ group

□
3□
3□
3□
3□

2

□
4□
4□
4□
4□

3

4

20f. Do you share any of the above types of information using a “Summary Care Record”? [A Summary Care Record is an

□

electronic file that contains the above health data in a standardized format.] 1
21. When you refer your patient to a provider outside of your office or
group:
21a. Do you receive a report back from the other provider with results
of the consultation?

Yes,
routinely

□
1□
1

21b. Do you receive it electronically (not fax)?

□

Yes

2

Yes, but
not
routinely

□
2□
2

□

No

3

Unknown
Does not
apply

No

□
3□

□
4□

3

4

22. When you see a patient referred to you by a provider outside of your office or group:
22a. Do you receive notification of both the patient’s history and
reason for consultation?

1

22b. Do you receive them electronically (not fax)?

1

□

2

□

3

□

2

□

2

□

4

□

3

□

3

□

□

4

□

4

□

23. When your patient is discharged from an inpatient setting:
23a. Do you receive all of the information you need to continue
managing the patient?

1

23b. Is the information timely, available when needed?

1

□
1□

23c. Do you receive it electronically (not fax)?
24. Who owns the reporting location? CHECK ONE.

□1
□2
□3
□4
□5
□6
□7

Physician or physician group
HMO
Community health center
Medical/academic health center
Other hospital

Thank you for your participation. Please return your survey in
the envelope provided. If you have misplaced this envelope,
please send survey to: 2605 Meridian Parkway, Suite 200,
Durham, NC 27713

□
3□

□
4□

3

4

25. Roughly, what percent of your patient care revenue
at the reporting location comes from the following?
1. Medicare
2. Medicaid/CHIP

%
%

3. Private insurance

%

4. All other sources

%

Roughly, the total should sum to:

Other health care corporation
Other

□
2□
2

□

100 %

26. Who completed this survey?

□1
□2
□3

The physician to whom it was addressed
Office staff
Other

Boxes for Admin Use

4