Form 0917-0036-08 OMB Form No. 0917-0036-08, iCare-CMET Post Course Survey

1. 

REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) iCare CMET 

Form Approved 
OMB Form No. 0917­0036­08 
Expiration Date: 5/31/2015 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information 
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0917­0036. 
The time required to complete this information collection is estimated to average 5 minutes per response, including the 
time to review instructions, search existing data resources, gather the data needed, and complete and review the 
information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for 
improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence 
Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer. 

2. General Information

OIT needs your help in evaluating the RPMS­iCare/CMET training approach. Your input will be used to help us improve 
our materials and presentation approach as we deploy the application throughout all IHS, Tribal and Urban Facilities.  
Questions with a * are required. 

1. Select the term(s) that best describes your role:
c Physician
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c Dentist
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c Pharmacist
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c Nurse Practitioner
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c Physician Assistant
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c Registered Nurse
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c Public Health Nurse
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c Case Manager
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c Licensed Practical Nurse
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c Nursing Assistant
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c Site Manager/IT Representative
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c Clinical Applications Coordinator
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c Medical Records
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c GPRA Coordinator
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c Other (please describe)
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2. How did you hear about this RPMS/iCare ­ CMET I training course? Select as many
information sources as apply, and/or add others:
c iCare Web site
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c iCare List Serve
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c Other IHS List Serve
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c IT Newsletter
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c Email
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c Word of mouth
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c OIT Training Website
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c Other (please describe)
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3. What types of Clinical RPMS Applications are used by you and/or your organization?
c Diabetes Management System
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c Women's Health
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c Dental
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c Behavioral Health
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c Asthma 
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c Immunization
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c Case Management
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c EHR
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c HIV Management System
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g
c Other (please specify)
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4. What did you expect from this CMET training?
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5. Overall, did you feel that your objectives were met?

j Yes
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j No
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6. If no, describe how they could have been met better:
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7. Were the right people from your organization at the Training?

j Yes
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j No
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8. If no, who should have attended? Describe by position and name:
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3. Objectives

Please check one box only to rate each of the statements listed below. 

9. How well did this training session cover the following objectives?
Overview of CMET and the 

Poor

Fair

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Very Good

Excellent

N/A

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CMET workflow
List the 4 pre­defined 
CMET event categories
Navigate the Patient 
Record to organize, track, 
and manage CMET events
Utilize the CMET worksheet 
to track an event to 
completion
Describe the CMET ticklers 
used when tracking an 
event

10. Comments:
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4. Presentation Materials / Methods

Please check a box to rate each of the statements listed below: 

11. Please describe the quality of the presentation materials and methods used in this
training.
Poor

Fair

Good

Very Good

Excellent

N/A

Powerpoint Handout

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Pace of Training

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Length of Training

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Application Demo

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12. Comments:
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5. Technical Support

13. Please rate the technical components below.
Adobe 

Strongly Disagree

Disagree

Somewhat Agree

Agree

Strongly Agree

N/A

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Connect/teleconference 
information was received 
the day of the session (if 
you were registered to 
participate).
The Adobe Connect 
information supplied the 
correct login password.
The teleconference 
information supplied the 
correct number and access 
code.
Instructions on accessing 
the session were clear.

14. Is there anything that would improve the accessibility of this session?
j No
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j Yes
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If yes, please note how accessibility may be improved. 

6. General Questions

15. What part of the Training did you find most useful?
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16. What part of the Training did you find least useful?
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17. After this training, do you feel that you will be able to begin to use iCare: CMET at your
site?

j Yes
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j No
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18. Why or why not?
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19. If you answered "yes" to question above, do you think you could help others at your
site start to use iCare/CMET?

j Yes
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j No
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If yes, how? 

20. List at least two things you will incorporate into your professional/clinical work as a
result of this training.
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21. What barriers, if any, do you anticipate encountering as you make changes in your
practice?
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22. Did you perceive any commercial bias toward any particular product or company in
any of the presentations?
j No
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j Yes
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If yes, please explain: 

7. Presenter Evaluation

Please rate the coverage by the presenter of each educational objective. 

23. Joanna Kelsey
Poor

Fair

Good

Very Good

Excellent

N/A

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Prepared and organized

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Clearly explained 

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Encouraged participation

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Controlled the audience 

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Was professional

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Presented information 

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Demonstrated knowledge of 
the subject material
Responsive to audience 
questions and issues

objectives at beginning and 
met them

effectively

clearly
Made the material 
interesting

24. Comments:
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