Form 0917-0036-09 OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Cla

1. 

REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) iCare Nuts and Bolts 

Form Approved 
OMB Form No. 0917­0036­09 
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 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 ­ Nuts and Bolts 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 Case Management
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c HIV Management System
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c Behavioral Health
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c Immunization
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c Diabetes Management System
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c EHR
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c Women's Health
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c Asthma 
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c Dental
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c Other (please specify)
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4. What did you expect from this iCare 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 current features 

Poor

Fair

Good

Very Good

Excellent

N/A

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of iCare
Utilize Windows and iCare 
functions to navigate the 
Main View of iCare
Describe the process for 
initial access to the iCare 
system and completion of 
the User Preferences Wizard
Identify a practical use of 
iCare for managing groups 
of patients
List 2 key features that are 
unique to the iCare 
application
Create a panel using a 
population search option
List 2 resources for iCare 
users

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.
WebEx/teleconference 

Strongly Disagree

Disagree

Somewhat Agree

Agree

Strongly Agree

N/A

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information was received 
the day of the session (if 
you were registered to 
participate).
WebEx/teleconference 
information was received 
the day of the session (if 
you were registered to 
participate).
WebEx/teleconference 
information was received 
the day of the session (if 
you were registered to 
participate).
WebEx/teleconference 
information was received 
the day of the session (if 
you were registered to 
participate).

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 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?

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
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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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