Form Approved
OMB No. 0955-0005
Exp. Date 07/31/2014
Attachment A: FINAL survey questionnaire
Survey among Primary Care Physicians (PCPs) and Nurse Practitioners (NPs)
Are you familiar with an incentive program provided by the federal government to encourage the adoption and implementation of electronic health records (EHRs) or electronic medical records (EMRs)?
Yes
No
Not sure
[If yes] What is the name of this program? [open-ended]
Are you familiar with the term “meaningful use” as it relates to electronic health records (EHRs) or electronic medical records (EMRs)?
Yes
No
Not sure
[If yes] Please describe the “meaningful use” of EHRs/EMRs. [open-ended]
Do you currently use an electronic health record (EHR) system in your practice?
Yes [route to QUESTIONS FOR ADOPTERS]
How long has your practice had the electronic health record (EHR) system in place?
Less than one year
One to three years
More than three years
No, but in the process of implementing (route to QUESTIONS FOR IMPLEMENTERS]
Not using and not in the process of implementing [route to QUESTIONS FOR NON-ADOPTERS]
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 0990-xxxx . The time required to complete this information collection is estimated to average 4 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 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
QUESTIONS FOR ADOPTERS
Indicate to what extent your practice experienced the following as a CHALLENGE in implementing an electronic health record (EHR) system. Please use a scale of 1-5, where “1” represents no challenge at all and “5” represents a major challenge.
|
No challenge at all 1 |
2 |
Somewhat a challenge
3 |
4 |
Major challenge
5 |
Acquisition cost of an EHR system |
|
|
|
|
|
Annual EHR system maintenance cost |
|
|
|
|
|
Ability to secure financing for an EHR system |
|
|
|
|
|
Finding an EHR system that met my practice’s needs |
|
|
|
|
|
Finding an EHR system that is interoperable with the systems of other health care providers in my area |
|
|
|
|
|
Access to high speed Internet (e.g., broadband, cable) |
|
|
|
|
|
Loss of productivity during transition to EHR system |
|
|
|
|
|
Finding staffing solutions to implement the system |
|
|
|
|
|
Adequacy of technical support resources |
|
|
|
|
|
Adequacy of training support resources |
|
|
|
|
|
Reliability of system (e.g. frequency of system failures) |
|
|
|
|
|
Indicate your level of agreement with the following statements about BENEFITS TO YOUR PRACTICE since implementing your electronic health record (EHR) system. Please use a scale of 1-5, where “1” indicates you strongly disagree and “5” indicates you strongly agree.
|
Strongly disagree 1 |
Somewhat disagree 2 |
Neutral
3 |
Somewhat agree 4 |
Strongly agree 5 |
Billing for services is more accurate |
|
|
|
|
|
Billing for services is more efficient |
|
|
|
|
|
The ability to send prescriptions electronically saves me time |
|
|
|
|
|
My practice receives lab results faster |
|
|
|
|
|
My practice can send information electronically to other providers |
|
|
|
|
|
Electronic access to my patient’s chart allows me to work remotely (e.g. from home) |
|
|
|
|
|
My practice saves on costs associated with managing and storing paper records |
|
|
|
|
|
My EHR system is an asset when recruiting clinicians to join the practice |
|
|
|
|
|
My practice delivers better care when records are readily available |
|
|
|
|
|
Overall, my practice has functioned more efficiently with an EHR system |
|
|
|
|
|
In providing patient care since adopting an electronic health record (EHR) system at your practice, have you…
|
Yes, in last 6 months |
Yes, ever |
No |
Avoided medication errors because of an EHR? |
|
|
|
Avoided medication allergy because of an EHR? |
|
|
|
Implemented drug-drug and/or drug-allergy interaction checks more easily because of an EHR? |
|
|
|
Been alerted to critical lab values? |
|
|
|
Provided preventive care (e.g. vaccine, cancer screening) prompted by an EHR? |
|
|
|
Provided care that meets clinical guidelines for patients with chronic conditions because of EHR prompts? |
|
|
|
Ordered a critical lab test (such as HbA1c or LDL) because of an EHR prompt? |
|
|
|
Avoided ordering an unnecessary test because of an EHR prompt? |
|
|
|
Prescribed an on-formulary drug rather than an off-formulary drug more easily because of an EHR? |
|
|
|
Referred patients to an in-network provider rather than an out-of-network provider? |
|
|
|
Used tools available in the EHR (e.g. trending, web-based tools, risk assessments) to enhance patient care? |
|
|
|
Directly communicated with a patient via email or secure messaging? |
|
|
|
Provided a patient with clinical summaries for each office visit? |
|
|
|
Provided a patient with an electronic copy of his/her health information? |
|
|
|
Tracked patient compliance using an EHR? |
|
|
|
Electronically exchanged key clinical information among providers and/or patient-authorized entities |
|
|
|
Reported clinical quality measures to CMS or states using an EHR? |
|
|
|
Indicate the level of VALUE each of the following provides in improving QUALITY OF CARE for patients. Please use a scale of 1-5, where “1” represents no value at all, and “5” represents high value.
|
No value at all 1 |
2 |
Moderate value 3 |
4 |
High value 5 |
Avoiding medication errors because of an EHR |
|
|
|
|
|
Avoiding medication allergy because of an EHR |
|
|
|
|
|
Implementing drug-drug and/or drug-allergy interaction checking |
|
|
|
|
|
Being informed of critical lab values |
|
|
|
|
|
Providing preventive care (e.g., vaccine, cancer screening) guided by an EHR |
|
|
|
|
|
Providing care that meets clinical guidelines for patients with chronic conditions because of EHR guidance |
|
|
|
|
|
Ordering a critical lab test (such as HbA1c or LDL) because of an EHR intervention |
|
|
|
|
|
Avoiding ordering an unnecessary test because of an EHR intervention |
|
|
|
|
|
Prescribing an on-formulary drug rather than an off-formulary drug more easily because of an EHR intervention |
|
|
|
|
|
Referring patients to an in-network provider rather than an out-of-network provider |
|
|
|
|
|
Using tools available in the EHR (e.g. trending, web-based tools, risk assessments) to enhance patient care |
|
|
|
|
|
Directly communicating with a patient via secure email or secure messaging |
|
|
|
|
|
Providing a patient with clinical summaries for each office visit |
|
|
|
|
|
Providing a patient with an electronic copy of his/her health information |
|
|
|
|
|
Tracking patient compliance using an EHR |
|
|
|
|
|
Electronically exchanging key clinical information among providers and/or patient-authorized entities |
|
|
|
|
|
Reporting clinical quality measures to CMS or a state using an EHR |
|
|
|
|
|
A series of messages has been developed to help explain aspects of the use of EHR systems. Please read the following messages carefully and provide your feedback about each of them.
Message #1:
Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
Message #2:
Meaningful use is using certified electronic health record (EHR) technology to: improve quality, safety, and efficiency; reduce health disparities; engage patients and family; improve care coordination; and maintain privacy and security of patient health information. Ultimately, it is hoped that meaningful use compliance will result in: better clinical outcomes; improved population health outcomes; increased transparency and efficiency; empowered individuals; and more robust research data on health systems.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
QUESTIONS FOR IMPLEMENTERS
Indicate to what extent your practice experienced the following as a CHALLENGE in implementing an EHR system. Please use a scale of 1-5, where “1” represents no challenge at all and “5” represents a major challenge.
|
No challenge at all 1 |
2 |
Somewhat a challenge
3 |
4 |
Major challenge
5 |
Acquisition cost of an EHR system |
|
|
|
|
|
Annual EHR system maintenance cost |
|
|
|
|
|
Ability to secure financing for an EHR system |
|
|
|
|
|
Finding an EHR system that met my practice’s needs |
|
|
|
|
|
Finding an EHR system that is interoperable with the systems of other health care providers in my area |
|
|
|
|
|
Access to high speed Internet (e.g., broadband, cable) |
|
|
|
|
|
Loss of productivity during transition to EHR system |
|
|
|
|
|
Finding staffing solutions to implement the system |
|
|
|
|
|
Adequacy of technical support resources |
|
|
|
|
|
Adequacy of training support resources |
|
|
|
|
|
Reliability of system (e.g. frequency of system failures) |
|
|
|
|
|
Indicate your level of agreement with the following statements about ANTICIPATED BENEFITS TO YOUR PRACTICE by implementing an EHR system. Please use a scale of 1-5, where “1” indicates you strongly disagree and “5” indicates you strongly agree.
|
Strongly disagree 1 |
Somewhat disagree 2 |
Neutral
3 |
Somewhat agree 4 |
Strongly agree 5 |
Billing for services will be more accurate |
|
|
|
|
|
Billing for services will be more efficient |
|
|
|
|
|
The ability to send prescriptions electronically will save me time |
|
|
|
|
|
My practice will receive lab results faster |
|
|
|
|
|
My practice will be able to send information electronically to other providers |
|
|
|
|
|
Electronic access to my patient’s chart will allow me to work remotely (e.g. from home) |
|
|
|
|
|
My practice will save on costs associated with managing and storing paper records |
|
|
|
|
|
My EHR system will be an asset when recruiting clinicians to join the practice |
|
|
|
|
|
My practice will deliver better care when records are readily available |
|
|
|
|
|
Overall, my practice will function more efficiently with an EHR system |
|
|
|
|
|
Indicate the level of VALUE you believe each of the following provides in improving QUALITY OF CARE for patients. Please use a scale of 1-5, where “1” represents no value at all, and “5” represents high value.
|
No value at all 1 |
2 |
Moderate value 3 |
4 |
High value 5 |
Avoiding medication errors because of an EHR |
|
|
|
|
|
Avoiding medication allergy because of an EHR |
|
|
|
|
|
Implementing drug-drug and/or drug-allergy interaction checking |
|
|
|
|
|
Being informed of critical lab values |
|
|
|
|
|
Providing preventive care (e.g., vaccine, cancer screening) guided by an EHR |
|
|
|
|
|
Providing care that meets clinical guidelines for patients with chronic conditions because of EHR guidance |
|
|
|
|
|
Ordering a critical lab test (such as HbA1c or LDL) because of an EHR intervention |
|
|
|
|
|
Avoiding ordering an unnecessary test because of an EHR intervention |
|
|
|
|
|
Prescribing an on-formulary drug rather than an off-formulary drug more easily because of an EHR intervention |
|
|
|
|
|
Referring patients to an in-network provider rather than an out-of-network provider |
|
|
|
|
|
Using tools available in the EHR (e.g. trending, web-based tools, risk assessments) to enhance patient care |
|
|
|
|
|
Directly communicating with a patient via secure email or secure messaging |
|
|
|
|
|
Providing a patient with clinical summaries for each office visit |
|
|
|
|
|
Providing a patient with an electronic copy of his/her health information |
|
|
|
|
|
Tracking patient compliance using an EHR |
|
|
|
|
|
Electronically exchanging key clinical information among providers and/or patient-authorized entities |
|
|
|
|
|
Reporting clinical quality measures to CMS or a state using an EHR |
|
|
|
|
|
A series of messages has been developed to help explain aspects of the use of EHR systems. Please read the following messages carefully and provide your feedback about each of them.
Message #1:
Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
Message #2:
Meaningful use is using certified electronic health record (EHR) technology to: improve quality, safety, and efficiency; reduce health disparities; engage patients and family; improve care coordination; and maintain privacy and security of patient health information. Ultimately, it is hoped that meaningful use compliance will result in: better clinical outcomes; improved population health outcomes; increased transparency and efficiency; empowered individuals; and more robust research data on health systems.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
QUESTIONS FOR NON-ADOPTERS
Indicate to what extent you perceive the following as a CHALLENGE or BARRIER to implementing an EHR system. Please use a scale of 1-5, where “1” represents no challenge at all and “5” represents a major challenge.
|
No challenge at all 1 |
2 |
Somewhat a challenge
3 |
4 |
Major challenge
5 |
Acquisition cost of an EHR system |
|
|
|
|
|
Annual EHR system maintenance cost |
|
|
|
|
|
Ability to secure financing for an EHR system |
|
|
|
|
|
Finding an EHR system that met my practice’s needs |
|
|
|
|
|
Finding an EHR system that is interoperable with the systems of other health care providers in my area |
|
|
|
|
|
Access to high speed Internet (e.g., broadband, cable) |
|
|
|
|
|
Loss of productivity during transition to EHR system |
|
|
|
|
|
Finding staffing solutions to implement the system |
|
|
|
|
|
Adequacy of technical support resources |
|
|
|
|
|
Adequacy of training support resources |
|
|
|
|
|
Reliability of system (e.g. frequency of system failures) |
|
|
|
|
|
Indicate your level of agreement with the following statements about potential BENEFITS TO YOUR PRACTICE that may be obtained by implementing an EHR system. Please use a scale of 1-5, where “1” indicates you strongly disagree and “5” indicates you strongly agree.
|
Strongly disagree 1 |
Somewhat disagree 2 |
Neutral
3 |
Somewhat agree 4 |
Strongly agree 5 |
Billing for services will be more accurate |
|
|
|
|
|
Billing for services will be more efficient |
|
|
|
|
|
The ability to send prescriptions electronically will save me time |
|
|
|
|
|
My practice will receive lab results faster |
|
|
|
|
|
My practice will be able to send information electronically to other providers |
|
|
|
|
|
Electronic access to my patient’s chart will allow me to work remotely (e.g. from home) |
|
|
|
|
|
My practice will save on costs associated with managing and storing paper records |
|
|
|
|
|
My EHR system will be an asset when recruiting clinicians to join the practice |
|
|
|
|
|
My practice will deliver better care when records are readily available |
|
|
|
|
|
Overall, my practice will function more efficiently with an EHR system |
|
|
|
|
|
Indicate the level of VALUE you believe each of the following provides in improving QUALITY OF CARE for patients. Please use a scale of 1-5, where “1” represents no value at all, and “5” represents high value.
|
No value at all 1 |
2 |
Moderate value 3 |
4 |
High value 5 |
Avoiding medication errors because of an EHR |
|
|
|
|
|
Avoiding medication allergy because of an EHR |
|
|
|
|
|
Implementing drug-drug and/or drug-allergy interaction checking |
|
|
|
|
|
Being informed of critical lab values |
|
|
|
|
|
Providing preventive care (e.g., vaccine, cancer screening) guided by an EHR |
|
|
|
|
|
Providing care that meets clinical guidelines for patients with chronic conditions because of EHR guidance |
|
|
|
|
|
Ordering a critical lab test (such as HbA1c or LDL) because of an EHR intervention |
|
|
|
|
|
Avoiding ordering an unnecessary test because of an EHR intervention |
|
|
|
|
|
Prescribing an on-formulary drug rather than an off-formulary drug more easily because of an EHR intervention |
|
|
|
|
|
Referring patients to an in-network provider rather than an out-of-network provider |
|
|
|
|
|
Using tools available in the EHR (e.g. trending, web-based tools, risk assessments) to enhance patient care |
|
|
|
|
|
Directly communicating with a patient via secure email or secure messaging |
|
|
|
|
|
Providing a patient with clinical summaries for each office visit |
|
|
|
|
|
Providing a patient with an electronic copy of his/her health information |
|
|
|
|
|
Tracking patient compliance using an EHR |
|
|
|
|
|
Electronically exchanging key clinical information among providers and/or patient-authorized entities |
|
|
|
|
|
Reporting clinical quality measures to CMS or a state using an EHR |
|
|
|
|
|
A series of messages has been developed to help explain aspects of the use of EHR systems. Please read the following messages carefully and provide your feedback about each of them.
Message #1:
Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
Message #2:
Meaningful use is using certified electronic health record (EHR) technology to: improve quality, safety, and efficiency; reduce health disparities; engage patients and family; improve care coordination; and maintain privacy and security of patient health information. Ultimately, it is hoped that meaningful use compliance will result in: better clinical outcomes; improved population health outcomes; increased transparency and efficiency; empowered individuals; and more robust research data on health systems.
On a scale from 1 to 5, where 1 indicates you “strongly disagree”, and 5 indicates you “strongly agree,” please indicate how much you agree or disagree with each of the following statements.
|
|
Strongly Disagree 1 |
Somewhat Disagree 2 |
Neutral
3 |
Somewhat Agree 4 |
Strongly Agree 5 |
1 |
This message is relevant to my practice |
|
|
|
|
|
2 |
This message is motivating |
|
|
|
|
|
3 |
I believe this message |
|
|
|
|
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ketchum |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |