EHR Vendor

Form Approved

OMB No. 0955-0005

Exp. Date 07/31/2014

1. How many systems or organizations does your product currently serve?

1. 1 to 99

2. 100-499

3. 500-999

4. 1,000 or more

2. How do you implement an eMeasure into your EHR?

   1. Read the human-readable description and translate it into my system’s language and data model, then hand-code the measure into my system

   2. Consume the HQMF XML to automatically pull the data for the measure out of my system

   3. A combination of a and b

   4. None of the above

3. Do you think that the HQMF XML format could be improved to make it more suitable for machine processing?

   1. Yes

   2. No

4. Are you considering or working on an engine to consume the HQMF XML format?

   1. Currently developing a method for automated consumption of HQMF XML

   2. Considering developing a method for automated consumption of HQMF XML

   3. Would consider if improvements to the standard were made

   4. Not considering automated consumption of HQMF XML

5. Do you think your product will be able to automatically consume HQMF and calculate measures as required by CMS and ONC Final Rules?

   1. Yes

   2. No

6. What would you like to improve about the current HQMF standards?

7. Do you currently consume any clinical decision support without manual processing or with minimal processing?

   1. Currently perform completely automated processing of artifacts in the following format: ____

   2. Am able to partially consume the following format(s): ________________

   3. My product does not consume any available artifacts—all of my measures and decision support are hand-coded

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 0955-0005 . 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 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

8. How frequently should eMeasure value sets be updated to fix and/or improve the measure?

   1. Never

   2. Annually

   3. Monthly

   4. Weekly

   5. Daily

   6. As desired by vendor and submitted with code system version labeled

   7. As often as code systems are updated

9. What is your technical expertise?

   1. Certification

   2. HQMF and/or programming

   3. Measure data calculation

   4. EHR Implementation

   5. None of the above

10. If you possess any of the technical expertise in the previous question are you interested in attending the Kaizen event February 10 – 14, 2014

    1. Yes

    2. No

If yes, please provide name and email:

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