Attachment H -- Clinician and Office Staff Survey Invitation

ATTACHMENT H

Clinician and Office Staff Survey Invitation

You are being invited to fill out this survey because you work in a practice that uses health information technology (IT) to collect or use information reported by patients. Health IT used to collected patient-reported information can include:

• Patient portals (sometimes referred to as [electronic] personal health records or PHRs); allow patients to view portions of their medical records [e.g., laboratory test results] and support other health-related tasks such as making appointments or requesting medication refills. Some patient portal applications exist as stand-alone Web sites; other portal applications are integrated into an existing electronic health record [EHR] system);

• Secure messaging with patients (use of secure e-mail between patients and clinicians, typically using the secure messaging functionality in the EHR and/or patient portal); and

• e-forms (surveys that are administered using computerized media [e.g., tablets, laptops] to collect information from patients using pre-formatted forms before or during patient visits).

Patients may use these systems to share information such as symptoms (e.g., pain, fatigue), results of self-testing (e.g., blood glucose levels, blood pressure), questions and concerns about weight, or over-the-counter medication use.

This research is sponsored by Agency for Healthcare Research and Quality (AHRQ), an agency within the U.S. Department of Health and Human Services, and is being led by researchers from Abt Associates, the University of Alabama-Birmingham, and the University of Wisconsin-Madison. The purpose of this research is to examine how patient-reported information and health information technology can be used well in small and medium-sized practices.

If you decide to participate, we would like you to fill out a survey describing your perceptions of your work using patient-reported information and health IT. The survey will take about 15 minutes to complete.

There is minimal risk associated with these activities. No identifying information about you will be collected and the surveys will be anonymous. All collected data will be stored on a secure password-protected computer server. We would like to assure you that all the information you share with us will be kept confidential to the extent permitted by law, including Section 944(c) of the Public Health Service Act.  42 U.S.C. 299c-3(c).  That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied.

If your practice is interested, the researchers will provide you with suggestions for improving the ways you collect and use patient-reported information. In addition, this research could give benefits to society by helping to improve how small and medium-sized practices collect and use patient-reported information.

Your practice will also be compensated for participating.

Participation in this study is voluntary. You may change your mind at any time and discontinue your participation without being penalized or losing any benefits you would have otherwise been entitled to.

Your participation in the survey implies that you have read the information above and that you give your consent to be a participant in the study.

If you have any questions about this research, please contact Andrea Hassol, the Project Director for this study, at (617) 349-2488 or Pascale Carayon, the Principal Investigator, at (608) 265-0503.

If you have any questions about your rights as a research subject or complaints about the research study that you could not resolve with the study team contact UWHC Patient Relations Representative at 608-263-8009 or the University of Wisconsin Medical Foundation Patient Relations Representative at 800-552-4255 or 608-821-4819.

Thank you for your assistance with this project.