E. Physician Workflow Survey Year 2013 (EHR adopters)

National Ambulatory Medical Care Survey - A

OMB No. 0920-0234: Approval expires 03/31/2013

Attachment E

NOTICE - Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Information Collection Review Office; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0234).

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Physician Workflow Supplement Year 2013

The purpose of the Physician Workflow study is to collect information about the experiences office-based physicians are having with and without electronic health records (EHR). Your participation is greatly appreciated and voluntary. Your answers are completely confidential. If you have questions or comments about this survey, please call 866-966-1473.

This survey asks about ambulatory care, that is, care for patients receiving health services without admission to a hospital or other facility.

_}

1. Do you directly care for any ambulatory patients in your work?

4. At which of the settings in question 3 do you see the most ambulatory patients? WRITE THE NUMBER

1□ Yes

_{2□ No}

3□ I am no longer in practice

Continue to Question 2. Please stop here and return the questionnaire in the envelope provided. Thank you for your time.

NEXT TO THE BOX YOU CHECKED

2. For this question, please think about a normal week—that is, a week with a normal caseload, with no holidays, vacations, or conferences. Overall, at how many office locations do you see ambulatory patients in a normal week? (Please exclude hospital emergency or outpatient departments)

____ locations

3. Do you see ambulatory patients in any of the following settings? CHECK ALL THAT APPLY.

1□ Private solo or group practice

_{2□ Freestanding clinic/urgicenter (not part of a hospital}

outpatient department)

3□ Community Health Center (e.g., Federally

Qualified Health Center (FQHC), federally

funded clinics or “look-alike” clinics)

4□ Mental health center

_{5□ Non-federal government clinic (e.g., state, county, city,}

maternal and child health, etc.)

_{6□ Family planning clinic (including Planned Parenthood)}

_{7□ Health maintenance organization or other prepaid}

practice (e.g., Kaiser Permanente)

8□ Faculty practice plan (An organized group of physicians

that treat patients referred to an academic medical center)

9□ Hospital emergency or outpatient departments

_{10□ None of the above}

If you answered only hospital emergency department or none of the above in question 3, skip to question 38. If you marked boxes 1-8 in question 3, continue to question 4.

5. What are the county, state, zip code, and telephone number of the reporting location?

Country	USA
County
State
Zip Code
Telephone	( ) -

6a. How many physicians, including you, work at the reporting location? WRITE BELOW.

_________

6b. How many physicians, including you, work at this practice (including physicians at the reporting location, and physicians at any other locations of the practice)?

1□ 1 physician

2□ 2-3 physicians

3□ 4-10 physicians

4□ 11-50 physicians

5□ 51-100 physicians

6□ More than 100 physicians

7. How many of the following types of staff are associated with the reporting location? If none, mark box provided.

Number of midlevel providers (NP, PA) □None

Number of clinical staff (RN, MA) □None

Number of administrative/non-clinical staff □None

8. Is the reporting location a single- or multi-specialty

(group) practice?

1□ Single

2□ Multi-specialty

9. Are you a full or part owner, employee, or an independent contractor at the reporting location?

1□ Owner

2□ Employee

3□ Contractor

10. Who owns the reporting location? CHECK ONE.

1□ Physician or physician group

2□ Insurance company, health plan, or HMO

3□ Community health center

4□ Medical/academic health center

5□ Other hospital

6□ Other health care corporation

7□ Other

11. Does the reporting location receive any additional compensation beyond routine visit fees for offering Patient-Centered Medical Home (PCMH) type services or does the reporting location participate in a certified PCMH arrangement?

1□ Yes, we participate

2□ No, but we plan to participate

3□ No, and we don’t plan to participate

4□ Uncertain

12. Does the reporting location participate in a Pay-for- performance arrangement in which you can receive financial bonuses based on your performance?

1□ Yes, we participate

2□ No, but we plan to participate

3□ No, and we don’t plan to participate

4□ Uncertain

13. Does the reporting location participate in an Accountable Care Organization or similar arrangement by which you may share savings with insurers (including private insurance, Medicare, Medicaid, and other public options)?

1□ Yes, we participate

2□ No, but we plan to participate

3□ No, and we don’t plan to participate

4□ Uncertain

The next questions are related to your general experiences with practicing medicine.

14. Overall, how satisfied or dissatisfied are you with practicing medicine?

1□ Very satisfied

2□ Somewhat satisfied

3□ Somewhat dissatisfied

4□ Very dissatisfied

15. Please consider the following statement:

_{“I am able to provide high quality care to most of}

my patients at the reporting location.”

Would you say you…

1□ Strongly agree

2□ Somewhat agree

3□ Somewhat disagree

_{4□ Strongly disagree}

The next questions are about electronic health records (EHR) systems.	17. Medicare and Medicaid offer incentives to practices that demonstrate “meaningful use of health IT.” At the reporting location, are there plans to apply for these incentive payments? 1□ Yes, we already applied (Skip to 18) 2□ Yes, we intend to apply (Skip to 18) 3□ No, we will not apply (Go to 17a) 4□ Uncertain if we will apply (Go to 17a) 17a. Please indicate the reasons for not applying for incentives. CHECK ALL THAT APPLY. 1□ Not qualified as an “eligible provider” 2□ The process to apply is difficult 3□ Not familiar with the incentive program 4□ Unsure that incentives will actually be paid 5□ My EHR system does not exchange health information electronically with other providers (e.g., EHR systems “don’t talk to each other”) 6□ Not prepared to implement electronic prescribing 7□ Other reason for not applying: Please specify: ______________________________________________________________________\ 18. Has the reporting location received any type of assistance from a Regional Extension Center? 1□ Yes 2□ No 3□ Uncertain 4□ I am not familiar with the term regional extension center.
 EHRs may include multiple modules and capabilities such as computerized order entry and clinical decision support.  EHRs do not include faxing, photocopying, or printing the medical information from an external website, and then including the information in a paper-based record.
16. Which of the following best describes the reporting location’s current EHR adoption status? 1□ We are actively using an EHR system that was installed more than 12 months ago. (skip to 17) 2□ We are actively using an EHR system that was installed within the past 12 months. (skip to 17) 3□ We are not actively using an EHR system but have one installed. (skip to 17) 4□ We do not have an EHR system. (go to 16a) 16a. Do you plan to ever implement an EHR system? 1□ Yes (skip to 17) 2□ No (go to 16b) 3□ Uncertain (go to 16b) 16b. Why do you not plan on implementing an EHR system? CHECK ALL THAT APPLY. 1 □ No systems fit with my specialty 2 □ Plan to retire soon 3 □ Lack of time 4 □ Lack of staff 5 □ Lack of financial resources 6 □ Privacy/security concerns 7□ Other, specify:_______________________

19. Please answer the 3 questions to the right of this box about the following clinical workflow tasks for the reporting location.	How important is the task to delivering better patient care?			How often is the task performed at this location?			Is this task computerized?
	Very important	Somewhat important	Not important	Often	Sometimes	Never	Yes	No
Population management: Create a list of patients by particular diagnosis	1□	2□	3□	1□	2□	3□ (skip to b)	1□	2□
Create a list of patients by particular lab result	1□	2□	3□	1□	2□	3□ (skip to c)	1□	2□
Create a list of patients by particular vital signs (e.g., high blood pressure)	1□	2□	3□	1□	2□	3□ (skip to d)	1□	2□
Create a list of patients who are due for tests or preventive care	1□	2□	3□	1□	2□	3□ (skip to e)	1□	2□
Provide patient reminders for preventive or follow-up care	1□	2□	3□	1□	2□	3□ (skip to f)	1□	2□
Quality improvement: Create reports on clinical care measures for patients with specific chronic conditions (e.g., H1AC for diabetic patients)	1□	2□	3□	1□	2□	3□ (skip to g)	1□	2□
Create reports on clinical care measures by patient demographic characteristics (e.g., age, sex, race)	1□	2□	3□	1□	2□	3□ (skip to h)	1□	2□
Submit clinical care measures to public and private insurers (e.g., blood pressure control, Hb1AC, smoking status)	1□	2□	3□	1□	2□	3□ (skip to i)	1□	2□
Patient communication/access to health data: Provide patients with a copy of their health information	1□	2□	3□	1□	2□	3□ (skip to j)	1□	2□
Record a patient advanced directive	1□	2□	3□	1□	2□	3□ (skip to k)	1□	2□
Provide patients with a clinical summary for each visit	1□	2□	3□	1□	2□	3□ (skip to l)	1□	2□
Coordination of care: Receive patient clinical information from other physicians treating your patient (e.g., referral summaries)	1□	2□	3□	1□	2□	3□ (skip to m)	1□	2□
Receive information needed to continue managing a patient post-hospital discharge	1□	2□	3□	1□	2□	3□ (skip to n)	1□	2□
Share patient clinical information with other providers treating your patient	1□	2□	3□	1□	2□	3□ (Go to 19)	1□	2□

If you do not have an EHR system or are not actively using an EHR system skip to Question 32 (page 8).

If you are not sure about your EHR status, please refer to your answer in Question 16.

19. Please indicate whether you agree or disagree with the following statements about using your EHR system:	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
Overall, my practice has functioned more efficiently with an EHR system.	1□	2□	3□	4□
The amount of time spent to plan, review, order, and document care has increased.	1□	2□	3□	4□
The amount of time spent responding to pharmacy calls increased.	1□	2□	3□	4□
Overall, my EHR saves me time.	1□	2□	3□	4□
Sending prescriptions electronically saves me time.	1□	2□	3□	4□
The number of weekly office visits increased.	1□	2□	3□	4□
My practice receives lab results faster.	1□	2□	3□	4□
My practice saves on costs associated with managing and storing paper records.	1□	2□	3□	4□
Billing for services is less complete.	1□	2□	3□	4□
My EHR produces financial benefits for my practice.	1□	2□	3□	4□
My EHR produces clinical benefits for my practice.	1□	2□	3□	4□
My EHR allows me to deliver better patient care.	1□	2□	3□	4□
My EHR makes records more readily available at the point of care.	1□	2□	3□	4□
My EHR disrupts the way I interact with my patients.	1□	2□	3□	4□
My EHR is an asset when recruiting physicians to join the practice.	1□	2□	3□	4□
My EHR enhances patient data confidentiality.	1□	2□	3□	4□
Health information is less secure in my EHR system than a paper-based system.	1□	2□	3□	4□
My EHR reduces transcription costs.	1□	2□	3□	4□
Clinical summaries from my EHR contain unnecessary information.	1□	2□	3□	4□
Clinical summaries from my EHR contain too much information.	1□	2□	3□	4□
Overall, the benefits of having an EHR outweigh its purchase and maintenance costs.	1□	2□	3□	4□

20. This question is about the ways that an EHR system might affect your reporting location. Has your EHR system:	Yes, within the past 30 days	Yes, but not within the past 30 days	Not at all	Not Applicable
Alerted you to a potential medication error?	1□	2□	3□	4□
Led to a potential medication error?	1□	2□	3□	4□
Alerted you to critical lab values?	1□	2□	3□	4□
Led to less effective communication during patient visits?	1□	2□	3□	4□
Reminded you to provide preventive care (e.g., vaccine, cancer screening)?	1□	2□	3□	4□
Reminded you to provide care that meets clinical guidelines for patients with chronic conditions?	1□	2□	3□	4□
Helped you identify needed lab tests (such as HbA1c or LDL)?	1□	2□	3□	4□
Helped you order fewer tests due to better availability of lab results?	1□	2□	3□	4□
Helped you order more on-formulary drugs (as opposed to off-formulary drugs)?	1□	2□	3□	4□
Facilitated direct communication with a patient (e.g., email or secure messaging)?	1□	2□	3□	4□
Facilitated direct communication with other providers that are part of my patient care team?	1□	2□	3□	4□
Helped you access a patient’s chart remotely (e.g., to work from home)?	1□	2□	3□	4□
Helped you access a patient’s chart through your personal device (e.g., smart phone, tablet)?	1□	2□	3□	4□
Alerted you that you received a patient summary from another provider?	1□	2□	3□	4□
Helped you order a referral?	1□	2□	3□	4□
Helped you follow-up a referral?	1□	2□	3□	4□
Inadvertently led you to select the wrong medication or lab order from a list?	1□	2□	3□	4□
Led you to overlook something important because you received too many alerts?	1□	2□	3□	4□
Been accessed by an unauthorized outside entity?	1□	2□	3□	4□
Enhanced overall patient care?	1□	2□	3□	4□

21. To what extent have you experienced the following as a barrier to using your reporting location’s EHR system?	Major Barrier	Minor Barrier	Not a Barrier
Annual cost of maintaining an EHR system	1□	2□	3□
Loss of productivity during the transition to an EHR system	1□	2□	3□
Adequacy of training for you and your staff	1□	2□	3□
Adequacy of EHR technical support	1□	2□	3□
Reliability of the system (e.g., EHR down or unavailable when needed)	1□	2□	3□
Templates customized to your specialty or specific patient conditions	1□	2□	3□
Resistance of your practice to change work habits	1□	2□	3□
Ability to encrypt information to securely send information to other providers	1□	2□	3□
Ability to keep patient data private and secure	1□	2□	3□
Efficiency of performing tasks (e.g., too many clicks (“click fatigue” ))	1□	2□	3□
Ability to access patient records (e.g. log in)	1□	2□	3□

22. To what extent do you agree or disagree with the following statements about electronic information exchange. “Electronically exchanging clinical information with other providers…”	Strongly agree	Somewhat agree	Somewhat disagree	Strongly disagree	Uncertain
…improves my practice’s quality of care	1□	2□	3□	4□	5□
…increases my practice’s efficiency	1□	2□	3□	4□	5□
…increases my practice’s vendor costs.	1□	2□	3□	4□	5□
…requires multiple systems or portals	1□	2□	3□	4□	5□
…increases my practice’s liability due to other providers lacking adequate privacy/security safeguards	1□	2□	3□	4□	5□
…decreases my ability to separate sensitive health information from other data being exchanged.	1□	2□	3□	4□	5□

23. Overall, how satisfied or dissatisfied are you with your EHR system?

_{1□ Very satisfied}

2□ Somewhat satisfied

3□ Somewhat dissatisfied

4□ Very dissatisfied

24. Would you purchase this EHR again?

1□ Yes

2□ No

3□ Uncertain

25. In which year did you install your EHR system?

_ _/_ _/_ _/_ _ Year (YYYY): 2□ Unknown

26. What is the name of the current EHR system? CHECK ONLY ONE BOX.

1□ Allscripts 2□ Amazing Charts 3 □ Athenahealth

4□ Cerner 5□ eClinicalWorks 6□ e-MDs

7□ Epic 8□ GE/Centricity 9□ Greenway Medical

10□ NextGen 11□ Practice Fusion 12□ McKesson/

13□ Sage/Vitera Practice Partner

14□ Other please specify_________ 15□ Unknown

27. Does your current system meet meaningful use criteria as defined by the Department of Health and Human Services (HHS)?

_{1□ Yes (Skip to 28)}

2□ No (Go to 27a)

3□ Uncertain (Go to 27a)

27a. Are there plans to upgrade your system to meet meaningful use criteria?

1□ Yes 2□ No 3□ Uncertain

28. How many hours, on average, did you spend in ongoing training over the past year to use your practice’s EHR?

1□ 1 to 8 hours 2□ 9 to 40 hours 3□ 41 to 80 hours

_{4□ Over 80 hours 5□ Did not receive ongoing training}

29. As a result of implementing an EHR, did you experience any changes in clinical staff (e.g., other MDs, RNs, MAs) at the reporting location? CHECK ALL THAT APPLY.

_{1□ Yes, overall clinical staff increased}

2□ Yes, overall clinical staff decreased

3□ Yes, shift in responsibilities among existing staff

4□ No clinical staff changes

5□ Uncertain

30. As a result of implementing an EHR, did you experience any changes in non- clinical/administrative staff at the reporting location? CHECK ALL THAT APPLY.

_{1□ Yes, overall administrative staff increased}

_{2□ Yes, overall administrative staff decreased}

_{3□ Yes, shift in responsibilities among existing staff}

4□ No administrative staff changes

5□ Uncertain

Over the past year, has the following increased, decreased, or stayed about the same for the reporting location?

31. Practice revenue has…

Was this due, in part, to the EHR?

_{1□ Yes}

_{2□ No}

_{3□ Uncertain}

_{4□ N/A}

1□ increased

2□ decreased

3□ stayed about the same

4□ Uncertain (Go to 32)

32. Number of office visits has…

Was this due, in part, to the EHR?

_{1□ Yes}

_{2□ No}

_{3□ Uncertain}

_{4□ N/A}

1□ increased

2□ decreased

3□ stayed about the same

4□ Uncertain (Go to 33)

33. Can patients seen at the reporting location do any of the following online activities? CHECK ALL THAT APPLY.

_{1□ View test results online}

2□ Request referrals online

3□ Request refills for prescriptions online

4□ Request appointments online

5□ Incorporate patient generated/device data (e.g. blood glucose)

6□ My patients cannot do any of the above activities

7□ Uncertain

34. At the reporting location, are there plans for installing a new EHR system within the next 12 months?

1□ Yes

2□ No

3□ Maybe

4□ Unknown

35. Who completed this survey?

1□ The physician to whom it was addressed

_{2□ Office staff}

_{3□ Other}

2605 Meridian Parkway, Suite 200, Durham, NC 27713

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