National Electronic Health Records Survey 2014

Attachment C – Regular 2014 National Electronic Health Records Survey
1
National Electronic
Health Records Survey
Form Approved OMB No. 0920-xxxx: Approval expires xx/xx/xxxx
NOTICE - Public reporting burden of this collection of information is estimated to average 20 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).
Assurance of Confidentiality - All information which would permit identification of an individual, a practice, or an establishment will be held confidential,
will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other
persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m)
and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

National Electronic Health Records Survey 2014
The National Electronic Health Records Survey is affiliated with the National Ambulatory Medical Care Survey (NAMCS). The
purpose of the survey is to collect information about the adoption of electronic health records/electronic medical records
(EHRs/EMRs) in ambulatory care settings. Your participation is greatly appreciated. Your answers are completely confidential.
Participation in this survey is voluntary. If you have questions or comments about this survey, please call 866-966-1473.

1. We have your specialty as:

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

□
2□

□1
□2

Yes
No

What is your specialty?

□

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

Yes

Continue to Question 3

□2

No

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

I am no longer
in practice

}

Community Health Center (e.g.,
Federally Qualified Health Center
(FQHC), federally funded clinics or
“look-alike” clinics)

□
5□

Mental health center

4

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

□1

Freestanding clinic/urgicenter (not
part of a hospital outpatient
department)

3

_______________________________________

□3

Private solo or group practice

1

Is that correct?

Non-federal government clinic (e.g.,
state, county, city, maternal and child
health, etc.)

□

Family planning clinic (including
Planned Parenthood)

6

□

Health maintenance organization or
other prepaid practice (e.g., Kaiser
Permanente)

7

□

Faculty practice plan (An organized
group of physicians that treats
patients referred to an academic
medical center)

8

The next question asks about a normal week.
We define a normal week as a week with a normal caseload,
with no holidays, vacations, or conferences.
3. Overall, at how many office locations (excluding
hospital emergency or hospital outpatient
departments) do you see ambulatory patients in a
normal week?

□

Hospital emergency or hospital
outpatient departments

9

□

__________ locations

If you see
patients in
any of
these
settings,
go to
question 5

None of the above

10

}

If you
select only
9 or 10,
go to Q24

For the remaining questions, please answer regarding the reporting location indicated in question 5
even if it is not the location where this survey was sent.
5.

At which of the settings (1-8) in question 4 do you see the most ambulatory patients?
WRITE THE NUMBER LOCATED NEXT TO THE BOX YOU CHECKED.

__________ (For the rest of the survey, we will refer to this as the “reporting location.”)
6.

What are the county, state, zip code, and telephone number of the reporting location?
Country
Zip Code

USA

County
Telephone

State
(

)

1

National Electronic Health Records Survey
12a In which year did you install your current
EHR/EMR system?
Year: ______________

7. How many physicians, including you, work at the
reporting location? ___________
7a

□1
□2
□3

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

□4
□5
□6

1 physician
2-3 physicians
4-10 physicians

□2

Single

More than 100 physicians

Multi

}

Unknown

10a If yes, from those new patients, which of the
following types of payment do you accept?
Yes
2. Private insurance non-capitated
3. Medicare
4. Medicaid/CHIP
5. Workers’ compensation
6. Self pay
7. No charge

□1
□1
□1
□1
□1
□1
□1

No Unknown

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

11. Does the reporting location submit any claims
electronically (electronic billing)?

□1

Yes

□2

□3

No

Unknown

12. Does the reporting location use an electronic health
record (EHR) or electronic medical record (EMR)
system? Do not include billing record systems.

□1
□2
□3
□4

Yes, all electronic
Yes, part paper and
part electronic
No
Unknown

}
}

Unknown

□6
□7
□8
□9

Allscripts
Amazing
Charts
athenahealth
Cerner

□11 NextGen
□12 Practice Fusion
□13 Sage/Vitera
□14 Other, specify

e-MDs
Epic
GE/Centricity
Greenway
Medical

□10 McKesson/

eClinicalWorks

__________________

□15 Unknown

12d Has your practice made an assessment of the
potential risks and vulnerabilities of your
electronic health information within the last 12
months? This assessment would help identify
privacy or security related issues that may
need to be corrected.

Skip to Question 11

1. Private insurance capitated

□3

No

Practice
Partner

Go to Question 10a

No

□1
□2
□3
□4
□5

10. At the reporting location, are you currently
accepting new patients?
Yes

□2

Yes

12c What is the name of your current EHR/EMR
system? CHECK ONLY ONE BOX. IF OTHER IS
CHECKED, PLEASE SPECIFY THE NAME.

51-100 physicians

9. How many mid-level providers (i.e., nurse
practitioners, physician assistants, and nurse
midwives) are associated with the reporting
location?
__________ mid-level providers

□1
□2
□3

□1

11-50 physicians

8. Is the reporting location a single- or multi-specialty
(group) practice?

□1

12b Does your current system meet meaningful use
criteria as defined by the Department of Health
and Human Services?

□1

□2

Yes

□3

No

Unknown

12e Does your EHR have the capability to
electronically send health information to
another provider whose EHR system is
different from your system?

□1

□2

Yes

□3

No

Unknown

13. At the reporting location, are there plans for
installing a new EHR/EMR system within the next 18
months?

□1

□2

Yes

□3

No

Maybe

□4

Unknown

14. Medicare and Medicaid offer incentives to practices
that demonstrate “meaningful use of health IT.” At
the reporting location, are there plans to apply for
Stage 1 of these incentive payments?

□1 Yes, we already applied
□2 Yes, we intend to apply
□3 Uncertain if we will apply
□4 No, we will not apply

Go to Question 14a

}

Skip to Question 15

Go to Question 12a
14a Are there plans to apply for Stage 2 incentive
payments?
Skip to Question 13

□1

Yes

□2

No

□3

Maybe

□4

Unknown
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National Electronic Health Records Survey
15. Indicate whether the reporting location has each of
the computerized capabilities listed below and how
often these capabilities are used. CHECK NO MORE
THAN ONE BOX PER ROW.

Yes,
used
routinely

Yes,
but not
used
routinely

Yes,
but turned
off or not
used

No

Unknown

□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

□4
□4
□4
□4
□4
□4
□4

□5
□5
□5
□5
□5
□5
□5

□1

□2

Ordering prescriptions?

□1

□2

□3
□3

□4
□4

□5
□5

Skip to 15j

15i1 Are prescriptions sent electronically to the
pharmacy?
15i2 Are warnings of drug interactions or
contraindications provided?

□1

□2

□3

□4

□5

15i3 Are drug formulary checks performed?

□1
□1

□2
□2

Ordering lab tests?

□1

□2

□3
□3
□3

□4
□4
□4

□5
□5
□5

15j1 Are orders sent electronically?

□1

□2

□1

□2

Skip to 15l

□1
□1
□1
□1

□2
□2
□2
□2

□3
□3
□3
□3

□4
□4
□4
□4

□5
□5
□5
□5

□1

□2

□3

□4

□5

□1

□2

□3

□4

□5

□1
□1
□1
□1

□2
□2
□2
□2

□3
□3
□3
□3

□4
□4
□4
□4

□5
□5
□5
□5

□1

□2

□3

□4

□5

15a Recording patient history and demographic
information?
15b Recording patient problem list?
15c Recording and charting vital signs?
15d Recording patient smoking status?
15e Recording clinical notes?
15f Recording patient’s medications and allergies?
15g Reconciling lists of patient medications to
identify the most accurate list?
15h Providing reminders for guideline-based
interventions or screening tests?
15i

15j

15k Viewing lab results?
15k1 Can the EHR/EMR automatically graph a
specific patient’s lab results over time?
15l

Ordering radiology tests?

15m Viewing imaging results?
15n Identifying educational resources for patients’
specific conditions?
15o Reporting clinical quality measures to federal or
state agencies (such as CMS or Medicaid)?
15p Identifying patients due for preventive or followup care in order to send patients reminders?
15q Generating lists of patients with particular health
conditions?
15r Electronic reporting to immunization registries?
15s Providing patients with clinical summaries for
each visit?
15t Exchanging secure messages with patients?
15u Providing patients the ability to view online,
download or transmit information from their
medical record?

Skip to 15j Skip to 15j

Skip to 15k Skip to 15k Skip to 15k

□3
□3

□4
□4

□5
□5

Skip to 15l Skip to 15l

The next questions are about sharing (either sending or receiving) patient health information.
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National Electronic Health Records Survey
16. Do you refer any of your patients 16a Do you send the patient’s clinical
to providers outside of your
information to the other
providers?
office or group?

□1
□2

□1
□2
□3

Yes  Go to Question 16a 
No  Skip to Question 17

17. Do you see any patients referred
to you by providers outside of
your office or group?

16b Do you send it electronically
(not fax)?

Yes, routinely
Yes, but not routinely
No  Skip to Question 17

□1
□2
□3

Yes, routinely
Yes, but not routinely
No

17a Do you send a consultation report 17b Do you send it electronically
with clinical information to the
(not fax)?
other providers?
1 Yes, routinely
1 Yes  Go to Question 17a 
1 Yes, routinely
2 Yes, but not routinely
2 Yes, but not routinely
3 No
2 No  Skip to Question 18
3 No  Skip to Question 18

□
□

□
□
□

□
□
□

18. Do you take care of patients after 18a Do you receive a discharge
18b Do you receive
they are discharged from an
summary with clinical information
it electronically (not fax)?
from the hospital?
inpatient setting?
1 Yes, routinely
1 Yes  Go to Question 18a 
1 Yes, routinely
2 Yes, but not routinely
2 Yes, but not routinely
3 No  Skip to
2 No  Skip to Question 19
3 No  Skip to Question 19
Question 19

□
□

□
□
□

□
□
□

18c Can you automatically incorporate the received information into your
EHR system without manually entering the data?

□1

Yes

□2

□3

No

Not applicable, I do not have an EHR system

19. Do you share any patient health information (e.g., lab results, imaging reports, problem lists, medication lists)
electronically (not fax) with any other providers, including hospitals, ambulatory providers, or labs?

□1

□2

Yes  Go to Question 19a

No  Skip to Question 20

19a How do you electronically share patient health information? CHECK ALL THAT APPLY.

□1
□3

□2

EHR/EMR

Web portal (separate from EHR/EMR)

Other electronic method (not fax) ____________________

19b Is the patient health information that you share electronically sent directly from your EHR system to
another EHR system?

□1

□2

Yes, routinely

Yes, but not routinely

□3

□4

No

Unknown

19c With what types of providers do you electronically share patient health information? CHECK ALL THAT
APPLY.

□1
□2
□3
□4

Ambulatory providers inside your office/group
Ambulatory providers outside your office/group
Hospitals with which you are affiliated

□5
□6
□7

Behavioral health providers
Long-term care providers
Home health providers

Hospitals with which you are not affiliated

20. Who owns the reporting location? CHECK ONE.

□1
□2
□3

□4
□5
□6
□7

Physician or physician group
Insurance company, health
plan, or HMO
Community health center

21. Roughly, what percent of your patients
are insured by Medicaid?
Medical/academic health center
_______________%
Other hospital
22. Do you treat patients insured by
Other health care corporation
Medicare?
Other
□1 Yes
□2 No
□3 Unknown

23. What is a reliable E-mail address for the physician to whom this survey was mailed?
@
24. Who completed this survey?

□1

The physician to whom it was addressed

Thank you for your participation. Please return your survey in the
envelope provided. If you have misplaced the envelope, please send the
survey to: 2605 Meridian Parkway, Suite 200, Durham, NC 27713.

□2

Office staff

□3 Other

Boxes for Admin Use

4