National Electronic Health Records Survey 2013

National Electronic Health Records Survey

Attachment D

OMB No. 0920-0234: Approval expires 12/31/2014

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 2013

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

Is that correct?

□1 Yes

□2 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.

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

   □1 Yes		Continue to Question 3.
   □2 No □3 I am no longer in practice	}	Please stop here and return the questionnaire in the envelope provided. Thank you for your time.

3. In a typical year, about how many weeks do you NOT see any ambulatory patients because of such events as conferences, vacations, illness, etc.?

__________ weeks

The next set of questions asks about a normal week. We define a normal week as a week with a normal caseload, with no holidays, vacations, or conferences.

4. Overall, at how many office locations do you see ambulatory patients in a normal week? (Please exclude hospital emergency or outpatient departments.)

__________ locations

5. During your last normal week of practice how many office visits did you have at all locations?

__________ office visits

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

□1 Private office–based 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 department

□10 None of the above

If you only answered hospital emergency or outpatient department or none of the above in question 6, skip to question 27.

If you checked any of the boxes 1-8 in question 6, continue to question 7.

7. At which of the settings (1-8) in question 6 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”).

For the remaining questions, please answer regarding the reporting location indicated in question 7 even if it is not the location where this survey was sent.

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

   Country	USA	County
   State		Zip Code
   Telephone	( )

9. During your last normal week of practice, approximately how many office visits did you have at the reporting location? Note: Please only include visits where you personally saw the patient.

__________ office visits

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

1. In 2012, open-ended fill-in responses.

10a. 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

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

    □1 Single

    □2 Multi

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

__________ mid-level providers

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

□1 Yes
□2 No □3 Unknown	}	Skip to Question 14

13a. If yes, from those new patients, which of the following types of payment do you accept?

	Yes	No	Unknown
1. Private insurance capitated	□1	□2	□3
2. Private insurance non-capitated	□1	□2	□3
3. Medicare	□1	□2	□3
4. Medicaid/CHIP	□1	□2	□3
5. Workers compensation	□1	□2	□3
6. Self pay	□1	□2	□3
7. No charge	□1	□2	□3

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

    □1 Yes

    □2 No

    □3 Unknown

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

□1 Yes, all electronic □2 Yes, part paper and part electronic	}	Go to Question 15a
□3 No □4 Unknown	}	Skip to Question 16

15a. In which year did you install your current EHR/EMR system?

Year: ______________

15b. Does your current system meet meaningful use criteria as defined by the Department of Health and Human Services?

□1 Yes

□2 No

□3 Unknown

15c. What is the name of your current EHR/EMR system? CHECK ONLY ONE BOX. IF OTHER IS CHECKED, PLEASE SPECIFY THE NAME.

□1 Allscripts □2 Amazing Charts □3 athenahealth □4 Cerner □5 eClinicalWorks

□6 e-MD □7 Epic □8 GE/Centricity □9 Greenway Medical □10 McKesson/ Practice Partner

□11 NextGen □12 Practice Fusion □13 Sage/Vitera □14 Other, specify __________________ □15 Unknown

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

    □1 Yes

    □2 No

    □3 Maybe

    □4 Unknown

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?

17a. When did you first apply or when do you first intend to apply?

□1 Yes, we already applied □2 Yes, we intend to apply	}	□1 2011 □2 2012 □3 2013	□4 2014 or later □5 Unknown
□3 Uncertain if we will apply □4 No, we will not apply	}	Skip to Question 18

18. 

    2. *The three deleted questions from the table below are listed on the last page of attachment.

19. Please indicate whether the ambulatory 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

18a. Recording patient history and demographic information?

□1

□2

□3

Skip to 18b

□4

Skip to 18b

□5

Skip to 18b

18a1. If yes, does this include a patient problem list?

□1

□2

□3

□4

□5

18b. Recording and charting vital signs?

□1

□2

□3

□4

□5

18c. Recording patient smoking status?

□1

□2

□3

□4

□5

18d. Recording clinical notes?

□1

□2

□3

Skip to 18e

□4

Skip to 18e

□5

Skip to 18e

18d1. If yes, do the notes include a list of the patient’s medications and allergies?

□1

□2

□

□4

□5

18e. Reconciling lists of patient medications to identify the most accurate list?

□1

□2

□3

□4

□5

18f. Ordering prescriptions?

□1

□2

□

Skip to 18g

□4

Skip to 18g

□5

Skip to 18g

18f1. If yes, are prescriptions sent electronically to the pharmacy?

□1

□2

□3

□4

□5

18f2. If yes, are warnings of drug interactions or contraindications provided?

□1

□2

□3

□4

□5

18g. Providing reminders for guideline-based interventions or screening tests?

□1

□2

□3

□4

□5

18h. Ordering lab tests?

□1

□2

□3

Skip to 18i

□4

Skip to 18i

□5

Skip to 18i

18h1. If yes, are orders sent electronically?

□1

□2

□3

□4

□5

18i. Viewing lab results?

□1

□2

□3

Skip to 18j

□4

Skip to 18j

□5

Skip to 18j

18i1. If yes, can the EHR/EMR automatically graph a specific patient’s lab results over time?

□1

□2

□3

□4

□5

18j. Viewing imaging results?

□1

□2

□3

□4

□5

18k. Identifying educational resources for patients’ specific conditions?

□1

□2

□3

□4

□5

18l. Reporting clinical quality measures to federal or state agencies (such as CMS or Medicaid)?

□1

□2

□3

□4

□5

18m. Generating lists of patients with particular health conditions?

□1

□2

□3

□4

□5

18n. Electronic reporting to immunization registries?

□1

□2

□3

□4

□5

18o. Providing patients with clinical summaries for each visit?

□1

□2

□3

□4

□5

18p. Exchanging secure messages with patients?

□1

□2

□3

□4

□5

18q. Providing patients with an electronic copy of their health information?

□1

□2

□3

□4

□5

18r. Providing patients the ability to view online, download or transmit information from their medical record?

□1

□2

□3

□4

□5

The next questions are about sharing (either sending or receiving) patient health information.

Do you share any patient health information electronically (not fax) with other providers, including hospitals, ambulatory providers, or labs? □1 Yes  Go to Question 19a □2 No  Skip to Question 21				19a. How do you electronically share patient health information? CHECK ALL THAT APPLY. □1 EHR/EMR □2 Web portal (separate from EHR/EMR) □3 Other electronic method ________________
Please indicate which types of health data you share electronically (not fax) with the health care providers listed to the right. CHECK ALL THAT APPLY.		Hospitals with which you are affiliated		Ambulatory providers inside your office/group	Hospitals with which you are not affiliated	Ambulatory providers outside your office/group
20a. Lab results		□1		□2	□3	□4
20b. Imaging reports		□1		□2	□3	□4
20c. Patient problem lists		□1		□2	□3	□4
20d. Medication lists		□1		□2	□3	□4
20e. Medication allergy lists		□1		□2	□3	□4
20f. Do you share any of the above types of information using a “Summary Care Record”? [A Summary Care Record is an electronic file that contains the above health data in a standardized format.]
□1 Yes	□2 No		□3 Unknown

Do you refer any of your patients to providers outside of your office or group? □1 Yes  Go to Question 21a □2 No  Skip to Question 22		21a. Do you receive a report back from the other provider with results of the consultation? □1 Yes, routinely □2 Yes, but not routinely □3 No  Skip to Question 22			21b. Do you receive it electronically (not fax)? □1 Yes, routinely □2 Yes, but not routinely □3 No
Do you see any patients referred to you by providers outside of your office or group? □1 Yes  Go to Question 22a □2 No  Skip to Question 23		22a. Do you receive notification of both the patient’s history and reason for consultation? □1 Yes, routinely □2 Yes, but not routinely □3 No  Skip to Question 23			22b. Do you receive them electronically (not fax)? □1 Yes, routinely □2 Yes, but not routinely □3 No
Do you take care of patients after they are discharged from an inpatient setting? □1 Yes  Go to Question 23a □2 No  Skip to Question 24		23a. Do you receive all of the information you need to continue managing the patient? □1 Yes, routinely □2 Yes, but not routinely □3 No  Skip to Question 24			23b. Is the information available when needed? □1 Yes, routinely □2 Yes, but not routinely □3 No  Skip to Question 24
		23c. Do you receive it electronically (not fax)?
		□1 Yes, routinely	□2 Yes, but not routinely			□3 No
Who owns the reporting location? CHECK ONE.				Roughly, what percent of your patients are insured by Medicaid? _____________ Do you treat patients insured by Medicare? □1 Yes □2 No □3 Unknown
□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
Who completed this survey? □1 The physician to whom it was addressed □2 Office staff □3 Other

Deleted Questions from #18 matrix: • Providing standard order sets related to a particular condition or procedure? • Viewing data on quality of care measures? • If yes to (18n) “Electronic reporting to immunization registries? ◦ Delete (18n1) “Reported in standards specified by Meaningful Use criteria” Thank you for your participation. Please return your survey in the envelope provided. If you have misplaced this envelope, please send survey to: 2605 Meridian Parkway, Suite 200, Durham, NC 27713

Boxes for Admin Use

4