Form CMS-10546 Utilization of Health Information Technology in Post-Acu

Utilization of Health Information Technology in Post-Acute Care Settings

Survey Introduction
Dear Provider:  

In the absence of a financial incentive program for Long Term and Post­Acute Care (LTPAC) 
providers to adopt electronic health record (EHR) systems, the Centers for Medicare & Medicaid 
Services (CMS) is aware that many of these providers have begun to engage in both health 
information technology (HIT) adoption and electronic health information exchange (HIE) to support 
their clinical care services and to facilitate coordinated transitions in care across the continuum of 
health care services. 

In an interest to learn more about the adoption and utilization of HIT and HIE practices in post­acute 
care, CMS is conducting a survey related to the adoption and utilization of HIT, such as the usage of 
EHRs and HIE. 

The goal of the survey is to learn more about the adoption rate of HIT and engagement in HIE in 
LTPAC settings, and importantly the extent to which HIT and HIE is used in these settings. The 
information will help CMS understand where such technology may be playing a role in the delivery of 
health care services in LTPAC settings. It will also identify both the benefits and the gaps hindering 
provider participation in programs that promote care coordination, such as the participation in HIE. 

Due to the technical nature of these questions, we highly recommend a respondent with technical 
knowledge and experience about the system complete the survey. In addition, this survey includes 
administrative questions (e.g., number of FTEs, future plans). You may need to seek support from a 
person with experience with the operation of the facility to complete these questions.  

If you are an organization completing this survey and you represent multiple facilities, please consider 
completing a separate survey if the level of EHR readiness (implementation/adoption/use) varies 
among these settings. 

This survey is fully voluntary, and there is no penalty for not responding. Individual survey responses 
will not be made public. The estimated time to complete the survey is 20 minutes. 

If you need assistance or have questions, please contact the survey administrator.  

Survey Administrator: 
Lantana Consulting Group 
[email protected] 

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Utilization of Health Information Technology in Post-Acute Care Settings

Provider Information
This section gathers information about the type of provider and other distinguishing characteristics.  

If you are an organization completing this survey and you represent multiple facilities, please consider 
completing a separate survey if the level of EHR readiness (implementation/adoption/use) varies 
among these settings. 

*1. Type of Provider:

j Home Health Agency (HHA)
k
l
m
n

j Skilled Nursing Facility (SNF)
k
l
m
n

j Nursing Facility (NF)
k
l
m
n

j Swing Bed (SB)
k
l
m
n

j In­patient Rehabilitation Facility (IPPS­Excluded IRF PPS Unit, or certified Inpatient Rehabilitation Hospital)
k
l
m
n
j Long Term Care Hospital (LTCH)
k
l
m
n
j Hospice
k
l
m
n

j Other
k
l
m
n

Other (please specify) 

2. What is your organization's CMS Certification Number? (Not required.)

3. If answering on behalf of a organization operating a number of facilities, enter the
number of facilities for each type.
HHA
SNF
NF
SB
IRF
LTCH
Hospice­In­patient
Other

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Utilization of Health Information Technology in Post-Acute Care Settings
4. Number of patient's served annually:

j Less than 100
k
l
m
n
j 100 – 199
k
l
m
n
j 200 ­ 299
k
l
m
n

j 300 – 399
k
l
m
n
j 400 – 450
k
l
m
n

j Greater than 450
k
l
m
n

5. Service setting:
j Urban
k
l
m
n
j Rural
k
l
m
n
j N/A
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

Electronic Health Record (EHR) Usage
This section gathers information about current use of EHR technology. If an EHR is currently 
implemented, questions will focus on the capabilities of the implemented system. Someone with 
technical knowledge and experience using the system will likely be needed to complete this section of 
the survey. 

(Note: If an EHR is not currently implemented, the survey will skip to questions that focus on plans for 
future implementation.) 

*6. An Electronic Health Record (EHR) is an electronic version of a patient's medical

history, that is maintained by the provider over time, and may include all of the key
administrative clinical data relevant to that person's care under a particular provider,
including demographics, progress notes, problems, medications, vital signs, past medical
history, immunizations, laboratory data and radiology reports.
Not including accounting or billing purposes, to what extent does your facility currently
use an EHR to manage your patients' health records?

j An EHR is used to manage the health record for each patient
k
l
m
n

j An EHR is used to manage the health record for some patients
k
l
m
n

j An EHR is not used to manage the health records for any patient
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

EHR System Functionality
Which functional areas does your EHR support? 
7. What functionality does your EHR support and is your organization using it?
EHR functionality 
available, and is used.

EHR functionality 
available, but is not 
used.

EHR functionality is not 
available.

Capture and edit care team 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture and edit patient demographics

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture and edit health assessments

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture, edit and share care/service plans

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture, edit and share clinical documentation

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Maintain a person’s problem list

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Indicate a person’s advance directives

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Record physician orders for tests or 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

View diagnostic imaging requests

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture and edit physician orders for 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Document medication allergies

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Display alerts/warnings for drug interactions or 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Send/receive E­prescribing

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

View diagnostic imaging requests

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Share discharge and transfer summaries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Inclusion of encounter information from other 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Capture results from diagnostic tests

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Maintain a person’s immunizations list or 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

procedures
Send, receive and incorporate lab results 
electronically

medications
Supports discrete medication reconciliation 
list
Maintain a person’s medication administration 
records

contraindications

service providers (e.g. outpatient visits, 
inpatient services)

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Utilization of Health Information Technology in Post-Acute Care Settings
report immunizations to a state registry
j
k
l
m
n

Integrate clinical decision support to support 

j
k
l
m
n

j
k
l
m
n

best practice recommendations

8. Is your EHR certified for Meaningful Use Stage 1 or Stage 2?
j Yes
k
l
m
n
j No
k
l
m
n

9. Which statement best describes how your EHR supports and is compatible with CMS
assessment instruments (MDS 3.0, OASIS, LTCH CARE Data Set (LCDS), or IRF­PAI)?
j Assessment tools are not supported by the EHR.
k
l
m
n

j Assessment tools are accessible from the EHR, but data is not shared.
k
l
m
n
j The assessment tools push data to the EHR.
k
l
m
n

j The EHR pushes data to the assessment tools.
k
l
m
n

j The assessment tools and the EHR are integrated and share data back and forth.
k
l
m
n

Other (please specify) 

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Utilization of Health Information Technology in Post-Acute Care Settings

EHR Usage ­ Benefits
This section identifies functional areas that have benefited from EHR adoption. 
10. What benefits have been achieved as a result of implementing your EHR? (Check all
that apply)

c Improves patient safety
d
e
f
g

c Provides better quality of care
d
e
f
g

c Saves time
d
e
f
g

c Saves money
d
e
f
g

c Improves communication with patient/family
d
e
f
g

c Improves communication with other care providers
d
e
f
g

Other (please specify) 

11. What barriers have you experienced as a result of implementing your EHR? (Check all
that apply)

c Technology does not meet functional requirements
d
e
f
g

c Lack of experienced/trained personnel
d
e
f
g

c Lack of HIT expertise
d
e
f
g

c Benefit doesn't outweigh the cost
d
e
f
g

c Lack of funding
d
e
f
g

c Lack of internal commitment/support
d
e
f
g

Other (please specify) 

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Utilization of Health Information Technology in Post-Acute Care Settings

Health Information Exchange (HIE) ­ Receiving Capabilities
This section identifies the types of information the EHR is receiving from different data sharing 
partners. 

*12. Is your EHR system capable of receiving data from systems outside of your
organization?

j Yes
k
l
m
n
j No
k
l
m
n

j Not sure
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

13. Which of the following data transport methods does your EHR currently use to receive
data from other systems? Please check all that apply. If not applicable or unknown, please
leave blank.
HL7 V2 

HL7 V3 

Proprietary 

messages

messages

interfaces

c
d
e
f
g

c
d
e
f
g

c
d
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f
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c
d
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f
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c
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c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

LTPAC EHRs

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

Personal Health 

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
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c
d
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f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

Provider or Hospital 

Direct

XDS

c
d
e
f
g

XCA

EHRs
Laboratory Information 
Systems
Pharmacy Information 
Systems
Diagnostic Imaging 
Systems

Record Systems
Public Health 
Systems

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Utilization of Health Information Technology in Post-Acute Care Settings
14. Which of the following data representation methods does your EHR currently use to
receive data from other systems? Please check all that apply. If not applicable or
unknown, please leave blank.
HL7 C­CDA 
CCD Document

Other types of 
HL7 C­CDA 
Documents

Other CDA 
document 

HL7 V2 

PDF 

Proprietary 

(HITSP C32, 

messages

documents

formats

IHE)

c
d
e
f
g

c
d
e
f
g

c
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f
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c
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c
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c
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f
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c
d
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c
d
e
f
g

LTPAC EHRs

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

Personal Health 

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
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f
g

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f
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c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

Provider or Hospital 
EHRs
Laboratory Information 
Systems
Pharmacy Information 
Systems
Diagnostic Imaging 
Systems

Record Systems
Public Health 
Systems

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Utilization of Health Information Technology in Post-Acute Care Settings

Health Information Exchange (HIE) ­ Sending Capabilities
This section identifies the types of information the EHR is sending to different data sharing partners. 

*15. Is your EHR system capable of sending data to systems outside of your
organization?

j Yes
k
l
m
n
j No
k
l
m
n

j Not sure
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

16. Which of the following data transport methods does your EHR currently use to send
data to other systems? Please check all that apply. If not applicable or unknown, please
leave blank.
HL7 V2 

HL7 V3 

Proprietary 

messages

messages

interfaces

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
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f
g

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c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

LTPAC EHRs

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
e
f
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c
d
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f
g

Personal Health 

c
d
e
f
g

c
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f
g

c
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f
g

c
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f
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c
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f
g

c
d
e
f
g

c
d
e
f
g

Provider or Hospital 

Direct

XDS

c
d
e
f
g

XCA

EHRs
Laboratory Information 
Systems
Pharmacy Information 
Systems
Diagnostic Imaging 
Systems

Record Systems
Public Health 
Systems

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Utilization of Health Information Technology in Post-Acute Care Settings
17. Which of the following data representation methods does your EHR currently use to
send data to other systems? Please check all that apply. If not applicable or unknown,
please leave blank.
HL7 C­CDA 
CCD Document

Other types of 
HL7 C­CDA 
Documents

Other CDA 
document 

HL7 V2 

PDF 

Proprietary 

(HITSP C32, 

messages

documents

formats

IHE)

c
d
e
f
g

c
d
e
f
g

c
d
e
f
g

c
d
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f
g

c
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g

LTPAC EHRs

c
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g

c
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g

c
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f
g

c
d
e
f
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c
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c
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Personal Health 

c
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c
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f
g

Provider or Hospital 
EHRs
Laboratory Information 
Systems
Pharmacy Information 
Systems
Diagnostic Imaging 
Systems

Record Systems
Public Health 
Systems

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Utilization of Health Information Technology in Post-Acute Care Settings

Health Information Exchange (HIE) ­ Barriers
18. What issues have been the major barriers for health information exchange across
systems? (Check all that apply)

c Technology infrastructure does not enable information exchange
d
e
f
g

c Information that can be exchanged doesn't meet required uses
d
e
f
g

c Standards not implemented
d
e
f
g

c Lack of policies to permit data to be exchanged
d
e
f
g

c Lack of experienced/trained personnel
d
e
f
g

c Lack of HIT expertise
d
e
f
g

c Benefit doesn't outweigh the cost
d
e
f
g

c Lack of funding
d
e
f
g

c Lack of internal commitment/support
d
e
f
g

Other (please specify) 

19. How many resources do you current have supporting your HIE planning and
implementation efforts?

j Less than 1 FTE (full time equivalent)
k
l
m
n

j More than 1 FTE, but less than 2 FTEs
k
l
m
n

j More than 2 FTEs, but less than 3 FTEs
k
l
m
n

j More than 3 FTEs, but less than 4 FTEs
k
l
m
n

j More than 4 FTEs, but less than 5 FTEs
k
l
m
n

j 5 or more FTEs
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

EHR Adoption Planning

*20. Which of the following best describes your organization's timeline for EHR
adoption?

j Planning to implement an EHR within 1 year
k
l
m
n

j Planning to implement an EHR in the next 1­2 years
k
l
m
n

j Planning to implement an EHR in the next 3­5 years
k
l
m
n

j Not planning to implement an EHR within the next 5 years
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

EHR Adoption Expected Benefits
21. For your facility, what benefits are expected as a result of implementing an EHR?
(Check all that apply)

c Improves patient safety
d
e
f
g

c Provides better quality of care
d
e
f
g

c Saves time
d
e
f
g

c Saves money
d
e
f
g

c Improves communication with patient/family
d
e
f
g

c Improves communication with other care providers
d
e
f
g

Other (please specify) 

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Utilization of Health Information Technology in Post-Acute Care Settings

EHR Adoption and HIE Barriers
22. For your facility, what issues present the major barriers to adoption of an EHR system?
(Check all that apply)

c Technology does not meet functional requirements
d
e
f
g

c Lack of experienced/trained personnel
d
e
f
g

c Lack of HIT expertise
d
e
f
g

c Benefit doesn't outweigh the cost
d
e
f
g

c Lack of funding
d
e
f
g

c Lack of internal commitment/support
d
e
f
g

Other (please specify) 

23. For your facility, what issues present major barriers for health information exchange
across systems? (Check all that apply)

c Technology infrastructure does not enable information exchange
d
e
f
g

c Information that can be exchanged doesn't meet required uses
d
e
f
g

c Standards not implemented
d
e
f
g

c Lack of policies to permit data to be exchanged
d
e
f
g

c Lack of experienced/trained personnel
d
e
f
g

c Lack of HIT expertise
d
e
f
g

c Benefit doesn't outweigh the cost
d
e
f
g

c Lack of funding
d
e
f
g

c Lack of internal commitment/support
d
e
f
g

Other (please specify) 

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Utilization of Health Information Technology in Post-Acute Care Settings
24. How many resources do you current have supporting your EHR planning and
implementation efforts?

j Less than 1 FTE (full time equivalent)
k
l
m
n

j More than 1 FTE, but less than 2 FTEs
k
l
m
n

j More than 2 FTEs, but less than 3 FTEs
k
l
m
n

j More than 3 FTEs, but less than 4 FTEs
k
l
m
n

j More than 4 FTEs, but less than 5 FTEs
k
l
m
n

j 5 or more FTEs
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

Survey Participant Information
This section gathers information about the survey participant and distinguishing characteristics about 
their organization. 

*25. How would you categorize your role in the organization?

j Executive
k
l
m
n

j Manager
k
l
m
n

j Professional
k
l
m
n

j Other
k
l
m
n

Other (please specify) 

*26. How would your categorize your area of expertise?
c Business
d
e
f
g

c Technical
d
e
f
g
c Clinical
d
e
f
g

c Other
d
e
f
g

Other (please specify) 

*27. Which statement best describes your interest in participating in future surveys on
EHR implementation and adoption of electronic quality measures?

j Would be interested in participation
k
l
m
n

j Might be interested in future participation
k
l
m
n

j Would not be interested in future participation
k
l
m
n

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Utilization of Health Information Technology in Post-Acute Care Settings

Contact Information

*28. Contact Information:
Name:
Email Address:
Phone Number:

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Utilization of Health Information Technology in Post-Acute Care Settings

Thank you for your participation
Thank you for participating in the CMS Utilization of Electronic Health Information survey. If you have 
questions regarding the survey, please contact the survey administrator. 

Survey Administrator: 
Lantana Consulting Group 
[email protected]  

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