2015 Nehrs

Attachment A - 2015 National Electronic Health Records Survey
National Electronic Health Records Survey
OMB No. 0920-1015: Approval expires 04/30/2017
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).
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 2015
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

Is that correct?

□1
□2

Yes
No

What is your specialty?

□

3

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

□
5□
4

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

□1

Yes

Continue to Question 3

□2

No

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

□3

I am no longer
in practice

}

□

6

□

7

□

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?

□

9

□

10

__________ locations

Private solo or group practice
Freestanding clinic/urgicenter (not
part of a hospital outpatient
department)
Community Health Center (e.g.,
Federally Qualified Health Center
(FQHC), federally funded clinics or
“look-alike” clinics)
Mental health center

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

Non-federal government clinic (e.g.,
state, county, city, maternal and child
health, etc.)
Family planning clinic (including
Planned Parenthood)
Health maintenance organization or
other prepaid practice (e.g., Kaiser
Permanente)
Faculty practice plan (An organized
group of physicians that treats
patients referred to an academic
medical center)

Hospital emergency or hospital
outpatient departments
None of the above

}

If you
select only
9 or 10,
go to Q33

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.”)
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.
6.

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

USA

County
Telephone

State
(

)

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National Electronic Health Records Survey
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)?
1 physician
2-3 physicians
4-10 physicians

□4
□5
□6
□2

Single

□1
□2
□3

Yes (Go to 12b1)
No (skip to 12c)
Unknown(skip to 12c)

11-50 physicians
51-100 physicians
More than 100 physicians

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

□1

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

Multi

How many mid-level providers (i.e., nurse
practitioners, physician assistants, and nurse
midwives) are associated with the reporting
location?
__________ mid-level providers
10. How many patients do you currently take care of at
the reporting location?
___________ Number of patients
11. At the reporting location, are you currently
accepting new patients?
9.

□1

12b1. 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

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

□1
□2
□3
□4
□5

Allscripts
Community
Computer
Service, Inc
athenahealth
Cerner

□6
□7
□8
□9

□11 Practice Fusion
□12 Sage/Vitera/

e-MDs
Epic
GE/Centricity
Eyefinity/
Officemate

□10 NextGen

eClinicalWorks

Greenway

□13 Other, specify
__________________

□14 Unknown

Yes
□2 No
□3 Unknown
11a If yes, from those new patients, which of the
following types of payment do you accept?
Yes
1. Private insurance capitated
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

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 securityNo Unknown
related issues that may need to be corrected.

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

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

□1
□2
□3
□4

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

}
}

Go to Question 12a

□1

Yes

12a. In which year did you install your current
EHR system?

No

□3

Unknown

13. At the reporting location, are there plans to purchase a
new EHR system within the next 18 months?

□1
□2
□3
□4
□5

Yes, with the same EHR vendor
Yes, with a different EHR vendor
Yes, first-time purchase of EHR system
No
Unknown

14. Medicare and Medicaid offer incentives to practices
that demonstrate “meaningful use of health IT.” Has
your reporting location applied for Meaningful Use
Incentive Program payments?

□1Yes
Skip to Question 13

□2

□2No

□3Unknown

15. Does your reporting location plan to apply for
Meaningful Use Incentive Program payments in the
future?

□1Yes

□2No

□3Unknown

Year: ______________

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National Electronic Health Records Survey
Yes,
used
routinely

Yes,
but not
used
routinely

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

□1

□2

Ordering prescriptions?

□1

□2

□3
□3

□4
□4

16i1 Are prescriptions sent electronically to the pharmacy?

□1

□2

□3

□4

16i2 Are warnings of drug interactions or contraindications
provided?

□1

□2

Ordering lab tests?

□1

□2

□3
□3

□4
□4

16j1 Are orders sent electronically?

□1

□2

□1

□2

□1
□1
□1
□1

□2
□2
□2
□2

□3
□3
□3
□3

□4
□4
□4
□4

□1

□2

□3

□4

□1

□2

□3

□4

16u Ability for patients to electronically view their online medical
record?

□1
□1
□1
□1
□1

□2
□2
□2
□2
□2

□3
□3
□3
□3
□3

□4
□4
□4
□4
□4

16v Ability for patients to download their online medical record?

□1

□2

□3

□4

16w Ability for patients to electronically send their online medical
record to a third party (e.g., another provider, Patient Health
Records)?

□1

□2

□3

□4

16. 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.
16a Recording patient history and demographic information?
16b Recording patient problem list?
16c Recording and charting vital signs?
16d Recording patient smoking status?
16e Recording clinical notes?
16f Recording patient’s medications and allergies?
16g Reconciling lists of patient medications to identify the most
accurate list?
16h Providing reminders for guideline-based interventions or
screening tests?
16i

16j

16k Viewing lab results?
16k1 Can the EHR/EMR automatically graph a specific patient’s
lab results over time?
16l

Ordering radiology tests?

16m Viewing imaging results?
16n Identifying educational resources for patients’ specific
conditions?
16o Reporting clinical quality measures to federal or state agencies
(such as CMS or Medicaid)?
16p Identifying patients due for preventive or follow-up care in order
to send patients reminders?
16q Generating lists of patients with particular health conditions?
16r Electronic reporting to immunization registries?
16s Providing patients with clinical summaries for each visit?
16t Exchanging secure messages with patients?

Skip to 16j Skip to 16j

Skip to 16k Skip to 16k

□3
□3

□4
□4

Skip to 16l Skip to 16l

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National Electronic Health Records Survey
17. Has your reporting location been recognized as a
Patient Centered Medical Home (PCMH) by a state, a
commercial health plan, or a national organization,
such as the National Committee for Quality Assurance
(NCQA), the Joint Commission, URAC, or the
Accreditation Association of Health Care Practice?

□1

Yes

□2No □3

20. Who owns the reporting location? CHECK ONE.

□1
□2
□3
□4
□5
□6
□7

Unknown

18. Does the reporting location participate in an
Accountable Care Organization arrangement with
Medicare or private insurers? An ACO is an entity
typically composed of primary care physicians, specialists,
and hospitals, and held financially accountable for the cost
and quality of care delivered to a defined group of
patients.
□1 Yes
□2
No
□3
Unknown

Physician or physician group
Insurance company, health plan, or HMO
Community health center
Medical/academic health center
Other hospital
Other health care corporation
Other

21. Roughly, what percent of your patients are insured
by Medicaid?
_______________%

22. Do you treat patients insured by Medicare?

19. Does the reporting location participate in a Pay-forPerformance arrangement, where you can receive
financial bonuses based on your performance?
□1 Yes
□2
No
□3
Unknown

□1

Yes

□2

No

□3

Unknown

The following questions are about how the medical organization sends and receives patient health information.
By medical organization we mean the organization that employs physicians who work together and may share staff,
patient medical records, and profits; this also includes solo practices and groups owned by a hospital. Patient health
information may include information, such as medication lists, problem lists, medication and allergies lists, imaging
reports, laboratory results, registry data (e.g. immunizations, cancer), and referrals.
23. How often is patient health information sent

to sources (e.g., other providers, public
health agencies) outside your medical
organization using the following methods
of data transmission?
a. Paper-based method (e.g. mail, fax)
b. eFax

c. EHR (not eFax)
d. Web Portal (separate from EHR)

Often

□
1□
1□
1□
1

Sometimes

□
2□
2□
2□
2

Rarely

□
3□
3□
3□
3

Never

□
4□
4□
4□
4

Uncertain

□
5□
5□
5□
5

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National Electronic Health Records Survey

24. How often do you receive patient health
information from sources (e.g., other
providers, public health agencies) outside
your medical organization using the
following methods of data transmission?

Often

□
1□
1□
1□

a. Paper-based method (e.g. mail, fax)

1

b. eFax

c. EHR (not eFax)
d. Web Portal (separate from EHR)

Sometimes

□
2□
2□
2□
2

Rarely

□
3□
3□
3□
3

Never

Uncertain

□
4□
4□
4□

□
5□
5□
5□

4

5

25. Do you refer patients to the following providers? If yes, how often do you send patient health
information electronically through either your EHR or web portal? Do NOT include eFax, fax, or other
paper-based methods.
Yes

a. Ambulatory care

□

1

Skip to 19b

□

1

Skip to 19c

□

1

hospitals

□

1

Long-term care
providers

□

2

Skip to 19e

□

1

providers

f.

□

2

Skip to 19d

d. Affiliated hospitals
e. Behavioral Health

□

2

providers within
organization

c. Unaffiliated

□

2

providers outside
organization

b. Ambulatory care

No

□

2

Skip to 19f

□

1

□

2

Skip to 20

Often

Sometimes

□

2

□

2

□

2

□

2

□

2

□

2

1

1

1

1

1

1

Rarely

□

3

□

3

□

3

□

3

□

3

□

3

Never

□

4

□

□

4

□

4

□

4

□

4

□

4

□
□
□
□
□

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National Electronic Health Records Survey

26. Do you see patients that have received care from the following providers? If yes, how often do you
receive patient health information electronically through either your EHR or web portal? Do NOT
include eFax, fax, or other paper-based methods.
Yes

Sometimes

Rarely

Never

1

care providers
outside
organization

□

2

Skip to 20b

□

2

□

2

□

2

□

2

□

2

□

2

1

□

3

□

4

□

3

□

3

□

3

□

3

□

3

□

□

4

□

4

□

4

□

4

□

4

□

b. Ambulatory

1

care providers
within
organization

□

2

Skip to 20c

□

Unaffiliated
hospitals

□

1

2

Skip to 20d

□

d. Affiliated

□

1

hospitals

2

Skip to 20e

□

e. Behavioral

1

Health
providers
f.

Often

□

a. Ambulatory

c.

No

□

2

Skip to 20f

□

Long-term
care providers

1

□

2

Skip to 21

1

1

1

1

1

□
□
□
□
□

If you do not have an EHR system please skip to Question 29.
If you have an EHR system continue to Question 27.
27. Do you electronically send and receive, send only, or
receive only the following types of patient health
information to and from sources outside your medical
organization (e.g., other providers, public health
agencies)? Electronically does not include eFax, fax, or
paper-based methods.
Medication lists
Patient problem lists
Medication allergies lists
Imaging reports
Laboratory results
Registry data (e.g. immunizations, cancer)
Referrals
Transition of care summary or a summary of care record
Hospital discharge summaries
Emergency Department notifications

Both
send and
receive
electronically

□
1□
1□
1□
1□
1□
1□
1□
1

Send
electronically
only

□
2□
2□
2□
2□
2□
2□
2□
2

Receive
electronically
only

□
3□
3□
3□
3□
3□
3□
3□
3□
3□
3

Do not
send or receive
electronically

□
4□
4□
4□
4□
4□
4□
4□
4□
4□
4

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National Electronic Health Records Survey

28. Are you able to integrate the following types of
patient health information that you electronically
receive into your EHR without special effort
(e.g., manual entry or scanning)?
Medication lists

Yes

No

□
1□
1□
1□
1□
1□
1□
1□
1□
1□

□
2□
2□
2□
2□
2□
2□
2□
2□
2□

1

Patient problem lists
Medication allergies lists
Imaging reports
Laboratory results
Registry data (e.g. immunizations, cancer)
Referrals
Transition of care summary or a summary of care record
Hospital discharge summaries
Emergency Department notifications

Uncertain

2

□
3□
3□
3□
3□
3□
3□
3□
3□
3□
3

NA: Do not
receive
information
electronically

□
4□
4□
4□
4□
4□
4□
4□
4□
4□
4

29. While treating patients seen by other providers outside your medical organization, how often do you or your staff have the
necessary clinical information (such as hospital discharge or referral summaries) electronically available at the point of care?
Electronic does not include fax or e-fax.

□Often

1

□Sometimes

2

□Rarely

3

□Never

4

These questions ask about electronically searching, finding, or querying patient health information from sources
outside your medical organization.

30. Do you or your staff have the capability to
electronically search for your patient’s health
information from sources outside of your medical
organization (e.g. remote access to other facility,
health information exchange organization)?

□Yes (Go to 30a)

1

□No(Skip to 31)

2

□Uncertain (Skip to 31)

3

30a. What type of patient health information do you
or your staff routinely search for from sources
outside your medical organization? Check all that
apply.

□Lab results
2□Patient problem lists
3□Imaging reports
4□Medication lists
5□Medication allergy lists
6□ Discharge summary
7□Other___________________
1

30b. How often do you or your staff
electronically search for health
information from sources outside of
your medical organizationwhen seeing
a new patient or an existing patient
who has received services from other
providers?

□Always (Go to 30b1))
2□Often (Go to 30b1))
3□Sometimes (Go to 30b1))
4□Rarely (Go to 30b1)
5□Never (Skip to 31)
1

30b1. How do you or your staff search
patient health information from
outside sources? Check all that
apply.

□EHR
2□Web portal
3□Other______
1

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National Electronic Health Records Survey

31. To what extent do you agree or disagree
with the following statements about
electronic information exchange (exchange
refers to electronically sending, receiving, or
finding patient health information)?

Strongly
Agree

Somewhat Somewhat
Agree
Disagree

Strongly
Disagree

NA: Do not
electronically
exchange data

“Electronically exchanging clinical information with
other sources outside my medical organization…”

□

2

□

2

□

2

□

2

□

2

□

2

□

2

□

2

a. …improves my practice’s quality of care

1

b.…increases my practice’s efficiency

1

c. ...reduces duplicate test ordering

1

d. …prevents medical/medication errors

1

e. …is cumbersome to do with our EHR

1

f. …is limited;providers in my referral network do not
have the electronic capability to exchange data

1

g. … provides me with complete clinical information,
both current and historical, from sources outside my
medical organization.

1

h. … provides me with clinical information that I can
trust.

1

□

3

□

4

□

3

□

3

□

3

□

3

□

3

□

3

□

3

□

5

□

4

□

4

□

4

□

4

□

4

□

4

□

4

□

□

5

□

5

□

5

□

5

□

5

□

5

□

5

□
□
□
□
□
□
□

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

□1The 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.

□2Office staff

□3Other

Boxes for Admin Use

8