Nehrs 2016

The National Ambulatory Medical Care Survey (NAMCS) National Electronic Health Record Survey (NEHRS)

Attachment A - 2016 National Electronic Health Records Survey

National Electronic Health Records Survey 2016

OMB: 0920-1015

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-1015 can be found here:

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Attachment A - 2016 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 (0920-1015).
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 2016
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?

□

_______________________________________
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

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

□3

I am no longer
in practice

}

□
□
□

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?

□

__________ 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)
If you see
patients in
any of
these
settings,
go to
Question 5

Mental health center
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
Question 43

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
(

)

National Electronic Health Records Survey

OMB No. 0920-1015: Approval expires 04/30/2017

7. 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
□2
□3

□4
□5
□6

1 physician
2-3 physicians
4-10 physicians

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

8. How many physicians, including you, work at the
reporting location? ___________
9. Is the reporting location a single- or multi-specialty
(group) practice?

□1

□2

Single

Multi

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

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

□1
□2
□3

Yes
No (Skip to 13)
Don’t know (Skip to 13)

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

Yes

No Unknown

□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

13. What percent of your patients are insured by Medicaid?

_______________%

14. Do you treat patients insured by Medicare?

□1

Yes

□2

□3

Don’t know

Yes

□2

□3

□1
□2
□3
□4
□5
□6
□7

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

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 for Ambulatory Health
Care (AAAHC)?

□1

Don’t know

Yes

□2

□3

Don’t know

18. Does the reporting location participate in an
Accountable Care Organization (ACO) 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

□3

Don’t know

19. Estimate the approximate number of years you have
used any electronic health record (EHR) system? Do
not include billing record systems.

□ Never used an EHR system
□ Under 1 year
□ ________year(s)
20. Does the reporting location use an EHR system?

□1
□2
□3

Yes
No

(Skip to 22)

Don’t know (Skip to 22)

21. Does your EHR system meet meaningful use criteria
(certified EHR) as defined by the Department of
Health and Human Services?

□1

15. Is this medical organization affiliated with an
Independent Practice Association (IPA) or Physician
Hospital Organization (PHO)?

□1

16. Who owns the reporting location? CHECK ONE.

Yes

□2

□3

Don’t know

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

□1

Yes

□2

□3

Don’t know

National Electronic Health Records Survey

OMB No. 0920-1015: Approval expires 04/30/2017

23. Indicate whether the reporting location uses each of the computerized capabilities listed
below. CHECK NO MORE THAN ONE BOX PER ROW.
Does the reporting location use a computerized system to:

Yes

Don’t
know

Order radiology tests?

□
□
□
□
□
□
□
□
□
□
□

Provide reminders for guideline-based interventions or screening tests?

□

Reconcile lists of patient medications to identify the most accurate list?

□

Provide patients with clinical summaries for each visit?

□

□
□
□

□

Record patient history & demographic information?
Record patient problem list?
BASIC
COMPUTERIZED
CAPABILITIES

Record patients’ allergies and medications?
Record clinical notes?
View lab results?
View imaging reports?
Order prescriptions?
Are prescriptions sent electronically to the pharmacy?
Are warnings of drug interactions or contraindications provided?
Order lab tests?

SAFETY

PATIENT
ENGAGEMENT

Exchange secure messages with patients?
Identifying patients due for preventive or follow-up care?

POPULATION
MANAGEMENT

Providing data to generate lists of patients with particular health
conditions?
Providing data to create reports on clinical care measures for patients with
specific chronic conditions (e.g., HbA1c for diabetics)?

24. Do you refer patients to the following

Yes,

Yes,
we send patient
health information
electronically
(EHR, webportal or
online registries)

we send patient
health information
via paper-based
methods
(Fax, eFax, or mail)

Yes,
we send patient
health information
both electronically
and via paper
based methods

Yes,
we do not
send patient
health
information to
the provider

Ambulatory care providers outside your organization

□

Ambulatory care providers within your organization

□

Hospitals unaffiliated with your organization

□

Hospitals affiliated with your organization

□

Behavioral Health providers

□

Long-term care providers

□

providers? If so, how do you send patient
health information to them? Electronic
does not include fax, eFax, or mail.

National Electronic Health Records Survey

OMB No. 0920-1015: Approval expires 04/30/2017

25. Do you see patients from the following

providers? If so, how do you receive
patient health information from them?
Electronic does not include fax, eFax, or
mail.

Yes,
we receive patient
health information
electronically
(EHR, webportal or
online registries)

Yes,
we receive patient
health information
via paper-based
methods

Yes,
Yes,

(Fax, eFax, or mail)

we receive patient
health information
both electronically
and via paper based
methods

we do not
receive
patient
health
information
from the
provider

Ambulatory care providers outside your
organization

□

Ambulatory care providers within your organization

□

Hospitals unaffiliated with your organization

□

Hospitals affiliated with your organization

□

Behavioral Health providers

□

Long-term care providers

□

26. Do you ONLY send and receive patient health information through paper-based methods including fax,
eFax, or mail?

□1 Yes (Skip to
□2 No
□3 Don’t know

32)

27. Do you send or receive patient health information electronically? Electronically does not include scanned or
pdf documents from fax, eFax, or mail.

□1 Yes
□2 No (Skip to 32)
□3 Don’t know (Skip

to 32)

28. Do you electronically send patient health information to another provider whose EHR system is different from

your own?

□1 Yes
□2 No
□3 Don’t know
29. Do you electronically receive patient health information from another provider whose EHR system is different

from your own?

□1 Yes
□2 No
□3 Don’t know

National Electronic Health Records Survey
30. For providers outside of your medical organization,
do you electronically send and receive, send only,
or receive only the following types of patient health
information?
Medication lists
Patient problem lists
Medication allergy lists
Imaging reports
Laboratory results
Public health registry data (e.g., immunizations, cancer)
Clinical registries

OMB No. 0920-1015: Approval expires 04/30/2017

Both Send
Send
Receive
Do not Send
and Receive Electronically Electronically or Receive
Electronically
Only
Only
Electronically

□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2

□1

□2

Hospital discharge summaries
Emergency Department notifications
Summary of care records for transitions of care or referrals
Patient-generated data (e.g. data from self-monitoring

devices or mobile health applications)
31. When electronically receiving information from other
providers, do you integrate the following types of
patient health information into your EHR without
special effort like manual entry or scanning?

□3
□3
□3
□3
□3
□3
□3
□3
□3
□3

□4
□4
□4
□4
□4
□4
□4
□4
□4
□4

□3

□4

Yes

Don’t know

Not
Applicable

Medication lists

□1

□2

□3

□4

Patient problem lists

□1

□2

□3

□4

Medication allergy lists

□1

□2

□3

□4

Imaging reports

□1

□2

□3

□4

Laboratory results

□1

□2

□3

□4

Public health registry data (e.g., immunizations, cancer)

□1

□2

□3

□4

Referrals (e.g., referral requests or reports)

□1

□2

□3

□4

Hospital discharge summaries

□1

□2

□3

□4

Emergency Department notifications

□1

□2

□3

□4

Summary of care records for transitions of care or referrals

□1

□2

□3

□4

□1

□2

□3

□4

Patient-generated data (e.g. data from self-monitoring

devices or mobile health applications)

National Electronic Health Records Survey

OMB No. 0920-1015: Approval expires 04/30/2017

32. Can patients seen at the reporting location do the following
online activities? Can patients…

Yes

□
1□

View their medical record online?

Download health information from their electronic medical record to their
personal files?
Transmit health information from their electronic medical record to a
designated third party of their choice (e.g. another provider)?

□
1□
1□
1□
1

Request corrections to their electronic medical record?
Enter their health information online (e.g., weight, symptoms)?
Upload their data from self-monitoring devices (e.g., blood glucose readings)?

33. Within the last 30 days has your EHR system…

Yes

□
2□
2

□
2□
2□
2□
2

□

Alerted you to a potential medication error?

Led to a potential medication error?

Inadvertently led you to select the wrong medication or lab order from a list?

Led to less effective communication during patient visits?

Made it difficult for you to find clinical content needed for medical decision
making?

Sent you too many alerts, causing you to overlook something important?

Alerted you to critical lab values?

Reminded you to provide preventive care (e.g., vaccine, cancer screening)?

Reminded you to provide care that meets clinical guidelines for patients with
chronic conditions?

Facilitated direct communication with a patient (e.g., email or secure
messaging)?

Facilitated direct communication with other providers who are part of your
patient care team?

Enhanced overall patient care?

Don’t Know

□
3□
3

□
3□
3□
3□
3

Not
Applicable

□

□
□
□
□
□
□
□
□
□
□
□

34. When treating patients seen by other providers outside your medical organization, how often do you or your
staff have clinical information from those outside encounters electronically available at the point of care?
Electronically available does not include scanned or PDF documents.

□1

Often

□2

Sometimes

□3

□5

Don’t Know

□6

I do not see patients outside my medical organization

Rarely

□4

Never

National Electronic Health Records Survey

OMB No. 0920-1015: Approval expires 04/30/2017

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

□1

Yes (Go to 36)

□2

No (Skip to 41)

□3

37. Do you routinely search for

Don’t Know (Skip to 41)

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

the following patient health
information from sources
outside your medical
organization?

Yes

Lab results

□

Patient problem lists

□

Imaging reports

□

Medication lists

□

Medication allergy list

□

Discharge summaries

□

□1

Always

□2

Often

□3

Sometimes

Vaccination history

□

□4

Rarely

Advance directives

□

□5

Never

Care plans

□

38. How often do you use electronically received patient
health information from outside of your medical
organization to manage your patient population?

39. Do you prescribe controlled substances?

□1

Yes

□1

Often

□2

No (Skip to 41)

□2

Sometimes

□3

Don’t Know (Skip to 41)

□3

Rarely

□4

Never

□5

Don’t know

40. Are prescriptions for controlled substances sent
electronically to the pharmacy?

□1

Yes

□2

□3

Don’t Know

National Electronic Health Records Survey
41. To what extent do you agree or disagree with the
following statements.

OMB No. 0920-1015: Approval expires 04/30/2017

Strongly
Agree

Somewhat Somewhat
Agree
Disagree

Strongly
Disagree

Not
Applicable

Electronic information exchange with providers outside my
organization gives me access to the patient health
information I need.

□1

□2

□3

□4

□5

Electronically sending clinical information to providers
outside my organization is easy to do using my EHR.

□1

□2

□3

□4

□5

Electronically receiving clinical information from other

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization improves my ability to coordinate care for my
patients.

□1

□2

□3

□4

□5

Electronic information exchange with other providers
reduces duplicate test ordering.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization is cumbersome to do with our EHR.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization prevents medication errors.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization is difficultbecause providers in my referral
network do not have the capability to exchange data
electronically.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization provides me with clinical information that I can
trust.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside my
organization increases my practice’s vendor costs.

□1

□2

□3

□4

□5

providers is easy to do using my EHR

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

□1

The physician to whom it was addressed

□2

Office staff

□3

Other

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.
Boxes for Admin Use

File Type	application/pdf
File Title	EHR Survey
Author	Chris Martin-Otto
File Modified	2015-09-24
File Created	2015-09-24