NEHRS Supplement - Electronic Respondents

Attachment F1 - NEHRS Supp Quest - hie
Physician Experience with EHRs Survey 2017

Form Approved OMB No. 0920-1015, Exp.Date XX/XX/2017

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 (0920-1015).
Assurance of Confidentiality - We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals,
a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors and agents will not disclose or release responses in
identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC
242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with
CIPSEA every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both
if he or she willfully discloses ANY identifiable information about you. In addition, NCHS complies with the Cybersecurity Enhancement Act of 2015.
This law requires the Federal government to protect its information by using computer security programs to identify cybersecurity risks against federal
computer networks.
The Cybersecurity Act of 2015 permits monitoring information systems for the purpose of protecting a network from hacking, denial of service attacks
and other security vulnerabilities.1 The software used for monitoring may scan information that is transiting, stored on, or processed by the system. If the
information triggers a cyber threat indicator, the information may be intercepted and reviewed for cyber threats. The Cybersecurity Act specifies that the
cyber threat indicator or defensive measure taken to remove the threat may be shared with others only after any information not directly related to a
cybersecurity threat has been removed, including removal of personal information of a specific individual or information that identifies a specific
individual. Monitoring under the Cybersecurity Act may be done by a system owner or another entity the system owner allows to monitor its network and
operate defensive measures on its behalf.
“Monitor” means “to acquire, identify, or scan, or to possess, information that is stored on, processed by, or transiting an information system”;
“information system” means “a discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination
or disposition of information”; “cyber threat indicator” means “information that is necessary to describe or identify security vulnerabilities of an information
system, enable the exploitation of a security vulnerability, or unauthorized remote access or use of an information system”.
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Physician Experience with EHRs Survey 2017
The purpose of this survey is to collect information about physician experiences with electronically sharing patient health information
and your EHR more generally. 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 xxx-xxx-xxxx.
1.

□1 Yes

Do you still work at the location listed below?

□2 No (Skip to Q22)

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For the following questions, please provide information related to the location above in Q1, which is where you
previously indicated that you saw the most ambulatory care patients.
EHR Satisfaction & Use
2.

3.

Overall, how satisfied or dissatisfied are you with your EHR system?
□1 Very satisfied

□2 Somewhat satisfied

□4 Somewhat dissatisfied

□5 Very Dissatisfied

□3 Neither satisfied nor dissatisfied
□6 Not applicable

Has your reporting location changed EHR system vendor within the last 6 months?
□1 Yes
□2 No
□3 Don’t know

4.

}

(Skip to Q5)

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

□2 No

□3 Don’t know

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Physician Experience with EHRs Survey 2017

OMB No.

5. Does the reporting location use an EHR system to:
Public Health
Send immunization data to immunization registries?
Send syndromic surveillance data to public health agency?
Send case reporting of reportable conditions (e.g. measles, tuberculosis,
ebola) to public health agency?
Quality measurement
Send clinical quality measures to public and private insurers (e.g., blood
pressure control, Hb1AC, smoking status)?
Review your practice’s performance on clinical quality measures?
Patient engagement
Create educational resources tailored to the patients’ specific conditions?
Advanced Care Processes
Create shared care plans that are available across clinical care team?
Identify high risk patients that may require follow-up and services?

Yes

No

□1

□2

□1

□2

□1

□2

□1

Don’t Know Not applicable
□3

□4

□3

□4

□3

□4

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

Patient Access to their Medical Records
Does your EHR have the computerized capability to allow patients to…

Yes

No

Don’t Know

View their online medical record?

□1

□2

□3

Download their online medical record to their personal files?

□1

□2

□3

Send their online medical record to a third party (e.g. another provider, personal
health record)?

□1

□2

□3

Upload their health information from devices or apps (e.g., blood glucose meter,
Fitbit, questionnaires)?

□1

□2

□3

6.

7. Does your practice use telemedicine technology (e.g. telephone, web videoconference) for patient visits?
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

Privacy & Security
8. 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.
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

9. Are you required to use more than one of the following methods to access your EHR system? Methods to
access your system might include: username and password to login, security card or key, pin, biometric
data.
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

10. Does your practice generally obtain written authorization from patients to electronically exchange
information for treatment purposes? Note: HIPAA generally permits providers to electronically share patient
health information for treatment of patients they have in common without written authorization from the patient.
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

Participation in Programs offered by the Center for Medicare & Medicaid’s (CMS)
11. Do you participate in the Medicaid EHR Incentive Program (e.g. Meaningful Use Program)?
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

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Physician Experience with EHRs Survey 2017

OMB No.

12. Do you participate or plan to participate in the Merit-Based Incentive Payment System? Merit-Based Incentive
Payment System, a new program for Medicare-participating physicians, will adjust payment based on performance
and consolidate three programs: the Physician Quality Reporting System, the Physician Value-based Payment
Modifier, and the Medicare EHR Incentive Program (“Meaningful Use”).
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

13. Do you participate or plan to participate in the Alternative Payment Model? Alternative Payment Models are new
approaches to paying for medical care through Medicare that incentivize quality and value, including CMS Innovation
Center model, Medicare Shared Savings Program, Health Care Quality Demonstration Program or Demonstration
required by federal law.
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

Health Information Exchange and Health IT use
Note: In this section, the term “electronically” does NOT include scanned, pdf or e-faxed documents.
14. When you refer patients to providers outside your medical organization, does your practice typically send
their clinical information to these providers electronically?
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

15. Does your practice typically receive referral results electronically from providers outside your medical
organization?
□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

16. Please indicate whether these issues are barriers to electronic information exchange with providers outside
your medical organization. Note: Information exchange refers to electronically sending, receiving, finding or
integrating patient health information.
Yes

No

Don’t know

Not applicable

Providers outside my medical organization cannot electronically
exchange data with me.
My practice would have to pay additional costs to electronically
exchange data with providers outside my medical organization.

□1

□2

□3

□4

□1

□2

□3

□4

It is cumbersome to use my EHR to electronically exchange data
with providers outside my medical organization.
I have to use multiple systems or portals to electronically
exchange data with providers outside my medical organization.

□1

□2

□3

□4

□1

□2

□3

□4

It is challenging to electronically exchange data with other
providers who use a different EHR vendor.
It is difficult to locate the address of the provider to electronically
send patient health information.
My practice is concerned about the privacy and security of health
information that is electronically exchanged.
The information that is electronically exchanged is not useful.

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

17. To what extent do you agree or disagree with the following statements?
Note: Information exchange refers to electronically sending, receiving, finding or integrating patient health information.
Strongly
Agree

Somewhat
agree

Somewhat
disagree

Strongly
disagree

Not
applicable

“…improves my practice’s quality of care.”
“…increases my practice’s efficiency.”

□1

□2

□3

□4

□5

□1

□2

□3

□4

□5

“…prevents medication errors.”

□1

□2

□3

□4

□5

“…reduces duplicate test ordering.”
“…provides me with clinical information that I can trust.”

□1
□1

□2
□2

□3
□3

□4
□4

□5
□5

Electronically exchanging clinical information with other
providers outside my medical organization
.

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Physician Experience with EHRs Survey 2017

OMB No.

18. Please indicate your level of agreement with each of the following statements.
Strongly
agree

Somewhat
agree

Somewhat
disagree

Strongly
disagree

Not
applicable

Electronically reviewing quality meaures from my EHR helps me to
identify areas for improvement.

□1

□2

□3

□4

□5

Clinical information that I need from outside sources is readily
available within my EHR.

□1

□2

□3

□4

□5

My EHR allows me to follow-up with patients who have not filled
their prescriptions.

□1

□2

□3

□4

□5

Electronic access to recent laboratory results from other providers
saves me from ordering the same test.

□1

□2

□3

□4

□5

Electronic access to recent images from other providers saves me
from ordering the same image.

□1

□2

□3

□4

□5

Electronically receiving notifications of ED visits or hospital
admission enables me to follow-up with patients.

□1

□2

□3

□4

□5

Reconciling medication data electronically received from outside
my medical organization increases patient safety.

□1

□2

□3

□4

□5

Electronically exchanging care summaries with providers outside
my medical organization enhances care coordination.

□1

□2

□3

□4

□5

19. Since 2016, the National Center for Health Statistics (NCHS) has had a public health reporting registry that collects
data on patient visits from physicians for statistical purposes. Participation in this registry is recognized by CMS as
fulfilling one of the Public Health Reporting measures for Meaningful Use and Merit-Based Incentive Payment System.
Would you be willing to have NCHS contact your practice to obtain electronic health record (EHR) data on
patient visits for statistical purposes only?

□1 Yes

□2 No (Skip to Q21)

□3 Uncertain (Skip to Q21)

20. Starting in 2018, a certified EHR system will have the capability to produce Health Level-7 Clinical Document
Architecture (HL7 CDA) documents according to the National Health Care Surveys (NCHS) Implementation Guide.
Will your EHR system be able to produce HL7 CDA documents according to the NCHS Implementation
Guide?

□1 Yes, my EHR system will be able to produce such documents
□2 Yes, I will need to verify with administrative staff
□3 No
□4 Don’t know
21. What is a reliable E-mail address for the physician to whom this survey was mailed?

22. Who completed this survey? (Check all that apply)

□1 The physician to whom it was addressed

□2 Office staff

Thank you for your participation. Please return your survey in the envelope
provided. If you have misplaced the envelope, please send the survey to:

□3 Other
Boxes for Admin Use

4