NEHRS Supplement - Non-Electronic Respondents

Attachment F2 - NEHRS Supp Quest - nonhie
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 perceptions about 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. Do you still work at the location listed below?

□1

□2

Yes

No (Skip to Q17)

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For the following questions, please provide information related to the location above, which is where you
previously indicated that you saw the most ambulatory care patients.

EHR Satisfaction & Use
2. Does the reporting location use an EHR system? Do not include billing record systems.

□1 Yes

□2 No (Skip to Q8)

□3 Don’t know (Skip to Q8)

3. Overall, how satisfied or dissatisfied are you with your EHR system?

□1 Very satisfied

□2 Somewhat satisfied

□3 Neither satisfied nor dissatisfied

□4 Somewhat dissatisfied

□5 Very Dissatisfied

□6 Not applicable

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Physician Experience with EHRs Survey 2017

OMB No.

Patient Access to their Medical Records
4. 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?

□1

□2

□3

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

□1

□2

□3

Privacy & Security
5. 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

6. 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

7. Does the reporting location use an EHR system to:

Yes

No

Public Health
Send immunization data to immunization registries?

□1

Send syndromic surveillance data to public health agency?
Send case reporting of reportable conditions (e.g. measles,
tuberculosis, ebola) to public health agency?

Don’t Know

Not
applicable

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

□1

□2

□3

□4

Patient engagement
Create educational resources tailored to the patients’ specific
conditions?

□1

□2

□3

□4

Advanced Care Processes
Create shared care plans that are available across clinical care team?

□1

□2

□3

□4

□1

□2

□3

□4

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?

Identify high risk patients that may require follow-up and services?

8. 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
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Physician Experience with EHRs Survey 2017

OMB No.

Participation in Programs offered by the Center for Medicare & Medicaid’s (CMS)
9. 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

10. 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

11. 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
Note: Throughout this survey, the term “electronically” does NOT include scanned or pdf documents, nor does it include
fax, eFax, or e-mail.

12. 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.
Electronically exchanging clinical information with
other providers outside my medical
organization
_.

Strongly
Agree

Somewhat
agree

Somewhat
disagree

Strongly
disagree

Not
applicable

“…would improve my practice’s quality of care.”

□1

□2

□3

□4

□5

“…would increase my practice’s efficiency.”

□1

□2

□3

□4

□5

“…would prevent medication errors.”

□1

□2

□3

□4

□5

“…would reduce duplicate test ordering.”

□1

□2

□3

□4

□5

“…would provide me with clinical information that
I can trust.”

□1

□2

□3

□4

□5
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Physician Experience with EHRs Survey 2017

OMB No.

13. 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

My EHR does not have the capability to electronically exchange
health information with providers outside my medical organization.

□1

□2

□3

□4

My practice would have to pay additional costs to electronically
exchange data with providers outside my medical organization.

□1

□2

□3

□4

It is challenging to electronically exchange data with other providers

□1

□2

□3

□4

exchange data with me.

□1

□2

□3

□4

It is cumbersome to use my EHR to electronically exchange data with
providers outside my medical organization.

□1

□2

□3

□4

My practice is concerned about whether HIPAA permits electronic
exchange of patient health information without patient consent.

□1

□2

□3

□4

My practice is concerned about the privacy and security of health
information that is electronically exchanged.

□1

□2

□3

□4

who use a different EHR vendor.
Providers outside my medical organization cannot electronically

14. 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 Q16)

□3 Uncertain (Skip to Q16)

15. 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
16. What is a reliable E-mail address for the physician to whom this survey was mailed?

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

□1The physician to whom it was addressed

□2Office 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:

□3Other
Boxes for Admin Use

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