Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Mo

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

IHS Website Customer Service Satisfaction Survey CLASS - 2015

IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form

OMB: 0917-0036

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey
REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) Website Customer Service Satisfaction Survey – EHR Survey Monkey – CLASS 

Form Approved 
OMB Form No. 0917­0036
Expiration Date: 
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB 
control number. The valid OMB control number for this information collection is 0917­0036. The time required to complete this information 
collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the 
data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or 
suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., 
Suite 336­E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer 

OIT needs your help in evaluating the RPMS­EHR training approach. Your input will be used to help us improve our 
materials and presentation approach as we deploy the application throughout IHS.  
Questions with a * are required. 

*1. Please provide personal information:
First Name
Last Name
Credentails (RN, NP, CNM, 
LPN ­ only)
Business Address
Email
Facility
Location of Training
Date of Training

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*2. Select the term(s) that best describes your role:
c Physician
d
e
f
g

 

c Pharmacist
d
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f
g
c Nurse
d
e
f
g

 

 

c Physician Assistant
d
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g

 

c Site Manager/IT Representative
d
e
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g

 

c Clinical Applications Coordinator
d
e
f
g
c Medical Records
d
e
f
g
c EHR Super User
d
e
f
g

 

 

 

c EHR Implementation Team
d
e
f
g
c Area Support Staff
d
e
f
g

 

 

c Other (please describe)
d
e
f
g

 
 

*3. How did you hear about this RPMS­EHR course? Select as many information sources

as apply, and/or add others:
c Web site
d
e
f
g

 

c Other (please describe)
d
e
f
g

 
 

*4. What types of “Point­of Service” RPMS Applications are used by you and/or your

organization?

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*5. What did you expect from the EHR Training?
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*6. Overall, did you feel that your objectives were met?
 

j Yes
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j No
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Indian Health Service (IHS) Website Customer Service Satisfaction Survey
7. If no, describe how they could have been met better:
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*8. Were the right people from your organization at the Training?
 

j Yes
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j No
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9. If no, who should have attended? Describe by position and name:
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Please check a box to rate each of the statements listed below. 

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*10. Did the training meet the following educational objectives?
Define roles and 

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responsibilities of the 
Informaticist
Examine principles, 
practices and techniques of 
“Learning Communities” 
and re­usable learning 
objects (RLO)
Examine the framework of 
the Resource Patient 
Management System 
certified Electronic Health 
Record and its related 
clinical applications
Integrate best practices and 
guidelines of Meaningful 
Use (MU) measures within 
an electronic health record 
environment
Work collaboratively across 
disciplines to define, discuss 
and plan a process for 
updating and maintaining 
components of an 
electronic health record
Develop a process for 
configuring parameters 
within an electronic health 
record, understanding how 
these can be customized at 
specific levels depending 
on the needs of the user 
and the institution
Compare and contrast the 
unique roles of users for 
computer provider order 
entry (CPOE) and note 
documentation within an 
electronic environment
Identify processes by which 
customizable notifications 
can be constructed to alert 
specific individuals when a 
certain event occurs in an 
electronic health record 
(e.g. a patient is placed in 
restraints) for ensuring 
patient safety and effective 
communication

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey
Create advanced, structured 

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electronic note 
documentation tools to (a) 
facilitate communication (b) 
promote quality patient 
care and patient safety and 
(c) meet professional and 
legal standards
Integrate Institute for Safe 
Medication Practices 
(ISMP) guidelines and 
standards to include (a) 
content of orders, (b) format 
of orders, and (c) 
management of prescription 
approval, revisions and 
updates
Develop advanced 
electronic patient consult 
tools to promote 
coordination of care and 
collaboration between 
interdisciplinary providers
Implement solutions that 
assure confidentiality 
security and integrity, while 
maximizing electronic 
health record access and 
utilization
Customize picklists for ICD­9 
Diagnosis Codes, E/M 
Services, CPT Procedure 
Codes, and Patient 
Education Codes to 
optimize accuracy of 
clinical documentation
Customize the graphical 
user interface (GUI) to align 
the electronic health record 
with workflow changes
Synthesize advanced skills 
to problem solve issues 
associated with advancing 
electronic health record 
spread

11. Comments:
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6  

Please check a box to rate each of the statements listed below: 

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*12. Please describe the quality of the presentation materials and methods used in this

training.

Materials were clearly 

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Very Good

Excellent

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written and easy to 
understand
Training was paced 
appropriately
Sufficient time for 
comments and audience 
interaction was provided

13. Comments:
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Please check a box to rate each of the statements listed below: 

*14. Please describe the quality of the facilities used in this training.
The presentation 

Poor

Fair

Good

Very Good

Excellent

N/A

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equipment/computers 
functioned properly
The room was a 
comfortable learning 
environment

15. Comments:
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*16. What part of the Training did you find most useful?
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*17. What part of the Training did you find least useful?
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*18. Looking back, how would you rate your

knowledge of the subject before the training?
j Poor
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j Fair
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j Good
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j Very 
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j Excellent
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Good 

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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*19. Now that you have attended the training, how

do you rate your knowledge of the subject?
j Poor
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j Fair
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j Good
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j Very 
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j Excellent
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Good 

*20. List three things you learned that you will use when you go back to your site:
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21. Did you perceive any commercial bias toward any particular product or company in
any of the presentations?
c No
d
e
f
g

 
 

c Yes
d
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f
g

If Yes, please explain 

*22. Please rate the instructor: (Definitions and Roles of the Informaticist and

Informatician)

Demonstrated knowledge of 

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Fair

Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

23. Comments:
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*24. Please rate the instructor: (RPMS Clinical Application Optimization, Electronic Health

Record Customization and Workflow , Advanced TIU Note Templates, Computer Provider
Order Entry , Generic Orders,Overview of VA Fileman, Advanced Design Mode)
Demonstrated knowledge of 

Poor

Fair

Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

25. Comments:
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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*26. Please rate the instructor: (Consults and Effective Communication)
Demonstrated knowledge of 

Poor

Fair

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Very Good

Excellent

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the subject material
Presented information 
clearly

27. Comments:
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*28. Please rate the instructor: (Customizing ICD­9 Diagnoses, CPT Procedures and

Patient Education Picklists)
Demonstrated knowledge of 

Poor

Fair

Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

29. Comments:
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*30. Please rate the instructor: (Advanced Design Mode)
Demonstrated knowledge of 

Poor

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Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

31. Comments:
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*32. Please rate the instructor:(Advanced Informaticist Management Tools)
Demonstrated knowledge of 

Poor

Fair

Good

Very Good

Excellent

N/A

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Presented information 
clearly

33. Comments:
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Indian Health Service (IHS) Website Customer Service Satisfaction Survey

*34. Please rate the instructor: (Notifications Alerts and Ensuring Patient Safety)
Demonstrated knowledge of 

Poor

Fair

Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

35. Comments:
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*36. Please rate the instructor: (CPOE & Patient Safety)
Demonstrated knowledge of 

Poor

Fair

Good

Very Good

Excellent

N/A

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the subject material
Presented information 
clearly

37. Comments:
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Thank You for completing this survey.  
For a certificate of completion, please click here. 
If you have difficulty please contact Mollie Ayala at [email protected]  

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