Form EHR Questionnaire EHR Questionnaire EHR Questionnaire

Behavioral Health IT
and Interoperability Survey
May 2018

The next questions ask about electronic health records (EHRs). For the purpose of this survey, EHRs are
an electronic version of a patient's medical history that is maintained by the provider over time, and may
include all of the key clinical data relevant to that person's care under a particular provider.
1.

Does your facility use an EHR system? Do not include billing record systems.
1
2
3
4

1a.

Yes, we exclusively use an EHR system. No paper charts.
Yes, we use a combination of an EHR system and paper charts.
No, but we plan to implement an EHR system

SKIP TO QUESTION 12, PAGE 4

No, and we have no plan to implement an EHR system

SKIP TO QUESTION 13, PAGE 4

If your facility is part of a larger organization, please indicate whether EHRs are used across all or
some facilities within your organization.
1
2
3
4

2.

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All of the facilities within this organization use EHRs.
Some of the facilities within this organization use EHRs.
Don’t know if other facilities within the organization use EHRs.
This is the only facility in this organization.

Please indicate the name of this facility’s EHR system vendor(s).
SELECT ALL THAT APPLY
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2
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10
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12
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14

3.

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Accumedic

15

AMS

16

Askesis

17

Cerner

18

Co-Centrix

19

E-Clinical Works

20

Core Solutions

21

Credible Behavioral Healthcare Software

22

Echo Group

23

EPIC

24

GE

25

□
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Methasoft

Netanalytics
Netsmart
NextGen
Profiler
Qualifacts
Smart Management
SAMS
Tower Systems
Valant
Welligent
Other
___________________________________

Meditech

d

□

Don’t know

Methware

Does this facility’s EHR integrate or incorporate any type of clinical information (e.g. medications,
lab test results) that is received electronically from providers outside your organization without the
need for manual entry?


Electronic does not refer to e-Fax or scanned documents.



Please consider all organizations outside of your network.
1
0

□
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Yes
No

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May 2018

4.

Do external organization(s) provide this facility with “read only” access to EHR clinical
information?


This means that appropriate staff have the ability to view patient health information in a third party’s
EHR in accordance with HIPAA and 42CFR but not modify the record.
1

5.

Yes

0

□

No

d

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Don’t know

How often do staff at this facility electronically search or query for clients’ health information (e.g.,
medications, outside encounters) from other providers or external sources outside this facility?


Electronic does not refer to e-Fax or scanned documents.
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2
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6

6.

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Almost every day
At least once a week
At least once a month
Less than once a month
Never
Staff don’t have capability to search or query

Please indicate if this facility participates in a state, regional, and/or local Health Information
Exchange Organization (HIO).


A Health Information Exchange Organization (HIO) is an organization that oversees and governs the
exchange of health-related information among organizations according to nationally recognized
standards.
1
2
3
4
d

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HIO is available in my area and we are actively exchanging data in at least one HIO
HIO is available in my area but we are not participating
HIO is not available in my area

SKIP TO
Q.7
(BELOW)

SKIP TO
Q.7
(BELOW)

Not familiar with an HIO
Don’t know if this facility participates in an HIO

6a.

Why does this facility not participate in the HIO?

7.

When treating a patient previously seen by another health provider/organization, how often does
your facility have the patient health information (e.g. medication, labs) electronically available from
that provider/organization?
 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxx
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Always or often
Sometimes
Rarely
Never

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8.

Does this facility use your EHR to:
MARK ONE PER ROW
YES

NO

NOT
APPLICABLE

a. Conduct an intake assessment

1

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0

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na

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b. Record patient history

1

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0

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na

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c.

1

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0

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na

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d. Record social determinants of health (employment, housing)

1

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0

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na

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e. Record patients’ medications

1

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0

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na

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Record patients’ allergies

1

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0

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na

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g. Record diagnoses

1

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0

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na

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h. Record problem lists

1

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0

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na

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i.

Conduct behavioral health screenings or tools

1

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0

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na

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j.

Record clinical notes

1

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0

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na

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k.

Record treatment plans

1

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0

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na

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l.

Monitor client progress

1

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0

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na

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m. Record prescription orders

1

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0

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na

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n. Electronically send prescriptions to the pharmacy

1

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0

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na

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o. Review warnings of medication allergies, drug-drug interactions
or contraindications

1

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0

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na

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p. Reconcile medications when admitting, discharging, and/or
transitioning clients between care settings

1

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0

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na

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q. Order lab tests

1

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0

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na

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r.

View lab results

1

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0

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na

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s.

Record referrals

1

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0

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na

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t.

Record discharge plans

1

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0

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na

□

f.

Record patient demographic information

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May 2018

9.

Does this facility’s EHR allow clients to…
MARK ONE PER ROW
YES

10.

11.

NO

NOT
APPLICABLE

a. Exchange secure messages with their clinicians,
counselors or other medical staff?

1

□

0

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na

□

b. View their medical record (e.g. health and
behavioral health information) online?

1

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0

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na

□

c.

1

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0

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na

□

Download their medical record?

Are there any other functionalities that are missing from your EHR system that would be useful to
serving your clients?
1

□

Yes

0

□

No

IF YES, PLEASE SPECIFY BELOW:

Overall, how satisfied or dissatisfied are you with your EHR system?
1
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5

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Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

SKIP TO Q.14 (NEXT PAGE)

12.

When does this facility plan to implement an EHR system?
1
2
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4

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Within the next 6 months
6 months to 1 year
1 to 2 years
More than 2 years

SKIP TO Q.14 (NEXT PAGE)

13.

Why does this facility not plan to implement an EHR system?

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May 2018

14.

Who was primarily responsible for completing this form? This information will only be used if we need
to contact you about your responses. It will not be published.
MARK ONE ONLY
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Ms

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Mrs

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Mr

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Dr

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Other (specify) ______________________

Name: ______________________________________________________________________________
Title: ________________________________________________________________________________
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Fax Number:

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Email Address: _______________________________________________________________________
Facility Email Address: _________________________________________________________________

Thank you for your collaboration in this study!
Your feedback will be very useful in improving our surveys!

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May 2018