2018 NEHRS Questionnaire

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

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 - 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 U.S.C. 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 Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note).This
law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking,
internet attacks, and other security weaknesses. If information sent through government networks triggers a cyber threat indicator, the information may be
intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the government.
The Federal Cybersecurity Enhancement Act of 2015 allows software programs to scan information that is sent, stored on, or processed by government
networks in order to protect the networks from hacking, denial of service attacks, and other security threats. If any information is suspicious, it may be reviewed
for specific threats by computer network experts working for the government (or contractors or agents who have governmental authority to do so). Only
information directly related to government network security is monitored. The Act further specifies that such information may only be used for the purpose of
protecting information and information systems from cybersecurity risks.

National Electronic Health Records Survey 2018
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 (EHRs) 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 xxx-xxx-xxxx.

1. We have your specialty as:

4. Do you see ambulatory patients in any of the
following settings? CHECK ALL THAT APPLY.

Is that correct?

□1
□2

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.

2. Do you directly care for any ambulatory patients in
your work?

□1

Yes

Go to Question 3

□2

No

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

□3

□
2□
1

Yes

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

□

3

□
5□
4

□

6

□

7

□

8

□

9

□

10

Private solo or group practice
Freestanding clinic or Urgent Care
Center
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,
health system 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 50

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.
1

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

6. What are the county, state, zip code, and telephone number of the reporting location?
Country

USA

County

Zip Code

State

Telephone

7. How many physicians, including you, work at this
14. What percent of your patients are insured by
practice (including physicians at the reporting location,
Medicaid?
_______________%
and physicians at any other locations of the practice)?

□1
□2
□3

1 physician
2-3 physicians
4-10 physicians

□4
□5
□6

11-50 physicians

15. Do you treat patients insured by Medicare?

51-100 physicians

□1

More than 100 physicians

8. How many physicians, including you, work at the
reporting location? ___________

__________ Mid-level providers

10. Is the reporting location a single- or multi-specialty
(group) practice?

□2 Multi

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

□1 Yes

□2 No (Skip to 13) □3 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
2. Medicare
3. Medicaid/CHIP
4. Workers’ compensation
5. Self-pay
6. No charge

Yes

No

Don’t
Know

□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3

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

□1

Yes

□2 No

□3 Don’t know

□2 No

□3 Don’t know

16. Who owns the reporting location? CHECK ONE.

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

□1 Single

Yes

□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. Do you or your reporting location currently
participate in any of the following activities or
programs? Check all that apply.

□1 Patient Centered Medical Home (PCMH)
□2 Accountable Care Organization (ACO) arrangement with
public or private insurers

□3 Pay-for-Performance arrangement (P4P)
□4 Medicaid EHR Incentive Program (e.g., Meaningful Use
Program)

18. Do you participate or plan to participate in the
following Medicare programs? Check all that apply.
Merit-Based Incentive Payment System will adjust payment
based on performance. Advanced Alternative Payment Models
are new approaches to paying for medical care that incentivize
quality and value.

□1 Merit-Based Incentive Payment System
□2 Advanced Alternative Payment Model
□3 Not applicable
19. Does the reporting location use an EHR system? Do
not include billing record systems.

□1 Yes
□2 No (Skip to 23)
□3 Don’t know (Skip to 23)
2

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

20. What is the name of your primary EHR system? CHECK ONLY ONE BOX. IF OTHER IS CHECKED, PLEASE
SPECIFY THE NAME.

□1 Allscripts
□2 Amazing Charts
□3 athenahealth
□4 Cerner
□5 eClinical Works

□6 e-MDs
□7 Epic
□8 GE/Centricity
□9 Modernizing Medicine
□10 NextGen

□11 Practice Fusion
□12 Sage/Vitera/
Greenway

□13 Other, specify: ___________________
□14 Unknown

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

□1 Very satisfied
□4 Somewhat dissatisfied

□2 Somewhat satisfied
□5 Very dissatisfied

□3 Neither satisfied nor dissatisfied
□6 Not applicable

22. 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

23. Does the reporting location use a computerized system to (CHECK NO MORE THAN
ONE BOX PER ROW):
DOCUMENTATION
RECORDING

Yes

No

Don’t
Know

□1
□1
□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3
□3
□3

Create shared care plans that are available across the clinical care team?

□1
□1
□1
□1

□2
□2
□2
□2

□3
□3
□3
□3

Send clinical quality measures to public and private insurers (e.g., blood
pressure control, HbA1c, smoking status)?

□1

□2

□3

Record social determinants of health (e.g., employment, education)?

INFORMATION
Record behavioral determinants of health (e.g., tobacco use, physical
activity, alcohol use)?
Order prescriptions?
Are prescriptions sent electronically to the pharmacy?
Are warnings of drug interactions or contraindications provided?
SAFETY
SAFETY

Order lab tests?
Order radiology tests?
Provide reminders for guideline-based interventions or screening tests?

PATIENT
ENGAGEMENT
PATIENT
ENGAGEMENT

Create educational resources tailored to the patients’ specific conditions?
Exchange secure messages with patients?
Generate lists of patients with particular health conditions?

POPULATION
POPULATION
MANAGEMENT
MANAGEMENT
QUALITY
MEASUREMENT

Create reports on clinical care measures for patients with specific chronic
conditions (e.g., HbA1c for diabetics)?

24. How frequently do you use template-based notes in your EHR system?
Template-based notes are generated through forms or pre-filled text in an EHR rather than free text alone.

□1 Often (Go to 24a)
□2 Sometimes (Go to 24a)
□5 Don’t know (Skip to 25) □6 Not Applicable (Skip to 25)

□3 Rarely (Go to 24a)

□4 Never (Skip to 25)

24a. To what extent do you customize your templates?

□1 A great extent

□2 Somewhat □3 Very little or not at all □4 Don’t know
3

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

24b. How easy or difficult is it to locate information in template-based notes?

□1 Very easy

□2 Somewhat easy

□3 Somewhat difficult

□4 Very difficult

24c. How easy or difficult is it to locate information in free-text notes?

□1 Very easy

□2 Somewhat easy

□3 Somewhat difficult

□4 Very difficult

Patient Engagement
25. Does your practice use telemedicine technology (e.g., audio with video, web videoconference) for patient
visits?

□1 Yes

□2 No

□3 Don’t know

26. Does your EHR system allow patients to…

Yes

No

□1
□1
□1
□1

View their online medical record?
Download their online medical record to their personal files?
Send their online medical record to a third party (e.g., another provider, personal health record)?
Upload their health information from devices or apps (e.g., blood glucose meter, Fitbit,
questionnaires)?

Don’t
Know

□2
□2
□2
□2

□3
□3
□3
□3

Prescribing Controlled Substances
27. How frequently do you prescribe controlled substances?

□1

Often

□2

Sometimes

□3

Rarely

□4

Never (Skip to 30)

□4

Don’t know (Skip to 30)

28. How frequently are prescriptions for controlled substances sent electronically to the pharmacy?

□1

Often

□2

Sometimes

□3

□4

Rarely or Never

Don’t know

29. How frequently do you or designated staff check your state’s prescription drug monitoring program (PDMP)
prior to prescribing a controlled substance to a patient for the first time?

□1

Often (Go to 29a)

□2

Sometimes (Go to 29a)

□3

Rarely (Go to 29a) □4 Never (Skip to 30)

□5

Don’t know (Skip to 30)

29a. How do you or your designated staff check your state’s PDMP?

□1 Use EHR system

□2 Use system outside of EHR (e.g., PDMP portal or secure website) □3

Don’t know

29b. How easy or difficult is it to use your state’s PDMP to find your patient’s information?

□1 Very easy □2 Somewhat easy

□3 Somewhat difficult

□4 Very difficult

□5

Don’t Know

29c. When checking your state’s PDMP, do you or designated staff typically request to view PDMP data
from other states prior to prescribing a controlled substance for the first time?

□1 Yes

□2 No

□3 Don’t Know

29d. Have you done any of the following as a result of using the PDMP? Check all that apply.

□1 Reduced or eliminated controlled substance prescriptions for a patient
□2 Changed controlled substance prescriptions to non-opiod pharmacologic (e.g., NSAIDS or acetaminophen) or nonpharmacologic therapy (e.g., exercise/physical therapy or CBT).

□3 Prescribe naloxone
□4 Refer additional treatment (e.g., substance abuse treatment, psychiatric or pain management)
□5 Confirm patients’ misuse of prescriptions (e.g., engage in doctor shopping)
□6Confirm appropriateness of treatment
□7 Assess pain and fuction of patient (e.g., PEG)
□8 Consult with other prescribers listed in PDMP report
□9 Consult and/or coordinate with other members of the care team
4

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

Electronic Exchange of Patient Health Information
30. Do you ONLY send and receive patient health information through paper-based methods including fax, eFax,
or mail?

□1

□2 No (Go to 31)

Yes (Skip to 37)

□3

Don’t know (Go to 31)

31. Do you electronically send patient health information to other providers outside your medical organization
using an EHR (not eFax) or a Web Portal (separate from EHR)?

□1

□2

Yes (Go to 32)

□3

No (Skip to 33)

32. Do you send patient health information to any of the
following providers electronically? Electronically does not
include scanned or pdf documents, fax, or eFax.

Don’t know (Skip to 33)

Yes

No

Don’t
Know

Not
Applicable

Ambulatory care providers outside your organization

□1

□2

□3

□4

Hospitals unaffiliated with your organization

□1

□2

□3

□4

Behavioral Health providers

□1

□2

□3

□4

Long-term care providers

□1

□2

□3

□4

33. Do you electronically receive patient health information from other providers outside your medical
organization using an EHR system (not eFax) or a Web Portal (separate from EHR)?

□1

□2

Yes (Go to 34)

No (Skip to 35)

□3

Don’t know (Skip to 35)

34. Do you receive patient health information from the following
providers electronically? Electronically does not include
scanned or pdf documents, fax, or eFax.

Yes

No

Don’t
Know

Not
Applicable

Ambulatory care providers outside your organization

□1

□2

□3

□4

Hospitals unaffiliated with your organization

□1

□2

□3

□4

Behavioral Health providers

□1

□2

□3

□4

Long-term care providers

□1

□2

□3

□4

35. Does your reporting location electronically send or receive patient health information with public health
agencies? Public health agencies can include the CDC, state or local public health authorities.

□1 Yes (Go to 35a)

□2 No (Skip to 36)

□3 Don’t Know (Skip to 36)

□4 Not applicable (Skip to 36)

35a. What types of information do you electronically send or receive? Check all that apply.

□1 Syndromic surveillance data
□2 Case reporting of reportable conditions
□3 Immunization data
□4 Public health registry data (e.g., cancer)

5

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

36. For providers outside of your medical
organization, do you regularly
electronically send and receive, send
only, or receive only the following types
of patient health information?

Both Send and
Send
Receive
Electronically
Electronically
Only

Receive
Electronically
Only

Do not Send or
Receive
Electronically

Progress/Consultation notes

□1

□2

□3

□4

Clinical registry data

□1

□2

□3

□4

Emergency Department notifications

N/A

N/A

□3

□4

Summary of care records for transitions of care or
referrals

□1

□2

□3

□4

37. When seeing a new patient or a patient who has previously seen another provider, do you electronically
search or query for your patient’s health information from sources outside of your medical organization?
This could include via remote or view only access to other facilities’ EHR or health information exchange organization.

□1

□2

Yes (Go to 37a)

□3

No (Skip to 38)

Don’t know (Skip to 38)

37a. Do you electronically search for the following patient
health information from sources outside your medical
organization?

Yes

No

Don’t
Know

Progress/Consultation notes

□1

□2

□3

Vaccination/Immunization history

□1

□2

□3

Summary of care record

□1

□2

□3

38. Does your EHR system integrate any type of patient health information received electronically (not e-fax)
without special effort like manual entry or scanning?

□1

□2 No (Skip to 39) □3

Yes (Go to 38a)

□4

Don’t know (Skip to 39)

Not applicable (Skip to 39)

38a. Does your EHR system integrate summary of care records received electronically (not e-fax) without
special effort like manual entry or scanning?

□1

Yes

□2

No

□3

Don’t know

39. Do you reconcile the following types of clinical
information electronically received from providers
outside of your medical organization?
Reconciling involves comparing a patient’s information from
another provider with your practice’s clinical information.

□4

Not applicable

Yes

No

Don’t
Know

Not
Applicable

Medication lists

□1

□2

□3

□4

Medication allergy lists

□1

□2

□3

□4

Problem lists

□1

□2

□3

□4
6

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

Availability and use of Electronic Health Information
40. When treating patients seen by 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
□6

Often

□2

Sometimes

□3

Rarely

□4

□5

Never

Don’t Know

I do not see patients outside my medical organization

41. How frequently do you use patient health information electronically (not eFax) received from providers or
sources outside your organization when treating a patient?
1 Often (Skip to 41)

2 Sometimes (Skip to 41) 3 Rarely (Go to 40a)

4 Never (Go to 40a) 5 Don’t know (Skip to 41)

41a. If rarely or never used, please indicate the reason(s) why. Check all that apply.
1 Information not always available when needed (e.g., not timely, missing)
2 Do not trust accuracy of information
3 Difficult to integrate information in EHR
4 Information not available to view in EHR as part of clinicians’ workflow
5 Information not useful (e.g., redundant or unnecessary information)
6 Difficult to find necessary information

Benefits and Barriers to Exchange of Electronic Health Information
Information exchange refers to electronically sending, receiving, finding or integrating patient health information.
42. Please indicate your level of agreement with each of the following statements.
Strongly Somewhat Somewhat
Electronically exchanging clinical information with
Agree
Agree
Disagree
other providers outside my medical
organization_____________.
“…improves my practice’s quality of care.”
“…increases my practice’s efficiency.”
“…prevents medication errors.”
“…enhances care coordination.”
“…reduces duplicate test ordering.”

□1
□1
□1
□1
□1

□2
□2
□2
□2
□2

□3
□3
□3
□3
□3

Strongly
Disagree

Not
Applicable

□4
□4
□4
□4
□4

□5
□5
□5
□5
□5

43. Please indicate whether these issues are barriers to electronic information exchange with providers outside
your medical organization.
Yes

No

Don’t
know

Not
Applicable

Providers in our referral network lack the capability to electronically exchange
(e.g., no EHR system or HIE connection).

□1

□2

□3

□4

We have limited or no IT staff.

□1
□1
□1
□1

□2
□2
□2
□2

□3
□3
□3
□3

□4
□4
□4
□4

□1
□1
□1

□2
□2
□2

□3
□3
□3

□4
□4
□4

Electronic exchange involves incurring additional costs.
Electronic exchange involves using multiple systems or portals.
Electronic exchange with providers using a different EHR vendor is challenging.
The information that is electronically exchanged is not useful.
It is difficult to locate the electronic address of providers.
My practice may lose patients to other providers if we exchange information.

7

Att B –2018 NEHRS Questionnaire
National Electronic Health Records Survey

Form Approved
OMB No. 0920-1015
Exp. Date: 07/31/2020

Documentation and Burden Associated with Medical Record Systems
For the next questions, medical record system includes paper-based and EHR systems.
44. On average, how many hours per day do you spend outside of normal office hours documenting clinical care
in your medical record system?

□1 None

□2 Less than 1 hour

□3

□4 Greater than 2 hours to 4 hours

1 to 2 hours

□5 More than 4 hours

45. Do you have staff support (e.g., scribe) to assist you with documenting clinical care in your medical record
system?

□1 Yes

□2 No

46. How easy or difficult is it to document clinical care using your medical record system?

□1 Very easy

□2 Somewhat easy

□3 Somewhat difficult

□4 Very difficult

□5

Not applicable

47. Please indicate whether you agree or disagree with the following statements about using your medical record
system.
Strongly
Agree

Somewhat
Agree

Somewhat
Disagree

Strongly
Disagree

Not
Applicable

The amount of time I spend documenting clinical care
is appropriate.

□1

□2

□3

□4

□5

The amount of time I spend documenting clinical care
does not reduce the time I spend with patients.

□1

□2

□3

□4

□5

Additional documentation required solely for billing but
not clinical purposes increases the overall amount of
time I spend documenting clinical care.

□1

□2

□3

□4

□5

48. Clinical care documentation requirements for private insurers generally align with Medicare requirements.
□1 Strongly agree

□2 Somewhat agree

□3 Somewhat disagree

□4 Strongly disagree

□5 Not applicable

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

50. 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

8