NEHRS Supplement - Non-Respondents

Attachment F3 - NEHRS Supp Quest - nonresp
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 Physician Experience with EHRs 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/electronic medical records (EHRs/EMRs) 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 866-966-1473.

1. We have your specialty as:

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

Is that correct?

□1
□2

No

□ Private solo or group practice
2□ Freestanding clinic or Urgent Care
1

Yes
What is your specialty?

Center

□ Community Health Center (e.g.,

3

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

Continue to Question 3

Federally Qualified Health Center
[FQHC], federally funded clinics
or “look-alike” clinics)

□ Mental health center
5□ Non-federal government clinic (e.g.,

If you see
patients in
any of
these
settings,
go to
Question 5

4

state, county, city, maternal and child
health, etc.)

□ Family planning clinic (including

6

Planned Parenthood)

□2

Please stop here and return
the questionnaire in the
envelope provided. Thank
next
□3 The
I am
no question
longer asks about a normal week.
you for your time.
We define ainnormal
practiceweek as a week with a normal caseload, with
No

}

□ Health maintenance organization or

7

other prepaid practice (e.g., Kaiser
Permanente)

□ Faculty practice plan (an organized

8

group of physicians that treats
patients referred to an academic
medical center)

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

□ Hospital emergency or hospital

9

outpatient departments

□

10

None of the above

}

If you
select only
9 or 10,
go to
Question 26

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.”)

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Physician Experience with EHRs Survey 2017

OMB No.

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.

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

USA

County

State

Address
Zip Code

Telephone

(

)

7. How many physicians, including you, work at this practice (including physicians at the reporting location,
and physicians at any other locations of the practice)?

□1
□2
□3
□4
□5
□6

1 physician
2-3 physicians
4-10 physicians
11-50 physicians
51-100 physicians
More than 100 physicians

8. Who owns the reporting location? CHECK ONE.

□1 Physician or physician group
□2 Insurance company, health plan, or HMO
□3 Community health center
□4 Medical/academic health center
□5 Other hospital
□6 Other health care corporation
□7 Other
9. Does the reporting location use an EHR system? Do not include billing record systems.

□1 Yes

□2 No (Skip to 18)

□3 Don’t know (Skip to 18)

10. 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

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 electronically send or receive patient health information (e.g., laboratory results, medications) from
other providers outside your medical organization using an EHR (not eFax) or a Web Portal (separate from
EHR)?

□1 Send only

□2 Receive only

□3 Send and Receive

□4 Neither Send nor Receive (skip to 18)

13. Do you integrate patient health information into your EHR without special effort like manual entry or
scanning?

□1 Yes □2 No □3 Don’t know

□4 Not applicable

14. Do you integrate summary of care records into your EHR without special effort like manual entry or
scanning?

□1 Yes □2 No □3 Don’t know

□4 Not applicable

15. Do you electronically search for your patient’s health information from sources outside of your medical
organization (e.g., remote access to other facility, health information exchange organization)?

□1 Yes

□2 No

□3 Don’t know

16. When treating patients seen by other 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 Often □2 Sometimes □3 Rarely □4 Never □5 Don’t Know
□6 Do not see patients outside my organization
17. How frequently do you use patient health information electronically received from providers outside your
medical organization when treating a patient? Electronically available does not include scanned or PDF
documents.

□1 Often

□2 Sometimes

□3 Rarely □4 Never

□5 Don’t Know

17a. 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)
□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
□7 Other

18. Has your reporting location been recognized as a Patient Centered Medical Home (PCMH) by a state, a
commercial health plan, or a national organization?

□1 Yes

□2 No

□3 Don’t know
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Physician Experience with EHRs Survey 2017

OMB No.

19. Does the reporting location participate in an Accountable Care Organization (ACO) arrangement with
Medicare or private insurers?

□1 Yes

□2 No

□3 Don’t know

20. Does the reporting location participate in a Pay-for-Performance arrangement, where you can receive
financial bonuses based on your performance?

□1 Yes

□2 No

□3 Don’t know

21. 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

22. 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

23. 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 Q25)

□3 Uncertain (Skip to Q25)

24. 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
25. What is a reliable E-mail address for the physician to whom this survey was mailed?

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

□1 The physician to whom it was addressed

□2O ffice staff

□3 Other

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

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