Proposed Changes to NEHRS 2017

Attachment D - Proposed Changes to the NEHRS

Questions deleted
22. At the reporting location, are there plans to purchase a new EHR system within the next 18 months?

□1

Yes

□2

No

□3

Don’t know

24. To what extent do you agree or disagree that your practice has optimized the use of its EHR system?
□1

Strongly Agree

□2

Somewhat Agree

□3

Somewhat Disagree

□4 Strongly Disagree

30. To what extent do you agree or disagree that you can trust the clinical information you receive
electronically from providers outside your organization?
□1 Strongly Agree
□2

Somewhat Agree

□3

Somewhat Disagree

□4 Strongly Disagree

36. How often do you electronically search for health information from sources outside of your medical
organization when seeing a new patient or an existing patient who has received services from other
providers?

□1

Always

□2

Often

□3

Sometimes

□4

Rarely

□5 Never
38. How often do you use electronically received patient health information from outside of your medical
organization to manage your patient population?

□1

Often

□2

Sometimes

□3

Rarely

□4

Never

□5

Don’t know

1

Attachment D – Changes to Approved 2017 NEHRS

Changes to the Assurance of Confidentiality languages in the approved 2017 NEHRS, formerly the
2016 NEHRS (previously approved languages are in red; updated languages are in black)
All information which would permit identification of an individual, a practice, or an establishment will
be held confidential, will be used only by NCHS staff, contractors, and agents only when required and
with necessary controls, and will not be disclosed or released to other persons without the consent of
the individual or the 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 (PL-107347).
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 Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note).
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.
____________________________________
1

“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”.
2

Attachment D – Changes to Approved 2017 NEHRS

Questions modified (questions in approved 2017 NEHRS (previously ERB and OMB approved 2016
NEHRS) are in red; updated questions in the proposed 2017 NEHRS are in black)
4. Do you see ambulatory patients in any of the following settings? CHECK ALL THAT APPLY.

□

2

Freestanding clinic/urgicenter (not part of a hospital outpatient department)

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

□

2

Freestanding clinic or Urgent Care Center

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

USA

County

Zip Code



State

Telephone

(

)

Item below amends Q6 above to include a specific address, which will be used as part of the screening
question to verify that the respondent’s responses in the 2017 NEHRS follow-up survey is based on the
reporting location that was identified in the first NEHRS survey conducted in the first quarter of 2017.

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

USA

County

Zip Code
Address

State

Telephone

(

)

______________________________________________________________________________

12. If yes, from those new patients, which of the following types of payment do you accept?

1. Private insurance capitated
2. Private insurance non-capitated
3. Medicare
4. Medicaid/CHIP
5. Workers’ compensation
6. Self-pay
7. No charge



Yes

No

Unknown

□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

Item below amends Q12 above to maintain consistent response choices throughout the survey; the
response choice “Unknown” was changed to “Don’t know”.

3

Attachment D – Changes to Approved 2017 NEHRS
12. If yes, from those new patients, which of the following types of payment do you accept?

1. Private insurance capitated
2. Private insurance non-capitated
3. Medicare
4. Medicaid/CHIP
5. Workers’ compensation
6. Self-pay
7. No charge

Yes

No

Don’t know

□1
□1
□1
□1
□1
□1
□1

□2
□2
□2
□2
□2
□2
□2

□3
□3
□3
□3
□3
□3
□3

17. Has your reporting location been recognized as a Patient Centered Medical Home (PCMH) by a state, a
commercial health plan, or a national organization, such as the National Committee for Quality
Assurance (NCQA), the Joint Commission, URAC, or the Accreditation Association for Ambulatory
Health Care (AAAHC)?

□1

Yes

□2

No

□3

Don’t know

20. 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
□2
□3

Yes
No
Don’t know

18. Does the reporting location participate in an Accountable Care Organization (ACO) arrangement with
Medicare or private insurers? An ACO is an entity typically composed of primary care physicians,
specialists, and hospitals, and held financially accountable for the cost and quality of care delivered to a
defined group of patients.

□1

Yes

□2

No

□3

Don’t know

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

□1
□2
□3

Yes
No
Don’t know

4

Attachment D – Changes to Approved 2017 NEHRS
27. Do you send or receive patient health information electronically? Electronically does not include
scanned or pdf documents from fax, eFax, or mail.

□1 Yes
□2 No (Skip to 32)
□3 Don’t know (Skip


to 32)

Item below (Q25) amends question above (Q27) to assess how patient health data is shared with other
providers. Patient health information sharing was refined into separate questions, rather than including
both send or receive in one question, without listing each type of data transmission in the updated
2017: electronically send patient health information.

25. 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
□3

Yes
No (Skip to 28)
Don’t know

24. Do you refer patients to the following

providers? If so, how do you send
patient health information to them?
Electronic does not include fax, eFax, or
mail.

No

Yes,
Yes,
Yes,
we send patient
we send patient
we send patient
health information health information
health information
electronically
via paper-based both electronically
(EHR, webportal
methods
and via paper
or online
based methods
(Fax,
eFax,
or
mail)
registries)

Yes,
we do not
send patient
health
information
to the
provider

Ambulatory care providers outside your
organization

□

□

□

□

□

Ambulatory care providers within your
organization

□

□

□

□

□

Hospitals unaffiliated with your organization

□

□

□

□

□

Hospitals affiliated with your organization

□

□

□

□

□

Behavioral Health providers

□

□

□

□

□

Long-term care providers

□

□

□

□

□



Item below (Q26) amends Q24 above to assess how patient health data is sent to different providers.
The response choices were modified and 5 out of 6 providers were retain to reduce burden on the
respondents.

5

Attachment D – Changes to Approved 2017 NEHRS
26. Do you send patient health
information to any of the following
providers electronically? Electronically
does not include scanned or pdf
documents from fax, eFax, or mail.

Yes

No

Don’t know

Not Applicable

Ambulatory care providers outside your
organization

□

□

□

□

Hospitals unaffiliated with your organization

□

□

□

□

Hospitals affiliated with your organization

□

□

□

□

Behavioral Health providers

□

□

□

□

Long-term care providers

□

□

□

□

27. Do you send or receive patient health information electronically? Electronically does not include
scanned or pdf documents from fax, eFax, or mail.

□1 Yes
□2 No (Skip to 32)
□3 Don’t know (Skip


to 32)

Item below (Q27) amends question above (Q27) to assess how patient health data is shared with other
providers. Patient health information sharing was refined into separate questions, rather than including
both send or receive in one question, without listing each type of data transmission in the updated
2017: electronically receive patient health information.

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

□1
□2
□3

Yes
No (Skip to 31)
Don’t know

6

Attachment D – Changes to Approved 2017 NEHRS

25. Do you see patients from the following

providers? If so, how do you receive
patient health information from them?
Electronic does not include fax, eFax, or
mail.

No

Yes,
Yes,
we receive patient we receive patient
health information health information
electronically
via paper-based
(EHR, webportal
methods
or online
(Fax,
eFax, or mail)
registries)

Yes,
Yes,
we receive patient
health information
both electronically
and via paper
based methods

we do not
receive
patient
health
information
from the
provider

Ambulatory care providers outside your
organization

□

□

□

□

□

Ambulatory care providers within your
organization

□

□

□

□

□

Hospitals unaffiliated with your organization

□

□

□

□

□

Hospitals affiliated with your organization

□

□

□

□

□

Behavioral Health providers

□

□

□

□

□

Long-term care providers

□

□

□

□

□



Item below (Q28) amends Q25 above to assess how patient health data is received from different
providers. The response choices were modified and 5 out of 6 providers were retain to reduce burden
on the respondents.

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

Yes

No

Don’t know

Not Applicable

Ambulatory care providers outside your
organization

□

□

□

□

Hospitals unaffiliated with your organization

□

□

□

□

Hospitals affiliated with your organization

□

□

□

□

Behavioral Health providers

□

□

□

□

Long-term care providers

□

□

□

□

7

Attachment D – Changes to Approved 2017 NEHRS
31. When electronically receiving information from
other providers, do you integrate the following
types of patient health information into your EHR
without special effort like manual entry or
scanning?

Yes

No

Don’t know

Not
Applicable

Medication lists

□1

□2

□3

□4

Patient problem lists

□1

□2

□3

□4

Medication allergy lists

□1

□2

□3

□4

Imaging reports

□1

□2

□3

□4

Laboratory results

□1

□2

□3

□4

Public health registry data (e.g., immunizations, cancer)

□1

□2

□3

□4

Referrals (e.g., referral requests or reports)

□1

□2

□3

□4

Hospital discharge summaries

□1

□2

□3

□4

Emergency Department notifications

□1

□2

□3

□4

Summary of care records for transitions of care or referrals

□1

□2

□3

□4

□1

□2

□3

□4

Patient-generated data (e.g. data from self-monitoring

devices or mobile health applications)



Items below (Q31 and Q32) amend Q31 above to assess the type of patient health data that is being
integrated. Patient health information integration was refined and streamlined into separate questions
in the updated 2017.

31. 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
32. Do you integrate any other type of patient health information into your EHR without special effort like
manual entry or scanning?

□1
□2
□3
□4

Yes
No
Don’t know
Not applicable

8

Attachment D – Changes to Approved 2017 NEHRS
32. Can patients seen at the reporting location do the following
online activities? Can patients…
View their medical record online?
Download health information from their electronic medical record to their
personal files?
Transmit health information from their electronic medical record to a
designated third party of their choice (e.g. another provider)?
Request corrections to their electronic medical record?
Enter their health information online (e.g., weight, symptoms)?
Upload their data from self-monitoring devices (e.g., blood glucose
readings)?



Don’t Know

No

□
1□

□
2□

1

□
3□

2

□
1□
1□
1□

3

□
2□
2□
2□

1

□
3□
3□
3□

2

3

Item below (Q33) amends Q32 above to streamline the computerized capabilities question to 3 out of 6
sub-questions.

33. Does your EHR have the computerized capability to allow patients to…
Electronically view their health information (e.g. test results).
Request refills for prescriptions online.
Enter health information (e.g. weight, symptoms) online.

35. Within the last 30 days has your EHR system…
Sent you too many alerts, causing you to overlook something important?



Yes

Yes

□
1□
1□
1

Yes

□

1

Don’t Know

No

□
2□
2□

□
3□
3□

2

3

No

Not
Applicable

□

□

2

3

Item below (Q34) amends Q35 above. It was approved for 2014 attitudinal question (Q36g) so we
would like to retain this question for 2017 as part of the attitudinal measure.

34. Within the last 30 days has your EHR system…
Increased the time spent documenting patient care?

Yes

□

1

No

Not
Applicable

□

□

2

3

9

Attachment D – Changes to Approved 2017 NEHRS
38. How often do you use electronically received patient health information from outside of your medical
organization to manage your patient population?

□1

Often

□2

Sometimes

□3

Rarely

□4

Never

□5

Don’t know

41. To what extent do you agree or disagree with
the following statements.

Strongly Somewhat Somewhat Strongly
Agree
Agree
Disagree Disagree

Not
Applicable

Electronic information exchange with providers outside
my organization gives me access to the patient health
information I need.

□1

□2

□3

□4

□5

Electronically sending clinical information to providers
outside my organization is easy to do using my EHR.

□1

□2

□3

□4

□5

Electronically receiving clinical information from other

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization improves my ability to coordinate care
for my patients.

□1

□2

□3

□4

□5

Electronic information exchange with other providers
reduces duplicate test ordering.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization is cumbersome to do with our EHR.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization prevents medication errors.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization is difficult because providers in my
referral network do not have the capability to exchange
data electronically.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization provides me with clinical information
that I can trust.

□1

□2

□3

□4

□5

Electronic information exchange with providers outside
my organization increases my practice’s vendor costs.

□1

□2

□3

□4

□5

providers is easy to do using my EHR

10

Attachment D – Changes to Approved 2017 NEHRS


Item below (Q29 and Q29a) amends Q38 and Q41 above to assess attitudinal measures for not using
patient health data from other providers when treating a patient. These attitudinal measures were
refined and streamlined in the question below.

29. How frequently do you use patient health information electronically (not eFax) received from
providers or sources outside your organization when treating a patient?

 Often  Sometimes

Rarely

Never

Don’t know

29a. If rarely or never used, please indicate the reason(s) why. Check all that apply.
1.
2.
3.
4.
5.
6.
7.

Information not always available when needed (e.g. not timely)
Do not trust accuracy of information
Difficult to integrate information in EHR
Information not available to view in EHR as part of clinicians’ workflow
Information not useful (e.g. redundant or unnecessary information)
Difficult to find information necessary information
Other________________________________________________________________________

Questions added


Item below (Q22) was approved for 2014 and 2015 NEHRS but it was deleted from the approved 2017
NEHRS, formerly 2016 NEHRS, when the OMB nonsubstantive package was submitted. This question is
added to the proposed 2017 NEHRS as it has been part of the definition of delivery system reform (DSR):
Patient Centered Medical Home (PCMH), Accountable Care Organization (ACO) and Pay-forPerformance (P4P) arrangement.

22. 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

Unknown

11