3-EHRDPRAOMBApp

APPENDIX A
LEGISLATION FOR THE MEDICARE CARE MANAGEMENT PERFORMANCE
DEMONSTRATION

MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND
MODERNIZATION ACT OF 2003
TITLE VI—PROVISIONS RELATING TO PART B
SUBTITLE D—ADDITIONAL DEMONSTRATIONS, STUDIES,
AND OTHER PROVISIONS

SEC. 649. MEDICARE CARE MANAGEMENT PERFORMANCE DEMONSTRATION
(a) ESTABLISHMENT.
(1) IN GENERAL.—The Secretary shall establish a pay-for-performance demonstration
program with physicians to meet the needs of eligible beneficiaries through the adoption and
use of health information technology and evidence-based outcomes measures for
(A) promoting continuity of care;
(B) helping stabilize medical conditions;
(C) preventing or minimizing acute exacerbations of chronic conditions; and
(D) reducing adverse health outcomes, such as adverse drug interactions related to
polypharmacy.
(2) SITES.—The Secretary shall designate no more than 4 sites at which to conduct the
demonstration program under this section, of which
(A) 2 shall be in an urban area;
(B) 1 shall be in a rural area; and
(C) 1 shall be in a State with a medical school with a Department of Geriatrics that
manages rural outreach sites and is capable of managing patients with multiple chronic
conditions, one of which is dementia.
(3) DURATION.—The Secretary shall conduct the demonstration program under this section
for a 3-year period.
(4) CONSULTATION.—In carrying out the demonstration program under this section, the
Secretary shall consult with private sector and non-profit groups that are under taking similar
efforts to improve quality and reduce avoidable hospitalizations for chronically ill patients.
(b) PARTICIPATION.
(1) IN GENERAL.—A physician who provides care for minimum number of eligible
beneficiaries (as specified by the Secretary) may participate in the demonstration program
under this section if such physician agrees, to phase in over the course of the 3-year
demonstration period and with the assistance provided under subsection (d)(2)

A.1

(A) the use of health information technology to manage the clinical care of eligible
beneficiaries consistent with paragraph (3); and
(B) the electronic reporting of clinical quality and outcomes measures in accordance with
requirements established by the Secretary under the demonstration program.
(2) SPECIAL RULE.—In the case of the sites referred to in subparagraphs (B) and (C) of
subsection (a)(2), a physician who provides care for a minimum number of beneficiaries with
two or more chronic conditions, including dementia (as specified by the Secretary), may
participate in the program under this section if such physician agrees to the requirements in
subparagraphs (A) and (B) of paragraph (1).
(3) PRACTICE STANDARDS.—Each physician participating in the demonstration program
under this section must demonstrate the ability
(A) to assess each eligible beneficiary for conditions other than chronic conditions, such
as impaired cognitive ability and co-morbidities, for the purposes of developing care
management requirements;
(B) to serve as the primary contact of eligible beneficiaries in accessing items and
services for which payment may be made under the Medicare program;
(C) to establish and maintain health care information system for such beneficiaries;
(D) to promote continuity of care across providers and settings;
(E) to use evidence-based guidelines and meet such clinical quality and outcome
measures as the Secretary shall require;
(F) to promote self-care through the provision of patient education and support for
patients or, where appropriate, family caregivers;
(G) when appropriate, to refer such beneficiaries to community service organizations;
and
(H) to meet such other complex care management requirements as the Secretary may
specify.
The guidelines and measures required under subparagraph (E) shall be designed to take
into account beneficiaries with multiple chronic conditions.
(c) PAYMENT METHODOLOGY.—Under the demonstration program under this section the
Secretary shall pay a per beneficiary amount to each participating physician who meets or
exceeds specific performance standards established by the Secretary with respect to the clinical
quality and outcome measures reported under subsection (b)(1)(B). Such amount may vary based
on different levels of performance or improvement.
(d) ADMINISTRATION
(1) USE OF QUALITY IMPROVEMENT ORGANIZATIONS.—The Secretary shall
contract with quality improvement organizations or such other entities as the Secretary deems
appropriate to enroll physicians and evaluate their performance under the demonstration
program under this section.
(2) TECHNICAL ASSISTANCE.—The Secretary shall require in such contracts that the
contractor be responsible for technical assistance and education as needed to physicians
A.2

enrolled in the demonstration program under this section for the purpose of aiding their
adoption of health information technology, meeting practice standards, and implementing
required clinical and outcomes measures.
(e) FUNDING.
(1) IN GENERAL.—The Secretary shall provide for the transfer from the Federal
Supplementary Medical Insurance Trust Fund established under section 1841 of the Social
Security Act (42 U.S.C. 1395t) of such funds as are necessary for the costs of carrying out the
demonstration program under this section.
(2) BUDGET NEUTRALITY.—In conducting the demonstration program under this section,
the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed
the amount which the Secretary estimates would have been paid if the demonstration program
under this section was not implemented.
(f) WAIVER AUTHORITY.—The Secretary may waive such requirements of titles XI and
XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 1395 et seq.) as may be necessary for
the purpose of carrying out the demonstration program under this section.
(g) REPORT.—Not later than 12 months after the date of completion of the demonstration
program under this section, the Secretary shall submit to Congress a report on such program,
together with recommendations for such legislation and administrative action as the Secretary
determines to be appropriate.
(h) DEFINITIONS.—In this section:
(1) ELIGIBLE BENEFICIARY.—The term ‘‘eligible beneficiary’’ means any individual
who—
(A) is entitled to benefits under part A and enrolled for benefits under part B of title
XVIII of the Social Security Act and is not enrolled in a plan under part C of such title;
and
(B) has one or more chronic medical conditions specified by the Secretary (one of which
may be cognitive impairment).
(2) HEALTH INFORMATION TECHNOLOGY.—The term ‘‘health information
technology’’ means email communication, clinical alerts and reminders, and other
information technology that meets such functionality, interoperability, and other standards as
prescribed by the Secretary.

A.3

APPENDIX B
LEGISLATION FOR THE ELECTRONIC HEALTH RECORDS DEMONSTRATION

TITLE 42 - THE PUBLIC HEALTH AND WELFARE
CHAPTER 7 - SOCIAL SECURITY
SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLED

§ 1395B–1. INCENTIVES FOR ECONOMY WHILE MAINTAINING OR IMPROVING
QUALITY IN PROVISION OF HEALTH SERVICES
(a) Grants and contracts to develop and engage in experiments and demonstration projects
(1) The Secretary of Health and Human Services is authorized, either directly or through grants
to public or private agencies, institutions, and organizations or contracts with public or private
agencies, institutions, and organizations, to develop and engage in experiments and
demonstration projects for the following purposes:
(A) to determine whether, and if so which, changes in methods of payment or reimbursement
(other than those dealt with in section 222(a) of the Social Security Amendments of 1972) for
health care and services under health programs established by this chapter, including a change
to methods based on negotiated rates, would have the effect of increasing the efficiency and
economy of health services under such programs through the creation of additional incentives
to these ends without adversely affecting the quality of such services;
(B) to determine whether payments for services other than those for which payment may be
made under such programs (and which are incidental to services for which payment may be
made under such programs) would, in the judgment of the Secretary, result in more economical
provision and more effective utilization of services for which payment may be made under
such program, where such services are furnished by organizations and institutions which have
the capability of providing—
(i) comprehensive health care services,
(ii) mental health care services (as defined by section 2691 (c) 1 of this title),
(iii) ambulatory health care services (including surgical services provided on an
outpatient basis), or
(iv) institutional services which may substitute, at lower cost, for hospital care;
(C) to determine whether the rates of payment or reimbursement for health care services,
approved by a State for purposes of the administration of one or more of its laws, when
utilized to determine the amount to be paid for services furnished in such State under the
health programs established by this chapter, would have the effect of reducing the costs of
such programs without adversely affecting the quality of such services;
(D) to determine whether payments under such programs based on a single combined rate of
reimbursement or charge for the teaching activities and patient care which residents, interns,
and supervising physicians render in connection with a graduate medical education program
in a patient facility would result in more equitable and economical patient care arrangements

B.3

without adversely affecting the quality of such care;
(E) to determine whether coverage of intermediate care facility services and homemaker
services would provide suitable alternatives to posthospital benefits presently provided under
this subchapter; such experiment and demonstration projects may include:
(i) counting each day of care in an intermediate care facility as one day of care in a
skilled nursing facility, if such care was for a condition for which the individual was
hospitalized,
(ii) covering the services of homemakers for a maximum of 21 days, if institutional
services are not medically appropriate,
(iii) determining whether such coverage would reduce long-range costs by reducing the
lengths of stay in hospitals and skilled nursing facilities, and
(iv) establishing alternative eligibility requirements and determining the probable cost
of applying each alternative, if the project suggests that such extension of coverage would
be desirable;
(F) to determine whether, and if so which type of, fixed price or performance incentive
contract would have the effect of inducing to the greatest degree effective, efficient, and
economical performance of agencies and organizations making payment under agreements or
contracts with the Secretary for health care and services under health programs established
by this chapter;
(G) to determine under what circumstances payment for services would be appropriate and
the most appropriate, equitable, and noninflationary methods and amounts of reimbursement
under health care programs established by this chapter for services, which are performed
independently by an assistant to a physician, including a nurse practitioner (whether or not
performed in the office of or at a place at which such physician is physically present), and—
(i) which such assistant is legally authorized to perform by the State or political
subdivision wherein such services are performed, and
(ii) for which such physician assumes full legal and ethical responsibility as to the
necessity, propriety, and quality thereof;
(H) to establish an experimental program to provide day-care services, which consist of such
personal care, supervision, and services as the Secretary shall by regulation prescribe, for
individuals eligible to enroll in the supplemental medical insurance program established under
part B of this subchapter and subchapter XIX of this chapter, in day-care centers which meet
such standards as the Secretary shall by regulation establish;
(I) to determine whether the services of clinical psychologists may be made more generally
available to persons eligible for services under this subchapter and subchapter XIX of this
chapter in a manner consistent with quality of care and equitable and efficient administration;
(J) to develop or demonstrate improved methods for the investigation and prosecution of
fraud in the provision of care or services under the health programs established by this chapter;
and

B.4

(K) to determine whether the use of competitive bidding in the awarding of contracts, or the
use of other methods of reimbursement, under part B of subchapter XI of this chapter would
be efficient and effective methods of furthering the purposes of that part. For purposes of this
subsection, “health programs established by this chapter” means the program established by this
subchapter and a program established by a plan of a State approved under subchapter XIX of this
chapter.
(2) Grants, payments under contracts, and other expenditures made for experiments and
demonstration projects under paragraph (1) shall be made in appropriate part from the Federal
Hospital Insurance Trust Fund (established by section 1395i of this title) and the Federal
Supplementary Medical Insurance Trust Fund (established by section 1395t of this title) and
from funds appropriated under subchapter XIX of this chapter. Grants and payments under
contracts may be made either in advance or by way of reimbursement, as may be determined by
the Secretary, and shall be made in such installments and on such conditions as the Secretary
finds necessary to carry out the purpose of this section. With respect to any such grant, payment,
or other expenditure, the amount to be paid from each of such trust funds (and from funds
appropriated under such subchapter XIX of this chapter) shall be determined by the Secretary,
giving due regard to the purposes of the experiment or project involved.
(b) Waiver of certain payment or reimbursement requirements; advice and
recommendations of specialists preceding experiments and demonstration projects
In the case of any experiment or demonstration project under subsection (a) of this section, the
Secretary may waive compliance with the requirements of this subchapter and subchapter XIX of
this chapter insofar as such requirements relate to reimbursement or payment on the basis of
reasonable cost, or (in the case of physicians) on the basis of reasonable charge, or to
reimbursement or payment only for such services or items as may be specified in the experiment;
and costs incurred in such experiment or demonstration project in excess of the costs which
would otherwise be reimbursed or paid under such subchapters may be reimbursed or paid to the
extent that such waiver applies to them (with such excess being borne by the Secretary). No
experiment or demonstration project shall be engaged in or developed under subsection (a) of
this section until the Secretary obtains the advice and recommendations of specialists who are
competent to evaluate the proposed experiment or demonstration project as to the soundness of
its objectives, the possibilities of securing productive results, the adequacy of resources to
conduct the proposed experiment or demonstration project, and its relationship to other similar
experiments and projects already completed or in process.

B.5

APPENDIX C
FEDERAL REGISTER NOTICE

TO BE COMPLETED BY CMS

C.3

APPENDIX D
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)
ADVANCE LETTERS

CMS LETTERHEAD
ADVANCE LETTER EHRD OSS — TREATMENT GROUP PRACTICES
[DATE]
[NAME AND ADDRESS]
Dear [Dr./Mr./Ms.] [FILL LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) is sponsoring a study about the
Electronic Health Records Demonstration in which you are participating. The purpose of the study is
to evaluate the demonstration’s impact on the implementation and use of electronic health records
(EHRs) and related health information technology (HIT), and on the quality of care provided by
physicians in participating practices. Mathematica Policy Research, Inc. (MPR), an independent
research organization, is conducting the study on behalf of CMS.
MPR will survey approximately 800 physician practices across the United States about their use
of EHRs via an online Office Systems Survey (OSS). Half of these practices were randomly assigned
to a treatment group, and the other half were randomly assigned to a control group. The OSS is
designed to measure the extent of a practice’s use of EHRs and related HIT functionalities. Your
participation in the OSS is essential to the evaluation of the demonstration’s impact on EHR use and
quality of patient care. In addition, your responses on this survey will be used in the calculation of
the incentive payment to your practice as part of the EHR demonstration.
The purpose of this letter is to invite you to participate in the survey as a treatment group
practice. Your participation in the OSS is essential to the evaluation of the demonstration’s impact on
EHR use and quality of patient care. In addition, your responses on this survey will be used in the
calculation of the incentive payment to your practice as part of the EHR demonstration.
Please visit www.XXXXXXXX to complete the survey. In a pretest, practices took an average
of 29 minutes to complete the questionnaire. Your answers will remain completely confidential.
Neither your name nor your practice’s name will ever be included in any reports prepared as part of
this study.
If you have any questions, or if you would prefer to complete the survey by mail, please call
MPR toll-free at 1-XXX-XXX-XXXX and ask for Mindy Hu. If you would like to learn more about
the demonstration, please visit the CMS website at http://www.cms.hhs.gov/DemoProjectsEvalRpts/
downloads/EHR_EvaluationSummary.pdf.
We look forward to including your valuable input in this demonstration.
Sincerely,
CMS Project Officer
Enclosure
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 0938-NEW. The time required to complete this information collection is
estimated to average 0.48 hours or 29 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: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850.

D.3

CMS LETTERHEAD
ADVANCE LETTER EHRD OSS — CONTROL GROUP PRACTICES
[DATE]
[NAME AND ADDRESS]
Dear [Dr./Mr./Ms.] [FILL LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) is sponsoring a study about the
Electronic Health Records Demonstration. The purpose of the study is to evaluate the
demonstration’s impact on the implementation and use of electronic health records (EHRs) and
related health information technology (HIT), and on the quality of care provided by physicians in
participating practices. Mathematica Policy Research, Inc. (MPR), an independent research
organization, is conducting the study on behalf of CMS.
MPR will survey approximately 800 physician practices across the United States about their use
of EHRs via an online Office Systems Survey (OSS). Half of these practices were randomly assigned
to a treatment group, and the other half were randomly assigned to a control group. The OSS is
designed to measure the extent of a practice’s use of EHRs and related HIT functionalities.
The purpose of this letter is to invite you to participate in the survey as a control group practice.
Your participation in the OSS is very important. The evaluation of the impact of the demonstration
on EHR use and quality of patient care requires input from both the treatment and control groups.
Please visit www.XXXXXXXX to complete the survey. You will receive $50 for your
participation. In a pretest, practices took an average of 29 minutes to complete the questionnaire.
Your answers will remain completely confidential. Neither your name nor your practice’s name will
ever be included in any reports prepared as part of this study.
If you have any questions, or if you would prefer to complete the survey by mail, please call
MPR toll-free at 1-XXX-XXX-XXXX and ask for Mindy Hu. If you would like to learn more about
the demonstration, please visit the CMS website at http://www.cms.hhs.gov/DemoProjectsEvalRpts/
downloads/EHR_EvaluationSummary.pdf.
We look forward to including your valuable input in this demonstration.
Sincerely,
CMS Project Officer
Enclosure
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 0938-NEW. The time
required to complete this information collection is estimated to average 0.48 hours or 29 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:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

D.4

APPENDIX E
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)
FACT SHEETS

EHRD OSS FACT SHEET
(TREATMENT PRACTICES)
WHAT IS THE ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)?
The Section 402 Medicare Waiver Authority allows the Secretary of the Department of Health
and Human Services to develop a new pay-for-performance demonstration program with
physicians to meet the needs of eligible beneficiaries through the adoption and use of health
information technology (HIT) and evidence-based outcome measures. The Electronic Health
Records Demonstration (EHRD) is one of these demonstration programs. The EHRD is
sponsored by the Centers for Medicare & Medicaid Services (CMS).
WHAT ARE THE GOALS OF THE DEMONSTRATION?
The goal of the EHRD is to foster the implementation and adoption of electronic health records
(EHRs) and HIT more broadly as effective vehicles not only to improve the quality of care
provided, but also to transform the way medicine is practiced and delivered.
WHICH SITES ARE PARTICIPATING IN THE DEMONSTRATION?
Small- to medium-sized practices in Louisiana; Maryland/DC; Pittsburgh, PA (and surrounding
counties); and South Dakota (and selected counties in bordering states) were eligible to apply for
participation in the EHRD.
WHO IS CONDUCTING THE STUDY?
Mathematica Policy Research, Inc. (MPR) is an independent research company that was hired by
CMS to conduct the EHRD study. MPR is a leader in the policy research and analysis field and
has been conducting surveys and evaluations for more than 40 years. You can learn more about
MPR by visiting its website at www.mathematica-mpr.com.
WILL MY INFORMATION BE KEPT CONFIDENTIAL?
Yes. All of the information we collect in the survey will be kept confidential as provided in the
Privacy Act. The information will be used for research purposes only. Neither your name nor
your practice’s name will ever be used in any reports.
HOW LONG WILL THE DEMONSTRATION RUN?
The demonstration began operations on June 1, 2009, and will run for five years, ending May 31,
2014. Practices will each participate for five years.
HOW LONG WILL IT TAKE TO COMPLETE THE OFFICE SYSTEMS SURVEY
(OSS)?
In a pretest, most people took between 25 and 37 minutes to complete the OSS.
WHAT KIND OF QUESTIONS WILL BE ON THE SURVEY?
The survey asks about your practice’s use of EHRs and related HIT functionalities, and about the
characteristics of your practice and the providers participating in the demonstration.

E.3

HOW OFTEN WILL I BE ASKED TO COMPLETE THE SURVEY?
Practices in the treatment group must complete the survey annually over five years.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the demonstration, please visit the CMS website
athttp://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/EHR_EvaluationSummary.pdf
For more information about the survey, please call MPR toll-free at 1-XXX-XXX-XXX and ask
for Mindy Hu.

E.4

EHRD OSS FACT SHEET
(CONTROL PRACTICES)
WHAT IS THE ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)?
The Section 402 Medicare Waiver Authority allows the Secretary of the Department of Health
and Human Services to develop a new pay-for-performance demonstration program with
physicians to meet the needs of eligible beneficiaries through the adoption and use of health
information technology (HIT) and evidence-based outcome measures. The Electronic Health
Records Demonstration (EHRD) is one of these demonstration programs. The EHRD is
sponsored by the Centers for Medicare & Medicaid Services (CMS).
WHAT ARE THE GOALS OF THE DEMONSTRATION?
The goal of the EHRD is to foster the implementation and adoption of electronic health records
(EHRs) and HIT more broadly as effective vehicles not only to improve the quality of care
provided, but also to transform the way medicine is practiced and delivered.
WHICH SITES ARE PARTICIPATING IN THE DEMONSTRATION?
Small- to medium-sized practices in Louisiana; Maryland/DC; Pittsburgh, PA (and surrounding
counties); and South Dakota (and selected counties in bordering states) were eligible to apply for
participation in the EHRD.
WHY ARE YOU CONTACTING PRACTICES THAT ARE NOT RECEIVING ANY
PRACTICE PAYMENTS?
The evaluation is utilizing a random assignment design for the impact analysis. Practices that
enrolled in the demonstration were randomly assigned to a treatment group that receives pay for
performance, or to a control group that does not.
WHO IS CONDUCTING THE STUDY?
Mathematica Policy Research, Inc. (MPR), an independent research company, was hired by
CMS to conduct the EHRD study. MPR is a leader in the policy research and analysis field and
has been conducting surveys and evaluations for more than 40 years. You can learn more about
MPR by visiting its website at www.mathematica-mpr.com.
WILL MY INFORMATION BE KEPT CONFIDENTIAL?
Yes. All of the information we collect in the survey will be kept confidential as provided in the
Privacy Act. The information will be used for research purposes only. Neither your name nor
your practice’s name will ever be used in any reports.
HOW LONG WILL THE DEMONSTRATION RUN?
The demonstration began operations on June 1, 2009, and will run for five years, ending May 31,
2014. Practices will each participate for five years.
HOW LONG WILL IT TAKE TO COMPLETE THE OFFICE SYSTEMS SURVEY?
In a pretest, most people took between 25 and 37 minutes to complete the OSS.
WHAT KIND OF QUESTIONS WILL BE ON THE SURVEY?
The survey asks about your practice’s use of EHRs and related HIT functionalities, and about the
characteristics of your practice and the providers in your practice.

E.5

HOW OFTEN WILL I BE ASKED TO COMPLETE THE SURVEY?
Control group practices will be asked to complete the survey twice, at the end of the second and
fifth years of their participation in the demonstration.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the demonstration, please visit the CMS website at
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2008_Electronic_Health_Records_
Demonstration.pdf . For more information about the survey, please call MPR toll-free at 1-XXXXXX-XXX and ask for Mindy Hu.

E.6

APPENDIX F
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)
OFFICE SYSTEMS SURVEY

OMB Approval No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx

Electronic Health Records Demonstration
Office Systems Survey
April 1, 2009

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 0938-NEW.
The time required to complete this information collection is estimated to average 0.48 hours or 29 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: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C426-05, Baltimore, Maryland 21244-1850.

Prepared by Mathematica Policy Research,

F.3

Thank you for participating in the Centers for Medicare & Medicaid Services (CMS) Office Systems Survey
(OSS). This survey is being conducted as part of the Electronic Health Records Demonstration (EHRD)
and its evaluation. The goal of this demonstration is to unite technology and clinical practice in the
physician office setting. The evaluation of the EHRD will help CMS develop additional programs that can
assist physicians in moving toward the common goal of improving care. This is a unique opportunity for
your practice to contribute to a large-scale effort to improve the quality of ambulatory health care.
The survey asks about three types of health information technology (HIT) that you may be using in your
practice to help manage your patients’ health needs. The survey will first ask if your practice is currently
using or is in the process of obtaining:
• An Electronic Health Record (EHR) system
• A stand-alone electronic patient registry
• A stand-alone electronic prescribing system
The survey will then collect information about the functions of the systems you currently using.
Please complete all sections of the survey unless directed within it to skip a section. If you are
not aware of how all the providers in the practice are using the functions asked about in the survey, please
consult with them prior to answering the questions.
Again, we thank you for taking the time to fill out this important survey.

Prepared by Mathematica Policy Research,

F.4

SECTION 1 - General Information – Practice
{MERGE} FIELDS INDICATE DATA THAT WILL BE FILLED IN BASED ON RESPONSE TO THE
DEMONSTRATION APPLICATION OR A PREVIOUS OSS.
1.1. Date:
1.2. EHRD Assigned Practice ID Number: {MERGE FIELD}
Please review your practice information below for accuracy. Please make corrections where necessary.
1.3. Legal Name of Practice

{MERGE FIELD}

1.4.
Location
Address:
{MERGE FIELD} Add a second line as in IPG web form

1.5.
Location
City:

{MERGE FIELD}

1.8. Telephone No.:
1.9. Fax No.:

1.6.
Location
State

{MERGE}

1.7. Location
Zip Code:

{MERGE FIELD}

{MERGE FIELD}

{MERGE FIELD}

1.10. E-mail Address:

{MERGE FIELD}

1.11. Federal Tax ID for this
practice:

{MERGE FIELD}

1.12. Please check here if all of the above information is correct.
1.13. Is your practice affiliated with an Independent Practice Association (IPA), Physician Hospital Organization
(PHO) or other medical group?
Yes Please proceed to question 1.14
No Please proceed to question 1.15
1.14. Please indicate which type(s) of organization(s) your practice is affiliated with: {MERGE FIELD FROM PRIOR
OSS RESPONSE; NOT COLLECTED ON APPLICATION}
IPA (please specify) ___________________________________________________
PHO (please specify) __________________________________________________
Community health center (please specify) __________________________________
Academic medical center (please specify) __________________________________
Owned by a hospital, hospital system or integrated delivery system
(please specify) _______________________________________________________
Owned by a larger medical group (please specify)_____________________________
Other (please specify) __________________________________________________
Prepared by Mathematica Policy Research,

F.5

1.15 Is your practice currently participating in any of the following programs? Please check all that apply
Physician Quality Reporting Initiative (PQRI)
Bridges to Excellence (BTE)
Doctors Office Quality Information Technology (DOQIT) Warehouse submissions
State or regional public reporting group
Other private sector electronic health records (EHR) demonstrations or initiatives (please name, and
include the sponsoring insurer or employer):
Other federal quality improvement initiatives including pay-for-performance (please name):
State or other publicly funded quality improvement initiatives including pay-for-performance or
Medicaid IT initiatives (please name):
Private quality improvement initiatives including pay-for-performance (please name):
Other similar programs
(please name):
None of the above
Do not know

Prepared by Mathematica Policy Research,

F.6

SECTION 2 – Provider Profile

The following information comes from [your practice’s EHRD application form/AFTER YEAR 1 THIS WILL READ: the
most recent practice information you provided for the EHR demonstration]. Please review the information below for
accuracy and make corrections or additions where necessary.
Please note that provider identifiers are being requested in this survey to ensure that the correct information is
associated with the practice. The information you provide will be used by CMS internally, only for the purposes of the
EHRD and its evaluation. This information will not be shared or disseminated outside of the project staff.
2.0a. The number of providers currently participating in the demonstration is____ [MERGE FIELD] ___________.
Is that correct?
Yes Please proceed to instructions in bold below
No Please proceed to question 2.0b

2.0b. What is the correct number of participating providers? ____________

Please verify the information below for each primary care provider participating in the
demonstration who works at this practice location. (By primary care providers we mean: primary
care physicians, specialty physicians practicing primary care, and physician assistants and nurse
practitioners practicing primary care who bill Medicare independently, as enumerated in 2.0b or c).
Please note at the bottom of each box whether a previously mentioned provider has left the
practice and the date of that departure, or a new provider has joined the practice and is
participating in the demonstration and the date the provider joined the practice.

** ALL FIELDS BELOW WILL BE POPULATED WITH DATA FROM THE APPLICATION FORM, LAST OSS, OR
MOST RECENT DATA FROM ARC – WHICHEVER IS MOST RECENT.
THE WEB PROGRAM WILL INCLUDE ENOUGH BOXES TO CAPTURE ALL THE LOCATION’S
PARTICIPATING PROVIDERS’ INFORMATION

Prepared by Mathematica Policy Research,

F.7

2.1. First Name

2.2. MI

2.3. Last Name

2.4. Individual (NPI) National Provider Identification Number

2.5. Credentials (MD, DO, NP, PA)

2.6. Specialty

1

2.8. Language(s) spoken (other than English)

2.7. If other, please specify
2.9. Provider’s Primary Practice Location (Y/N)

2

Yes

2.10. PIN # (Individual Medicare Billing Number)

3

No

2.11. Please check here if all of the above is correct.
Please check here if any information was incorrect, and make necessary corrections
Please check here if this provider left the practice in the last year

Date of departure ______________

Please check here if this provider is new to the practice in the last year

2.1. First Name

Date joined practice_____________

2.2. MI

2.3. Last Name

2.4. Individual (NPI) National Provider Identification Number

2.5. Credentials (MD, DO, NP, PA)

2.6. Specialty

1

2.8. Language(s) spoken (other than English)

2.7. If other, please specify
2.9. Provider’s Primary Practice Location (Y/N)

2

Yes

2.10. PIN # (Individual Medicare Billing Number)

3

No

2.11. Please check here if all the information is correct.
Please check here if any information was incorrect, and make necessary corrections
Please check here if this provider left the practice in the last year
Please check here if this provider is new to the practice in the last year

Date of departure ______________
Date joined practice_____________

[ADDITIONAL BOXES WILL BE AVAILABLE AS NEEDED]
Footnotes:
1
2
3

Please use the following codes to indicate specialty: Cardiology (C); Endocrinology (E); Family Practice (F); Geriatrics (G); Internal Medicine (I); Other
(please specify)
Please indicate whether the provider listed primarily practices at this office location (that is, sees 50% or more of his or her patients primarily at this
location).
Please provide the Individual Medicare Billing Number (PIN) that is assigned by the Medicare Carrier in your state for use by this provider at this
practice location only. (HCFA 1500 form field 24K or 33).

2.12 What is the total number of providers currently working at this practice in this location? (Please include all
primary care physicians, specialty physicians, physician assistants, nurse practitioners, and nurse midwives,
including those who are participating in the demonstration, as well as those who are not eligible for or not
participating in the demonstration. Please exclude residents and fellows.) _________________
NOTE THAT THE REMAINDER OF THE SURVEY PERTAINS TO THE TOTAL NUMBER OF PROVIDERS (NOT
JUST THOSE PARTICIPATING IN THE DEMONSTRATION) AND TO ALL PATIENTS SEEN BY THOSE
PROVIDERS (NOT JUST THOSE ON MEDICARE).

Prepared by Mathematica Policy Research,

F.8

SECTION 3 - Use or Planned Use of Electronic Health Records, an Electronic Patient
Registry, or an Electronic Prescribing system

A. Electronic Health Records
An Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one
or more encounters in any care delivery setting. This record may include patient demographics (for example, age or
sex), diagnoses, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory
data, and imaging reports.
An EHR system has the capability of generating a complete record of a clinical patient encounter, as well as
supporting other care-related activities, such as evidence-based decision support, quality management, and
outcomes reporting. (The EHR covers all conditions that the patient might have, as distinct from a registry that covers
a specific disease or a limited set of diseases). A practice management or billing system is not an EHR system.
Implementation of specific functions within an EHR system may vary based on the goals set by a practice and could
include: entering progress notes; providing decision support within the patient encounter; and utilizing computerized
physician order entry for laboratory tests and prescriptions.
This subsection (A) asks about the use (or planned use) of an EHR system in this practice location. (Subsection B
will ask about electronic patient registries, and Subsection C will ask about electronic prescribing.)
Has your practice implemented an EHR in this location? (By “implemented” we mean an EHR has been
3.1 purchased, installed, and tested, and is currently being used.)
Yes Proceed to question 3.3
No Proceed to question 3.2
When do you plan to implement an EHR at this practice location?
0-6 months
7-12 months
3.2
13-24 months
other _______________________________
If you answered No to question 3.1, please proceed to Subsection B, Electronic Patient Registry
If you answered Yes to 3.1, please answer questions 3.3-3.6.
3.3 When did the practice purchase the current EHR from the vendor? ____________________(mm/dd/yy)
3.4 What is the vendor name, product name, and version of the EHR system you currently have at this
practice location?
___________________________________________________
___________________________________________________
3.5 Is the EHR system certified, or has it ever been certified, by the Certification Commission for Healthcare
Information Technology (CCHIT)? (http.//www.cchit.org)
Yes Please proceed to question 3.5a
No Please proceed to question 3.6
a

3.5 In what year was the EHR system certified? (If more than one year, indicate the most recent year.)
Don’t know
_____________(yyyy)
3.6 Are you currently using the system in this practice location? (By “use” we mean use for purposes related
to patient care. If the system is used solely for practice management or billing, please respond “no.”)
Yes
No Please proceed to question 3.8

Prepared by Mathematica Policy Research,

F.9

3.7 How many of the [FILL IN FROM 2.12] providers in this practice location currently use the practice’s EHR
system? ________ (By “use” we mean using for any purpose or functions.)
The total number of providers includes primary care physicians, specialty physicians, physician assistants,
nurse practitioners, and nurse midwives (including those who are participating in the demonstration, as well as
those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.
3.8 Have you received any technical assistance on the adoption of the EHR system or other health information
technology (HIT)?
Yes Please proceed to question 3.8a
No Please proceed to Subsection B, Electronic Patient Registry
3.8a IF YES: Where did you receive this technical assistance from? Please check all that apply.
DOQ-IT University
Quality Improvement Organization (QIO)
Health Information Technology Adoption or e-health Initiative
EHR vendor (please specify):
Private consultant
Larger organization that owns this practice
Other (please name):

B. Electronic Patient Registry
For purposes of this survey, an electronic patient registry is defined as an electronic system, either a component of an
EHR or a stand-alone system that is designed to: identify patients with specific diagnoses or medications; identify
patients overdue for specific therapies; facilitate prompt ordering of specific laboratory tests or recommended drugs;
and facilitate prompt communication with patients requiring follow-up. A stand-alone registry is a separate electronic
system from an EHR system. (It may also be referred to as a patient e-registry.)
For example, a practice may use a registry for its diabetes patients to document care at visits, and to create reports
that indicate which patients are due for certain blood tests, or are not meeting specific treatment goals for diabetes. A
registry may also be used to ensure all suggested preventive screenings take place.
These next questions ask about the use of electronic registries in your practice.
If this practice location has NOT implemented an EHR (that is, you answered “no” to 3.1), please proceed to 3.9b.
3.9a Has your practice at this location implemented an EHR (rather than a stand-alone patient registry) to perform
registry functions, such as tracking patients who have a specific chronic illness, or receive preventive care (that is,
immunizations, mammography and other cancer screening) for at least one condition? (By “implemented” we mean
an EHR has been purchased, installed, and tested, and is currently being used.)
Yes
No

Please proceed to Question 3.13
Please proceed to Question 3.9b

Prepared by Mathematica Policy Research,

F.10

3.9b Has your practice at this location implemented a stand-alone patient registry to track patients who have a
specific chronic illness, or receive preventive care (that is, immunizations, mammography and other cancer
screening) for at least one condition? (By “implemented” we mean an EHR has been purchased, installed, and
tested, and is currently being used.)
Yes
No

Please proceed to Question 3.9c
Please proceed to Question 3.14

3.9c Is this stand-alone patient registry linked with your EHR system? That is, do you electronically update the
registry from the EHR system?
An electronic update may include regularly running a program to transfer data from the EHR to the registry.
Yes
No
3.10 When did the practice purchase the current stand-alone patient registry from the vendor?
________________________(mm/dd/yy)
3.11 What is the vendor name, product name, and version of the stand-alone patient registry that you currently have
at this practice location?
___________________________________________________
___________________________________________________
3.12 Are you currently using the stand-alone patient registry system at this practice location? (By “use” we mean use
for purposes related to patient care. If the system is used solely for practice management or billing, please
respond “no.”)
Yes
No

Please proceed to question 3.13
Please proceed to Subsection C, Electronic prescribing

3.13 For which of the following conditions is your EHR system (or stand-alone patient registry) being used to manage
patient care?
By “manage patient care” we mean using the electronic system to help improve care for patients with a specific
diagnosis or condition. This often occurs, for example, through the use of electronic clinical reminders or other
informational or decision supports within the EHR or registry, or by the EHR or registry’s making it possible to
do targeted outreach to patients with the condition.
a. Diabetes
b. Coronary Artery Disease
c. Hypertension
d. Congestive Heart Failure
e. Preventive Care

Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

f. Adult Asthma
Yes
No
g. Depression
Yes
No
h. Anticoagulation
Yes
No
i. Other
Yes
No
If other, please specify: _________________
__________________________________

If you answered no to question 3.9b, please answer question 3.14. All others please proceed to Subsection C,
Electronic Prescribing System
3.14 When do you plan to implement a patient registry system, either within an EHR or as a stand-alone system, at
Do not plan to implement one
0-6 months
7-12 months
13-24 months
this practice location?
other _______________________________
Prepared by Mathematica Policy Research,

F.11

C. Electronic Prescribing System
Electronic prescribing tools are designed to generate prescriptions and to conduct other functions related to
medication prescribing. They may either be components of an EHR or stand-alone system and sometimes include
hand-held devices.
The next series of questions ask to what extent your practice uses an electronic prescribing tool and whether that
tool is a stand-alone or part of your EHR.
If this practice location has NOT implemented an EHR (that is, you answered “no” to 3.1), please proceed to 3.15b.
3.15a Has your practice at this location implemented an EHR to generate prescriptions? (By
mean an EHR has been purchased, installed, and tested, and is currently being used.)
Yes
No

“implemented”

we

Please proceed to Section 4, Electronic System Functions
Please proceed to Question 3.15b

3.15b Has your practice at this location implemented a stand-alone electronic prescribing system to generate
prescriptions? (By “implemented” we mean an EHR has been purchased, installed, and tested, and is currently being
used.)
Yes
No

Please proceed to Question 3.15c
Please proceed to Question 3.19

3.15c Is this stand-alone prescription system linked with your EHR system? That is, do you electronically update the
prescription system from the EHR system?
An electronic update may include regularly running a program to transfer data from the EHR to the e-prescribing
system.
Yes
No
3.16 When did the practice purchase the current stand-alone prescribing system? _________________ (mm/dd/yy)
3.17 What is the vendor name, product name, and version of the stand-alone prescribing system you currently have
at this practice location?
_____________________________________________________
_____________________________________________________
3.18 Are you currently using the stand-alone prescribing system at this practice location? (By “use” we mean use for
purposes related to patient care. If the system is used solely for practice management or billing, please respond
“no.”)
Yes
No

Please proceed to Section 4, Electronic System Functions
Please proceed to Section 4, Electronic System Functions

If you answered no to question 3.15b, please answer question 3.19. All others please proceed to section 4
3.19 When do you plan to implement an electronic prescribing system, either within an EHR or a free-standing
Do not plan to implement one
0-6 months
7-12 months
13-24 months
system?
other _________________
Prepared by Mathematica Policy Research,

F.12

If this practice location has NOT implemented an EHR, has NOT implemented an electronic patient registry, AND
has NOT implemented an electronic prescribing system (that is, you answered “no” to 3.1 AND 3.9b AND 3.15b),
please proceed to Section 5. All others please continue to Section 4, question 4.1.

SECTION 4 – Electronic Health Record, Patient Registry, and Prescribing System
Functions
An EHR system has the capability of generating a complete record of a clinical patient encounter, as well as
supporting other care-related activities, such as evidence-based decision support, quality management, and
outcomes reporting. An EHR system can have many functions such as: entering progress notes; providing decision
support within the patient encounter; and utilizing computerized physician order entry for laboratory and
prescriptions. Electronic patient registries and electronic prescribing systems may perform some of these functions.

Domain 1. Completeness of Information
PROPORTION OF PAPER RECORDS/CHARTS

4.1 Please estimate the proportion of…
4.1a

4.1b

None

Some, but
less than
¼

1/4 or
more, but
less than
1/2

1/2 or
more, but
less than
¾

3/4 or more

Paper records that have been transitioned to
the EHR system. By “transitioned” we mean
either scanned documents in full into the EHR
or keyed in data items by hand (such as patient
demographics, medical history, blood pressure
readings, test results)
Paper charts that were pulled for scheduled
patient visits over the past month

If response to 4.1a = “None”, please proceed to next section below. For all other responses to 4.1a, please proceed
to question 4.1c
4.1c What method did you predominantly use to transition your paper records to the EHR system? Was it to scan
documents in full into the system, key in the data items by hand, a combination of both, or some other method?
Scan documents in full
Key in data items by hand
Combination of scanning and keying in items
Other, please specify: ___________________________________________________
__________________________________________________________________

Prepared by Mathematica Policy Research,

F.13

Domain 1. Completeness of Information (Cont.)
This section asks about the extent to which your practice uses an EHR system, electronic patient registry, or
electronic prescribing system for maintaining different types of patient data.
When responding please refer to patients seen over the past month by ALL providers in this practice location, or by
other office staff acting on behalf of those providers. When the item is about using a function for a subset of patients –
such as those needing imaging studies – please refer to the proportion of relevant patients.
By “all providers” we mean all the primary care physicians, specialty physicians, physician assistants, nurse
practitioners, and nurse midwives in this practice location (including those who are participating in the demonstration,
as well as those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.
Please estimate the proportion of patients for which providers (or others acting on their behalf) at this practice
location use the EHR, electronic patient registry, or electronic prescribing system for each of the following functions
(as opposed to relying on paper charts).
PROPORTION OF PATIENTS

Functions

None

4.1d. Clinical notes for individual patients
Refers to using the electronic system to create, update, store
and display clinical notes.

4.1e. Allergy lists for individual patients
Refers to using the electronic system to create, update, store
and display a list of medications or other agents (food,
environmental) to which patient has a known allergy or
adverse reaction.

4.1f. Problem or diagnosis lists for individual patients
Refers to using the electronic system to create, update, store
and display a list of problems or diagnoses for a patient.

4.1g. Patient demographics (for example, age or sex)
Methods of entry include
entering notes/data using
menus; or dictation with the
voice recognition into text
system.

direct keyboard entry (typing);
templates, forms or drop-down
voice transcribed manually or via
that is later integrated into the

4.1h. Patient medical histories
4.1i. Recording (or entering) laboratory orders into
electronic system
Methods of entry include
entering notes/data using
menus; or dictation with the
voice recognition into text
system.

direct keyboard entry (typing);
templates, forms or drop-down
voice transcribed manually or via
that is later integrated into the

Includes orders for lab tests conducted by external providers
and the practice itself.

Prepared by Mathematica Policy Research,

F.14

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

Functions

None

4.1j. Receiving laboratory results by fax or mail and
scanning paper versions into electronic system
Refers to converting the image or text from paper into a digital
image or text that is saved in the electronic system.
Includes results from lab tests conducted by external providers
and the practice itself.

4.1k. Reviewing laboratory test results electronically
Refers to (1) system tracking that results have been received
and (2) physician examining screens with displays of results
stored in the system.

4.1l. Recording (or entering) imaging orders into
electronic system
Methods of entry include
entering notes/data using
menus; or dictation with the
voice recognition into text
system.

direct keyboard entry (typing);
templates, forms or drop-down
voice transcribed manually or via
that is later integrated into the

Includes orders for imaging conducted by external providers
and the practice itself.

4.1m Receiving imaging results by fax or mail and
scanning paper versions into electronic system
Refers to converting the image or text from paper into a digital
image or text that is saved in the electronic system.
Includes results from imaging conducted by external providers
and the practice itself.

4.1n. Reviewing imaging results electronically
Refers to (1) system tracking that results have been received
and (2) physician examining screens with displays of results
stored in the system.

4.1o. Recording that instructions or educational
information were given to patient
[This question will be asked for each CAD, HF, diabetes, and
preventive diagnosis identified in question 3.13]

4.1p Recording (or entering) prescription medications
(new prescriptions and refills) into electronic system
Methods of entry include
entering notes/data using
menus; or dictation with the
voice recognition into text
system.

direct keyboard entry (typing);
templates, forms or drop-down
voice transcribed manually or via
that is later integrated into the

Prepared by Mathematica Policy Research,

F.15

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

Domain 2: Communication of Care Outside the Practice
This section asks about the extent to which your practice uses an EHR system, electronic patient registry, or
electronic prescribing system for communication with providers outside the practice. Providers outside the
practice include those that are part of a larger organization or network with which the practice is affiliated.
When responding, please refer to all patients seen over the past month with certain conditions by ALL providers in
this practice location, or by other office staff acting on behalf of those providers.
By “all providers” we mean all the primary care physicians, specialty physicians, physician assistants, nurse
practitioners, and nurse midwives in this practice location (including those who are participating in the demonstration,
as well as those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.
Please estimate the proportion of patients for which providers (or others acting on their behalf) at this practice location
use the EHR, electronic patient registry, or electronic prescribing system to perform each of the following functions (as
opposed to relying on paper charts).

Functions

None

PROPORTION OF PATIENTS
1/2 or
1/4 or
Some,
more,
more,
but less
but less
but less
than ¼
than
than 1/2
¾

3/4 or
more

Laboratory Orders
Items 4.2a -2b, and -2c form a hierarchy of laboratory ordering
functions, ordered by degree of technological sophistication.
Your responses to the three questions should represent the
experience of all patients in your practice at this location who
needed laboratory work over the past month.
If the range of proportions given for these three questions sum
to more than 1, a pop up box will appear that asks you to review
your responses for accuracy and make any corrections as
needed.

* (If responses to the three items below sum to more than 1,
a pop up box will appear that says, “The range of proportions
that you responded to these three items sum to more than 1.
Please review your responses for accuracy and revise any as
needed.”)

4.2a Print and fax laboratory orders to facilities outside
the practice
Order is first printed and then sent over a telephone line using
a stand-alone fax machine.

4.2b Fax laboratory orders electronically from system, or
order electronically through a portal maintained by
facilities outside the practice
Order is generated electronically, using a macro or template,
and faxed directly through the electronic system to the
laboratory or ordered directly without using any paper or a
stand-alone fax machine.

4.2c Transmit laboratory orders electronically directly
from system to facilities outside the practice that
have the capability to receive such transmissions
Order is sent as machine-readable data.

Imaging Orders

Prepared by Mathematica Policy Research,

F.16

Functions

None

Items 4.2d,-2e, and -2f form a hierarchy of imaging ordering
functions, ordered by degree of technological sophistication.
Your responses to the three questions should represent the
experience of all patients in your practice at this location who
needed imaging over the past month.
If the range of proportions given for these three questions sum
to more than 1, a pop up box will appear that asks you to review
your responses for accuracy and make any corrections as
needed.

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

*(If responses to the three items below sum to more than 1, a
pop up box will appear that says, “The range of proportions
that you responded to these three items sum to more than 1.
Please review your responses for accuracy and revise any as
needed.”)

4.2d Print and fax imaging orders to facilities outside the
practice
Order is first printed and then sent over a telephone line using
a stand-alone fax machine.

4.2e Fax imaging orders electronically from system, or
order electronically through a portal maintained by
facilities outside the practice
Order is generated electronically, using a macro or template,
and faxed directly through the electronic system to the imaging
facility without using any paper or a stand-alone fax machine.

4.2f Transmit imaging orders electronically directly from
system to facilities outside the practice that have the
capability to receive such transmissions
Order is sent as machine-readable data.

Laboratory Results
Items 4.2g -2h and –2i form a hierarchy of inputting laboratory
results into an EHR system, ordered by degree of technological
sophistication. Your responses to the three questions should
represent the experience of all patients in your practice at this
location who received laboratory results over the past month.
If the range of proportions given for these three questions sum
to more than 1, a pop up box will appear that asks you to review
your responses for accuracy and make any corrections as
needed.

*(If responses to the three items below sum to more than 1, a
pop up box will appear that says, “The range of proportions
that you responded to these three items sum to more than 1.
Please review your responses for accuracy and revise any as
needed.”)

4.2g Transfer electronic laboratory results (received in
non-machine readable form, such as an e-fax)
directly into system
Refers to saving or attaching an electronic submission, such
as an e-fax, that is not electronically searchable in the EHR
system. (An e-fax is a transmission of the image of a document
directly from a computer or multi-purpose printer without the
use of stand-alone fax equipment to generate the paper-based
image.)

4.2i Receive electronically transmitted laboratory results
directly into system from facilities that have the
capability to send such transmissions
Results are received electronically and do not need to be
manually uploaded or posted into the system.

Prepared by Mathematica Policy Research,

F.17

Functions

None

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

Imaging Results
Items 4.2j -2k, and -2l form a hierarchy of inputting imaging
results into an EHR system, ordered by degree of technological
sophistication. Your responses to the three questions should
represent the experience of all patients in your practice at this
location who received imaging results over the past month.
If the range of proportions given for these three questions sum
to more than 1, a pop up box will appear that asks you to review
your responses for accuracy and make any corrections as
needed.

(If responses to the three items below sum to more than 1, a
pop up box will appear that says, “The range of proportions
that you responded to these three items sum to more than 1.
Please review your responses for accuracy and revise any as
needed.”)

4.2j Transfer electronic imaging results (received in nonmachine readable form, such as an e-fax) directly
into system
Refers to saving or attaching an electronic submission, such
as an e-fax, that is not electronically searchable into the EHR
system. (An e-fax is a transmission of the image of a document
directly from a computer or multi-purpose printer without the
use of stand-alone fax equipment to generate the paper-based
image.)

4.2k Enter imaging results manually into electronic
system in a searchable field (whether received by
fax, mail or phone)
Methods of entry include direct keyboard entry (typing);
entering notes/data using templates, forms or drop-down
menus; or dictation with the voice transcribed manually or via
voice recognition into text that is later integrated into the
electronic system and is searchable.

4.2l Receive electronically transmitted imaging results
directly into system from facilities that have the
capability to send such transmissions
Results are received electronically and do not need to be
manually uploaded or posted into the system.

Referral and Consultation Requests
4.2m Enter requests for referrals to or consultation with
other providers (for example, specialists, subspecialists, physical therapy, speech therapy,
nutritionists)
Refers to recording physician or patient requests for referral/
consultation, scheduling the referral/ consultation, and tracking
results of referral/ consultation.

Sharing Information with other Providers
4.2n Transmit medication lists or other medical
information to other providers (for example,
hospitals, home health agencies, or other
physicians)
Prepared by Mathematica Policy Research,

F.18

Functions

None

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

4.2o Transmit laboratory results to other providers (for
example, hospitals, home health agencies, or
other physicians)
Results are sent as machine-readable data.

4.2p

Transmit imaging results to other providers (for
example, hospitals, home health agencies, or
other physicians)
Results are sent as machine-readable data.

4.2q Receive electronically transmitted reports directly
into system, such as discharge summaries, from
hospitals or other facilities that have the capability
to send such transmissions
Prescription Orders
Items 4.2r -2s, and –2t form a hierarchy of sending
prescriptions, ordered by degree of technological sophistication.
Your responses to the three questions should represent the
experience of all patients in your practice at this location over
the past month.
If the range of proportions given for these three questions sum
to more than 1, a pop up box will appear that asks you to review
your responses for accuracy and make any corrections as
needed.

(If responses to the three items below sum to more than 1, a
pop up box will appear that says, “The range of proportions
that you responded to these three items sum to more than 1.
Please review your responses for accuracy and revise any as
needed.”)

Note that these questions exclude Schedule II-V drugs

4.2r Print prescriptions (new prescriptions and refills) on
a computer printer and fax to pharmacy or hand to
patient
4.2s Fax prescription orders (new prescriptions and
refills) electronically from electronic system
The prescription is faxed without using any paper or a standalone fax machine.

4.2t Transmit prescription orders (new prescriptions and
refills) electronically directly from system to
pharmacies that have the capability to receive such
transmissions
The prescription is sent and received without relying on a
stand-alone fax machine at either the provider’s office or the
pharmacy.

Prepared by Mathematica Policy Research,

F.19

Domain 3: Clinical Decision Support
This section asks about the extent to which your practice uses an EHR system, electronic patient registry, or
electronic prescribing system for clinical decision support.
When responding please refer to patients seen over the past month by ALL providers in this practice location, or by
other office staff acting on behalf of those providers.
By “all providers” we mean all the primary care physicians, specialty physicians, physician assistants, nurse
practitioners, and nurse midwives in this practice location (including those who are participating in the demonstration,
as well as those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.
Please complete all questions in the survey unless directed within it to skip a section. If you are not aware of how all
the providers in the practice are using the functions asked about in this section, please consult with them prior to
answering the questions.
Please estimate the proportion of patients for which providers (or others acting on their behalf) at this practice location
use the EHR, electronic patient registry, or electronic prescribing system to perform each of the following functions (as
opposed to relying on paper charts).

Functions

None

4.3a Enter information from
documentation templates

clinical

notes

into

Documentation templates are preset formats that determine
what information will be displayed on each page and how it will
be displayed. Templates usually allow information to be
displayed as discrete data elements (that is, each element of
data is stored in its own field or box.) For example, the clinical
notes page can have separate boxes for entry of notes or data
about a patient’s height, weight, blood pressure, or other vital
signs.
Methods of entry include
entering notes/data using
menus; or dictation with the
voice recognition into text
system.

direct keyboard entry (typing);
templates, forms or drop-down
voice transcribed manually or via
that is later integrated into the

4.3b View graphs of patient height or weight data over
time
4.3c View graphs of patient vital signs data over time
(such as blood pressure or heart rate)
4.3d Flag incomplete or overdue test results
4.3e Highlight out of range test levels
Refers to system comparing test results with guidelines or
provider-determined goals for this patient

4.3f View graphs of laboratory or other test results over
time for individual patients

Prepared by Mathematica Policy Research,

F.20

PROPORTION OF PATIENTS
1/2 or
1/4 or
Some,
more,
more,
but less
but less
but less
than ¼
than
than 1/2
¾

3/4 or
more

Functions

None

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

4.3g Prompt clinicians to order necessary tests, studies,
or other services
4.3h Review and act on reminders at the time of a patient
encounter regarding interventions, screening, or
follow-up office visits recommended by evidencebased practice guidelines
[This question will be asked for each CAD, HF, diabetes, and
preventive diagnosis identified in question 3.13]

4.3i

Reference
prescribed

information

on

medications

being

Electronic system displays information about medications
stored in its e-prescribing module/ subsystem or offers
providers links to Internet websites with such information.

4.3j

Reference guidelines and evidence-based
recommendations when prescribing medication for a
patient
Electronic system links to published diagnosis-specific
guidelines or recommendations that includes appropriate
medications for that diagnosis

Domain 3: Clinical Decision Support (Cont.)
The next section asks about the extent to which your practice uses an EHR system (or an electronic patient registry
or electronic prescribing system) for clinical decision support.
When responding please refer to this practice location’s experience over the past year.
If you are not aware of how all the providers in the practice are using the functions asked about in this section,
please consult with them prior to answering the questions.
For each type of report, please note the extent to which this practice location used the EHR, electronic patient registry
or electronic prescribing system (as opposed to reviewing paper charts) to generate reports.
Extent of Use During Last Year
Not used during
last year

Report types
4.3k Search for or generate a list of patients requiring a
specific intervention (such as an immunization)
4.3l Search for or generate a list of patients on a specific
medication (or on a specific dose of medication)
4.3m Search for or generate a list of patients who are due
for a lab or other test in a specific time interval

Prepared by Mathematica Policy Research,

F.21

As needed
basis or at
least once

Regularly for
full practice

Not used during
last year

Report types

As needed
basis or at
least once

Regularly for
full practice

4.3n Search for or generate a list of patients who fit a set
of criteria, such as age, diagnosis and clinical
indicator value.
For example, age less than 76, diagnosed with diabetes, and
has an HbA1c greater than 9 percent.

Domain 4: Use of the System to Increase Patient Engagement/Adherence
This section asks about the extent to which your practice uses an EHR system, electronic patient registry, or
electronic prescribing system for increasing patient engagement and adherence to their care plans.
When responding please refer to patients seen over the past month by ALL providers in this practice location, or by
other office staff acting on behalf of those providers.
By “all providers” we mean all the primary care physicians, specialty physicians, physician assistants, nurse
practitioners, and nurse midwives in this practice location (including those who are participating in the demonstration,
as well as those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.

Please estimate the proportion of patients for which providers (or others acting on their behalf) at this practice
location use the EHR, electronic patient registry, or electronic prescribing system to perform each of the following
functions (as opposed to relying on paper charts).
PROPORTION OF PATIENTS

Functions

None

4.4a Manage telephone calls
Refers to bringing up a patient’s record whenever the patient
calls or is called by the office and noting reason for the call.

4.4b Exchange secure messages with patients

4.4c. Allow patients to view their medical records online
4.4d Allow patients to provide information online to
update their records
4.4e Allow patients to request appointments online
4.4f Allow patients to request referrals online
4.4g Produce hard copy or electronic reminders for
patients about needed tests, studies, or other
services (for example, immunizations)
[This question will be asked for each CAD, HF, diabetes,
and preventive diagnosis identified in question 3.13]
Prepared by Mathematica Policy Research,

F.22

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

Functions

None

4.4h Generate written or electronic educational
information to help patients understand their
condition or medication
[This question will be asked for each CAD, HF, diabetes,
and preventive diagnosis identified in question 3.13]

4.4i Create written care plans (personalized to patient’s
condition or age/gender for preventive care) to help
guide patients in self-management
[This question will be asked for each CAD, HF, diabetes, and
preventive diagnosis identified in question 3.13]

4.4j Prompt provider to review patient self-management
plan (or patient-specific preventive care plan) with the
patient during a visit
[This question will be asked for each CAD, HF, diabetes, and
preventive diagnosis identified in question 3.13]

4.4k Modify self-management plan (or patient specific
preventive care plan) as needed following a patient
visit
[This question will be asked for each CAD, HF, diabetes, and
preventive diagnosis identified in question 3.13]

4.4l Identify generic or less expensive brand alternatives
at the time of prescription entry
Electronic system includes formularies that identify generic or
less expensive alternatives to selected medication or offers
providers links to Internet websites with such information.

4.4m Reference drug formularies of the patient's health
plans/ pharmacy benefit manager to recommend
preferred drugs at time of prescribing
Preferred drugs refer to medicines that receive maximum
coverage under the patient’s health plan.

Prepared by Mathematica Policy Research,

F.23

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

Domain 5: Medication Safety
The next section asks about the extent to which your practice uses an EHR system, electronic patient registry, or
electronic prescribing system for a variety of functions related to medication safety.
When responding please refer to patients seen over the past month by ALL providers in this practice location, or by
other office staff acting on behalf of those providers.
By “all providers” we mean all the primary care physicians, specialty physicians, physician assistants, nurse
practitioners, and nurse midwives in this practice location (including those who are participating in the demonstration,
as well as those who are not eligible for or not participating in the demonstration) as enumerated in 2.12.
Please estimate the proportion of patients for which providers (or others acting on their behalf) at this practice
location use the EHR, electronic patient registry system, or electronic prescribing system to perform each of the
following functions (as opposed to relying on paper charts).

Functions

None

4.5a Maintain medication list for individual patients
Refers to using the electronic system to create, update, store and
display a list of all medications (prescription and non-prescription)
that the patient is taking.

4.5b Generate new prescriptions (that is, system prompts
for common prescription details including medication
type and name, strength, dosage, and quantity)
4.5c Generate prescription refills (that is, system allows
provider to reorder a prior prescription by revising
original details associated with it, rather than
requiring re-entry)
4.5d Select individual medication for prescription (for
example, from a drop-down list in the electronic
system)
4.5e Calculate appropriate dose and frequency, or
suggest administration route based on patient
parameters such as age, weight, or functional
limitations
4.5f Screen prescriptions for drug allergies against the
patient's allergy information
4.5g Screen new prescriptions for drug-drug interactions
against the patient's list of current medications
4.5h. Check for drug-laboratory interaction
Such as to alert provider that patient is due for a certain
laboratory or other diagnostic study to monitor for therapeutic
or adverse effects of the medication or to alert provider that
Prepared by Mathematica Policy Research,

F.24

PROPORTION OF PATIENTS
1/2 or
1/4 or
Some,
more,
more,
but less
but less
but less
than ¼
than
than 1/2
¾

3/4 or
more

Functions

None

patient is at increased risk for adverse effects.
Electronic system may either store this information or link to
Internet websites with such information.

4.5i Check for drug-disease interaction
Electronic system may either store this information or link to
Internet websites with such information.

Prepared by Mathematica Policy Research,

F.25

Some,
but less
than ¼

1/4 or
more,
but less
than 1/2

1/2 or
more,
but less
than
¾

3/4 or
more

SECTION 5 - Data Attestation
WARNING: You will be unable to make changes to your responses once you have completed this section.
5.1 I have reviewed the data submitted in this survey and agree that it is a correct assessment of this practice. I
understand and acknowledge that my survey responses are accurate to the best of my knowledge and may be
subject to validation. (Practices that knowingly make false attestations could lose any incentive payments that
were made based on false data).
Agree

Disagree

5.2 Name: ______________________________________________________
5.3 Title: ________________________________________________________
Signature: (this line is for hard copy questionnaire. Otherwise 5.2 serves as the e-signature)
_________________________________________________________________

5.4 Comments? Please add any comments about the survey here.

Thank you for completing this survey.

Prepared by Mathematica Policy Research,

F.26

APPENDIX G
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD)
VALIDATION FORM

OMB Approval No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx

Electronic Health Records Demonstration
Office Systems Survey
Validation Form
November 7, 2008

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 0938-NEW. The time required to complete this
information collection is estimated to average 1.38 hours or 83 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: CMS, 7500 Security Boulevard, N2-14-26,
Baltimore, MD 21244-1850.

Prepared by Mathematica Policy Research, Inc.

G.3

Thank you for participating in the validation of the Centers for Medicare & Medicaid Services (CMS) Office
Systems Survey (OSS). This validation is being conducted as part of the Electronic Health Records
Demonstration (EHRD) and its evaluation. The goal of this evaluation is to unite technology and clinical practice
in the physician office setting. The evaluation of the EHRD will help CMS develop additional programs that can
assist physicians in moving toward the common goal of improving care. This is a unique opportunity for your
practice to contribute to a large-scale effort to improve the quality of ambulatory health care.
This form asks about the use of your Electronic Health Record (EHR) system to document clinical notes,
laboratory results and orders, imaging results and orders, and prescription medication orders. To document
each response, please print and send a screen shot (with all patient identifying information removed) from your
computer.
Please complete all sections of this form.
Again, we thank you for taking the time to fill out this important form.

Prepared by Mathematica Policy Research, Inc.

G.4

1.

Select three dates in the last two weeks on which more than five patients were seen at the practice.
Verify that, for each date, there is an electronic clinical note for 75 percent or more of every patient seen
in the office by a physician.
a.

Month/Day/Year:

|

|

|/|

|

|/|

|

|

|

|

Yes

No

b.

Month/Day/Year:

|

|

|/|

|

|/|

|

|

|

|

Yes

No

c.

Month/Day/Year:

|

|

|/|

|

|/|

|

|

|

|

Yes

No

2.

During the last two weeks, on the first day more than five patients were seen at the practice, select three
patients who had laboratory results reported to the practice.

2a.

For how many of these patients is the laboratory result received electronically in the practice’s system?
Patients

2b.

How were the laboratory results received by the electronic system?
Patient 1

a.

Fax………………………………………………….

b.

Mail………………………………………………….

c.

Scanned…………………………………………….

d.

Entered manually (keyboard entry)……………...

e.

Transferred directly (e-fax)……………………….

f.

Directly (electronically)……………………………

2c.

Are the laboratory orders for these three patients documented?

2ci.

2d.

Patient 2

Yes

Please proceed to Question 2ci

No

Please proceed to Question 2d

How many orders are documented?

Orders

For how many of these patients was the laboratory order sent electronically?
Patients

Prepared by Mathematica Policy Research, Inc.

G.5

Patient 3

2e.

How were the laboratory orders sent?
Patient 1

a.

Fax…………………………………………………..

b.

Mail………………………………………………….

c.

Scanned…………………………………………….

d.

Printed and faxed………………………………….

e.

Faxed electronically……………………………….

f.

Directly (electronically)……………………………

Patient 2

Patient 3

3.

During the last two weeks, on the first day more than five patients were seen at the practice, select three
patients who had imaging results reported to the practice.

3a.

For how many of these patients is the imaging result received electronically in the practice’s system?
Patients

3b.

How were the imaging results received by the electronic system?
Patient 1

a.

Fax…………………………………………………..

b.

Mail………………………………………………….

c.

Scanned…………………………………………….

d.

Entered manually (keyboard entry)……………..

e.

Transferred directly (e-fax)……………………….

f.

Directly (electronically)……………………………

3c.

Are the imaging orders for these patients documented?

3ci.

3d.

Patient 2

Yes

Please proceed to Question 3ci

No

Please proceed to Question 3d

How many orders are documented?

Orders

For how many of these patients was the imaging order sent electronically?
Patients

Prepared by Mathematica Policy Research, Inc.

G.6

Patient 3

3e.

How were the imaging orders sent?
Patient 1

a.

Fax…………………………………………………..

b.

Mail………………………………………………….

c.

Scanned…………………………………………….

d.

Printed and faxed………………………………….

e.

Faxed electronically……………………………….

f.

Directly (electronically)……………………………

Patient 2

Patient 3

4.

During the last two weeks, on the first day more than five patients were seen at the practice, select three
patients for whom a physician in the practice refilled prescription medications.

4a.

For how many of these patients was the order electronically documented in the system?
Patients

4b.

How were prescription orders sent?
Patient 1

a. Printed and faxed to pharmacy or handed to
patient…………………………………………………….
b.

Faxed electronically……………………………….

c.

Directly (electronically)…………………………....

Prepared by Mathematica Policy Research, Inc.

G.7

Patient 2

Patient 3

5.

For validation purposes, please provide the last four digits of each patient’s social security number.
Patient
1

Last Four Digits of Social Security Number

2
3
4
5
6
7
8
9
6a.

Please print a patient de-identified screen shot to document each of your responses to questions 1
through 4 above.
To print a de-identified screen shot:
PC users: Click the PrintScreen key on your keyboard. Then click Start -> Programs -> Accessories ->
Paint. In the Paint program, select Edit – Paste and then File – SaveAs to save the screen image to a file.
Mac users: Mac Command key-Shift-3 captures the whole screen and saves a file to your desktop.
Print out the image and manually black out (or cross out) all patient identifying information.

6b.

Please fax all printed screen shots to Mathematica Policy Research at 609-799-0005, attention Martha
Kovac.

6c.

I have printed a screen shot to document each of the responses to questions 1 through 4 and faxed
them to Mathematica Policy Research. All patient information is de-identified.
1

Agree

2

Disagree

7.

I understand and acknowledge that my survey responses are accurate to the best of my knowledge
and may be subject to verification.
1

Agree

2

Disagree

Prepared by Mathematica Policy Research, Inc.

G.8

8a.

Name: ____________________________________

8b.

Title:

8c.

Phone number: _____________________________

____________________________________

(we will only call you if we have questions about your responses).

Thank you for completing this form.

Prepared by Mathematica Policy Research, Inc.

G.9

APPENDIX H
MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP) DEMONSTRATION:
ADVANCE LETTERS

CMS LETTERHEAD
ADVANCE LETTER MCMP OSS — DEMONSTRATION PRACTICES

[DATE]
[NAME AND ADDRESS]
Dear [Dr./Mr./Ms.] [FILL LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) is sponsoring a study about the Medicare
Care Management Performance (MCMP) Demonstration in which you are participating. The purpose of
the study is to evaluate the demonstration’s impact on physicians’ ability to meet the needs of Medicare
beneficiaries through the use of health information technology (HIT) and evidence-based outcome
measures.
Mathematica Policy Research, Inc. (MPR), an independent research organization, is conducting the
study on behalf of CMS. As part of this study, MPR will survey approximately 980 physician practices
across the United States about their use of HIT. Half of these practices are participating in the
demonstration, and half will be from comparison practices that are not participating in the demonstration.
Your participation in the survey is essential in helping us evaluate the demonstration’s impact for
CMS. Please visit www.XXXXXXXX to complete the survey. In a pretest, practices took an average of
29 minutes to complete the questionnaire. Your answers will remain completely confidential. Neither
your name nor your practice’s name will ever be included in any reports prepared as part of this study.
If you have any questions, or if you would prefer to complete the survey by mail, please call MPR
toll-free at 1-XXX-XXX-XXXX and ask for Mindy Hu. If you would like to learn more about the study,
please visit the CMS website at http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/
MMA649_Summary.pdf.
We look forward to including your valuable input in this study.
Sincerely,
CMS Privacy Officer
Enclosure

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 0938-NEW. The time required to complete
this information collection is estimated to average 0.48 hours or 29 minutes per response, including the time to review instructions, search
existing data resources, and 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: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

H.3

CMS LETTERHEAD
ADVANCE LETTER MCMP OSS – COMPARISON PRACTICES
[DATE]
[NAME AND ADDRESS]
Dear [Dr./Mr./Ms.] [FILL LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) is sponsoring a three-year demonstration
called the Medicare Care Management Performance (MCMP) Demonstration. The goals of the
demonstration are to improve quality of care to eligible fee-for-service Medicare beneficiaries and
encourage the implementation and use of health information technology (HIT) among physicians who
serve Medicare beneficiaries.
Mathematica Policy Research, Inc. (MPR), an independent research organization, is conducting a
study of MCMP for CMS. The purpose of the study is to evaluate the demonstration’s impact on
physicians’ ability to meet the needs of Medicare beneficiaries through the use of health information
technology (HIT) and evidence-based outcome measures.
As part of this study, MPR will survey approximately 980 practices across the United States about
their use of HIT. Half of these practices are participating in the demonstration, and half are comparison
practices that are not participating in the demonstration. This letter is to invite you to participate in the
survey as a comparison practice.
Your participation in the survey is voluntary, but important. In order to evaluate the impact of the
demonstration, input from both participating and non-participating practices is needed. Please visit
www.XXXXXXXX to complete the survey. In a pretest, practices took an average of 29 minutes to
complete the questionnaire. Your answers will remain completely confidential. Neither your name nor
your practice’s name will ever be included in any reports prepared as part of this study.
If you have any questions, or if you would prefer to complete the survey by mail, please call MPR
toll-free at 1-XXX-XXX-XXXX and ask for Mindy Hu.
If you would like to learn more about the study, please visit the CMS website at
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MMA649_Eval.pdf .
We look forward to including your valuable input in this study.
Sincerely,
CMS Privacy Officer
Enclosure
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 0938-NEW. The time required to complete
this information collection is estimated to average 0.48 hours or 29 minutes per response, including the time to review instructions, search
existing data resources, and 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: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

H.4

APPENDIX I
MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP) DEMONSTRATION:
FACT SHEETS

MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP)
DEMONSTRATION FACT SHEET
(DEMONSTRATION PRACTICES)
WHAT IS THE MEDICARE CARE MANAGEMENT PERFORMANCE
DEMONSTRATION?
The Medicare Care Management Performance (MCMP) demonstration was authorized under Section
649 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It is
a three-year pay-for-performance demonstration with physicians to promote the adoption and use of
health information technology to improve the quality of care for chronically ill Medicare
beneficiaries. The demonstration is being sponsored by the Centers for Medicare & Medicaid
Services (CMS).
WHAT ARE THE GOALS OF THE DEMONSTRATION?
The goals of the demonstration are to improve quality of care to eligible fee-for-service Medicare
beneficiaries and encourage the implementation and use of health information technology (HIT).
The specific objectives are to promote continuity of care, help stabilize medical conditions, prevent
or minimize acute exacerbations of chronic conditions, and reduce adverse health outcomes.
WHICH STATES ARE PARTICIPATING IN THE DEMONSTRATION?
Solo and small- to medium-sized practices in Arkansas, California, Massachusetts, and Utah were
eligible to apply for participation in MCMP.
WHO IS CONDUCTING THE STUDY?
Mathematica Policy Research, Inc. (MPR), an independent research company, was hired by CMS to
conduct the MCMP study. MPR is a leader in the policy research and analysis field and has been
conducting surveys and evaluations for more than 40 years. You can learn more about MPR by
visiting its website at www.mathematica-mpr.com.
WILL MY INFORMATION BE KEPT CONFIDENTIAL?
Yes. All of the information we collect in the survey will be kept confidential as provided in the
Privacy Act. The information will be used for research purposes only. Neither your name nor your
practice’s name will ever be used in any reports.
HOW LONG WILL THE DEMONSTRATION RUN?
The demonstration began operations on July 1, 2007, and will end in June 2010.
WHAT KIND OF QUESTIONS WILL BE ON THE SURVEY?
The survey asks about your practice’s use of electronic health records (EHRs) and related HIT
functionalities, and about the characteristics of your practice and the providers participating in the
demonstration.
HOW LONG WILL IT TAKE TO COMPLETE THE SURVEY?
In a pretest, most people took between 24 and 35 minutes to complete the survey.

I.3

WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the demonstration, please visit the CMS website at
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MMA649_Summary.pdf.
For more information about the survey, please call MPR toll-free at 1-XXX-XXX-XXX and ask for
Mindy Hu.

I.4

MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP)
DEMONSTRATION FACT SHEET
(COMPARISON PRACTICES)

WHAT IS THE MEDICARE CARE MANAGEMENT PERFORMANCE
DEMONSTRATION?
The Medicare Care Management Performance (MCMP) demonstration was authorized under Section
649 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It is
a three-year pay-for-performance demonstration with physicians to promote the adoption and use of
health information technology to improve the quality of care for chronically ill Medicare
beneficiaries. The demonstration is being sponsored by the Centers for Medicare & Medicaid
Services (CMS).
WHAT ARE THE GOALS OF THE DEMONSTRATION?
The goals of the three-year demonstration are to improve quality of care to eligible fee-for-service
Medicare beneficiaries and encourage the implementation and use of health information technology
(HIT). The specific objectives are to promote continuity of care, help stabilize medical conditions,
prevent or minimize acute exacerbations of chronic conditions, and reduce adverse health outcomes.
WHICH STATES ARE PARTICIPATING IN THE DEMONSTRATION?
Solo and small- to medium-sized practices in Arkansas, California, Massachusetts, and Utah were
eligible to apply for participation in MCMP.
WHY ARE YOU CONTACTING NONPARTICIPATING PRACTICES?
The evaluation is utilizing a comparison group (or quasi-experimental) design for the impact
analysis. To identify the comparison group, Doctor’s Office Quality-Information Technology (DOQIT) practices in selected nondemonstration states that match most closely to those in the
demonstration states were selected.
WHO IS CONDUCTING THE STUDY?
Mathematica Policy Research, Inc. (MPR), an independent research company, was hired by CMS to
conduct the MCMP study. MPR is a leader in the policy research and analysis field and has been
conducting surveys and evaluations for more than 40 years. You can learn more about MPR by
visiting its website at www.mathematica-mpr.com
WILL MY INFORMATION BE KEPT CONFIDENTIAL?
Yes. All of the information we collect in the survey will be kept confidential as provided in the
Privacy Act. The information will be used for research purposes only. Neither your name nor your
practice’s name will ever be used in any reports.
HOW LONG WILL THE DEMONSTRATION RUN?
The demonstration began operations on July 1, 2007, and will end in June 2010.
WHAT KIND OF QUESTIONS WILL BE ON THE SURVEY?
The survey asks about your practice’s use of electronic health records (EHRs) and related HIT
functionalities, and about the characteristics of your practice and the providers in your practice.
I.5

HOW LONG WILL IT TAKE TO COMPLETE THE SURVEY?
In a pretest, most people took between 24 and 35 minutes to complete the survey.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the demonstration, please visit the CMS website at
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MMA649_Summary.pdf. For more
information about the survey, please call MPR toll-free at 1-XXX-XXX-XXX and ask for Mindy
Hu.

I.6

APPENDIX J
MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP) DEMONSTRATION
OFFICE SYSTEMS SURVEY

OMB Approval No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx

Medicare Care Management Performance
Demonstration
Office Systems Survey
November 7, 2008

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 0938-NEW. The time required to complete this
information collection is estimated to average 0.48 hours or 29 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: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Prepared by Mathematica Policy Research, Inc.

J.3

Thank you for volunteering to participate in the Centers for Medicare & Medicaid Services (CMS)
Office Systems Survey (OSS). This survey is part of the Medicare Care Management
Performance (MCMP) Demonstration. The goal of this demonstration is to unite technology and
clinical practice in the physician office setting. This is a unique opportunity for your practice to
contribute to a large-scale effort to improve the quality of ambulatory health care. The survey
asks about three types of electronic clinical information tools/functions that you may be using in
your practice to help manage your patients’ health needs. These tools allow for the systematic
application of evidence-based medical guidelines to your patient population with a goal of
developing care plans for any given patient.
In the survey you will be asked if you are currently using or are in the process of obtaining a:
• Electronic Health Record (EHR)
• Electronic registry software
• Electronic prescribing software
Throughout the survey we will ask you to provide information about the functions of the systems you
currently have in place. The goal is to use this information to help CMS develop additional programs that
can assist physicians in moving toward the common goal of improving care.
Please complete all sections of the survey unless directed within it to skip a section.
Again, we thank you for your participation and look forward to continuing to work with you.

Prepared by Mathematica Policy Research, Inc.

J.4

SECTION 1 – GENERAL INFORMATION - PRACTICE
1.1.

Date:

1.2.

MCMP Assigned Practice ID Number: {MERGE FIELD}

Please review your practice information below for accuracy. Please make corrections where necessary:

1.3. Legal Name of
Practice
{MERGE FIELD}
1.4. Location
Address:
{MERGE FIELD} Add a second line as in IPG web form
1.5.
1.6.
Location
Location
1.7. Location Zip
City:
{MERGE FIELD} State
{MERGE} Code:
{MERGEFIELD}
1.8. Telephone
No.:
{MERGE FIELD}
1.9. Fax
No.:
{MERGE FIELD}
1.10. E-mail
Address:
{MERGE FIELD}
1.11. Practice (Group) Medicare Billing Number
(PIN):
{MERGE FIELD}
(If unknown, please check with your billing manager or HCFA 1500 Form - field 33)
1.12. Federal Tax ID for this
practice:
{MERGE FIELD}.
1.13. Please check here if all of the above information is correct.
1.14. Is your practice affiliated with an Independent Practice Association (IPA), Physician Hospital Organization
(PHO) or medical group?

Yes

No

1.15. If Yes, Please indicate which IPA, PHO or medical group:

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J.5

1.16 Are you participating in any of the following programs? Please check all that apply

Physician Quality Reporting Initiative (PQRI)
Better Quality Information
Bridges to Excellence (BTE)
DOQ-IT Warehouse submissions
State or regional public reporting group
Other Federal Quality Improvement initiatives (Specify) ____________________
Other Private Quality Improvement initiatives (Specify) ____________________
Other Pay-for-Performance initiatives (Specify) _______________________
Other Electronic Health Record initiatives (Specify) ______________________
Other (please
specify):______________

Prepared by Mathematica Policy Research, Inc

J.6

SECTION 2 – PROVIDER PROFILE
Please review the information below for accuracy and make corrections/additions where necessary. Please note that
physician identifiers are being requested in this survey to ensure that the correct information corresponds with the
correct physician practice. The information you provide will be used by CMS internally, for the purposes of this project.
This information will not be shared or disseminated outside of the project staff. Please complete all information for
all MD/DO’s at your practice site.**
2.1. First Name

2.2. MI

2.3. Last Name

2.4. (NPI) National Provider Identification Number

2.5. Credentials (MD, DO)

2.8. Primary Practice Location (Y/N)
Yes

2.6. Specialty

1

2.7. Language(s) spoken (other than English)

2.9. PIN # (Individual Medicare Billing Number)

2

No

2.10. Please check here if all of the above is correct.

2.1. First Name

2.2. MI

2.3. Last Name

2.4. (NPI) National Provider Identification Number

2.5. Credentials (MD, DO)

2.8. Primary Practice Location (Y/N)
Yes

2.6. Specialty

1

2.7. Language(s) spoken (other than English)

2.9. PIN # (Individual Medicare Billing Number)

2

No

2.10. Please check here if all the information is correct.

2.1. First Name

2.2. MI

2.3. Last Name

2.6. Specialty

2.7. Language(s) spoken (other than English)

2.4. (NPI) National Provider Identification Number

2.5. Credentials (MD, DO)

2.8. Primary Practice Location (Y/N)
Yes

1

2.9. PIN # (Individual Medicare Billing Number)

2

No

2.10. Please check here if all of the above information is correct.
Footnotes:

1
Please indicate whether the provider listed primarily practices at this office location (50% or greater = practices primarily at this site).
2
Please provide the Individual Medicare Billing Number (PIN) that is assigned by the Medicare Carrier in your state for use by this physician/clinician at this
practice site only. (HCFA 1500 form field 24K or 33).

** WEB PROGRAM WILL INCLUDE ENOUGH BOXES TO CAPTURE ALL PROVIDERS’ INFORMATION
Prepared by Mathematica Policy Research, Inc

J.7

SECTION 3 – OFFICE PRACTICE

The implementation of information technology (IT) presents many operational challenges. As the
transition from paper to computer takes place, there are opportunities to redesign existing
workflows to gain maximum efficiencies. These questions focus on current workflow processes.
*

This series of questions refers to patient visits to ANY and ALL clinicians in your practice
over the past month.

3.1 Please estimate the proportion of patient encounters/visits for which clinicians or others in your practice engage
in each of the following activities.
None

About ¼

About ½

About ¾

0

1

2

3

Clinicians (or others) in your practice:

a. Pull paper charts for scheduled patient visits.
b. Dictate visit notes into a tape recorder or phone.
c. Dictate visit notes directly into the EHR.
(Add pop-up box here with definition of EHR: The
Electronic Health Record (EHR) is a longitudinal
electronic record of patient health information generated
by one or more encounters in any care delivery setting.
This record may include patient demographics,
diagnoses, progress notes, problems, medications, vital
signs, past medical history, immunizations, laboratory
data, and radiology reports. The EHR has the capability
of generating a complete record of a clinical patient
encounters, as well as supporting other care-related
activities, such as evidence-based decision support,
quality management, and outcomes reporting.)
Use a computerized (as opposed to paper) system to manage the following office workflows:
d.

Telephone calls

e.

Prescription refills

f.

Referrals

g.

Results follow-up (lab, diagnostic test, x-ray)

Prepared by Mathematica Policy Research, Inc

J.8

All or
nearly all
4

SECTION 4 - ELECTRONIC HEALTH RECORD

The Electronic Health Record (EHR) is a longitudinal electronic record of patient health
information generated by one or more encounters in any care delivery setting. This record may
include patient demographics, diagnoses, progress notes, problems, medications, vital signs,
past medical history, immunizations, laboratory data, and radiology reports. The EHR has the
capability of generating a complete record of a clinical patient encounters, as well as supporting
other care-related activities, such as evidence-based decision support, quality management, and
outcomes reporting. (The EHR covers all conditions that the patient might have and is distinct
from a registry that covers a specific disease or a limited set of diseases). Implementation of the
EHR may vary based on the goals set by a practice and the intended functions such as: enter
progress notes; provide decision support within the patient encounter; and utilize computerized
physician order entry for laboratory and prescriptions.
This section asks about the use or planned use of an EHR in your practice.

*

This series of questions refers to patient visits to ANY and ALL clinicians in your practice
over the past month.

4.1
Does your practice currently have an Electronic Health Record (EHR) [or signed a contract
for an EHR] at your site?
Yes

Proceed to question 4.2.

No

Proceed to question 4.5.

If you answered Yes to 4.1, please answer questions 4.2-4.4.
4.2

When was the vendor contract signed? __________________(mm/dd/yy)

4.3

What is the name and version of the EHR system you use at your site?

4.4

Are you currently using the system at your site?
Yes
No

Proceed to question 4.6.
Proceed to question 4.8

If you answered No to 4.1, please answer question 4.5 and then proceed to question 4.8.
4.5

When do you plan to implement an EHR?
Within 1 year
1-2 years
Not known at this time
Not planning to implement an EHR

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J.9

3-4 years

This series of questions refers to patient visits to ANY and ALL clinicians in your practice
over the past month.

*
4.6

Please estimate the proportion of patient visits/encounters for which clinicians or others in your practice use
the EHR to perform each of the following tasks.
None

About ¼

About ½

About ¾

0

1

2

3

Clinicians in your practice use the EHR to:

All or
nearly all
4

a. Place laboratory orders electronically
b. Review laboratory test results electronically
c. Place radiology orders electronically
d. Review radiology results electronically
e. Enter data into documentation templates
f. Review and act on reminders for care activities (e.g.
overdue health maintenance)
g. Maintain medication lists for individual patients
h. Maintain allergy list
i. Maintain problem and/or diagnosis list
j. Trend lab and/or other test results over time

4.7

Does your EHR include ALL or essentially all patients in your practice?
Yes

4.8

No
Are you familiar with the Certification Commission for Healthcare Information Technology (CCHIT) and its
electronic health record (EHR) Product-certification program?

Yes Proceed to question 4.8a
No Proceed to Section 5, Patient Registry/Care Management Processes
4.8a

If you have purchased an EHR since June 2006 or are in the process of purchasing an EHR now, how much
did the CCHIT certification status influence your decision?
1

2

3

1 = Not at all

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4

5
5 = High

J.10

SECTION 5 – PATIENT REGISTRY/CARE MANAGEMENT PROCESSES
For purposes of this survey, a registry is defined as an electronic system that is designed to identify patients with
specific diagnoses or medications; identify patients overdue for specific therapies; facilitate prompt ordering of
specific laboratory tests or recommended drugs; and facilitate prompt communication with patients requiring followup. For example, a practice may use a diabetes registry to document care at visits, and to create reports that indicate
which patients are due for certain blood tests, or are not meeting specific treatment goals for diabetes. A registry may
also be used to ensure all suggested preventive screenings take place. A Registry is usually a stand-alone system
that tracks specific information regarding a limited number of disease states, but otherwise lacks additional
functionality. An EHR can also be used for Patient Registry/Tracking purposes. If your practice uses either an EHR,
or a Registry, answer as appropriate the questions in this section.
These next questions ask about the existence and use of electronic registries in your practice.

*
5.1

This series of questions refers to patient visits to ANY and ALL clinicians in your practice
over the past month.
Does your practice site use an EHR to track patients who have a specific chronic illness, or receive
preventive care (i.e. immunizations, mammography and other cancer screening) for at least one condition?
Yes Please proceed to Question 5.7
No Please proceed to Question 5.2

5.2

Does your practice site use a stand alone electronic registry (e-registry) to track patients who have a specific
chronic illness, or receive preventive care (i.e. immunizations, mammography and other cancer screening)
for at least one condition?
Yes Please proceed to Question 5.3
No Please proceed to Question 5.6

5.3

What is the name and version of the e-registry system at your site? _________________________________

5.4

When was the e-registry contract signed? ________________________(mm/dd/yy)

5.5

Are you currently using the e-registry system at your site?
Yes Please proceed to question 5.7
No Please proceed to Section 5.6

5.6

When do you plan to start a registry?

this time

Within 1 year

Not planning to start a registry

If you answered question 5.6, please proceed to Section 6.

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J.11

1-2 years

3-4 years

Not known at

5.7

Which of the following conditions are included in your practice’s e-registry/EHR:

a. Diabetes
b. Coronary Artery Disease
c. Hypertension
d. Congestive Heart Failure
e. Preventive Care

*
5.8

Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

f. Adult Asthma
Yes
No
g. Depression
Yes
No
h. Anticoagulation
Yes
No
i. Other
Yes
No
If Others, please list: __________________________

This series of questions refers to patient visits to ANY and ALL clinicians in your practice over
the past month.
Following is a list of tasks that may be performed by registries. For each task, please estimate the proportion of
patients or patient encounters for which clinicians or others in your practice use each type of e-registry/EHR.

Types of Disease/Condition Registries
0= none
nearly all
E-registry/EHR Tasks

1= about ¼

Preventive Care

Diabetes

2= about ½
Coronary Artery
Disease

3= about ¾
Congestive
Heart Failure

4= all or
Hypertension

a. - Prompt your practice to
notify patients who are
overdue for office visits.

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

b. - Prompt clinicians to order
tests, studies, and other
services (e.g.,
immunizations).

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

c. - Produce reminders for
patients about needed tests,
studies, and other services
(e.g., immunizations).

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

d. – Generate a list of eligible
patients for each
disease/condition.

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

e. – Generate a list of patients
requiring intervention.

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J.12

Types of Disease/Condition Registries
0= none
nearly all
E-registry/EHR Tasks

1= about ¼

Preventive Care

Diabetes

2= about ½
Coronary Artery
Disease

3= about ¾
Congestive
Heart Failure

4= all or
Hypertension

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

i. - Modify self-management
plan (or patient specific
preventive care plan) as
needed following a patient
visit.

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

j. - Place laboratory orders
electronically.

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

k. - Review laboratory test
results electronically.

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

0
1
2
3
4

f. – Generate written or
electronic educational
information to help patients
understand their condition.
g. - Create written care plans
(personalized to patient’s
condition or age/gender for
preventive care) to help
guide patients in selfmanagement at
home/school/work.
h. Prompt clinician and/or
patient to review selfmanagement plan (or
patient specific preventive
care plan) together during a
visit.

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J.13

SECTION 6 - ELECTRONIC PRESCRIBING
With electronic prescribing tools, clinicians can generate prescriptions electronically using either a
freestanding product, or as a component of the EHR. The next series of questions ask to what extent your
practice uses an electronic prescribing tool and whether that tool is freestanding, or part of your EHR.

*

This series of questions refers to patient visits to ANY and ALL clinicians in your
practice over the past month.

6.1
Does your practice site use electronic software to generate prescriptions (as part
of an EHR or a freestanding e-prescribing system):
Yes Please proceed to Question 6.2
No Please proceed to Question 6.7
6.2
Please check which types of prescriptions your practice’s electronic software
generates:
New prescriptions only
6.3

Refills

Both

Is e-prescribing accomplished within your EHR?
Yes Please skip to question 6.8
No

6.4
What is the name and version of the e-prescribing system you use?
_____________________________________________________
6.5

When was the contract signed? __________________(mm/dd/yy)

After answering question 6.5, please proceed to Question 6.8
If you answered No to question 6.1, please answer question 6.7
6.7

1-2 years
When do you plan to implement e-prescribing? Within 1 year
3-4 years
Not known at this time
Not planning to implement e-prescribing

After answering question 6.7, please proceed to Section 7

*
6.8

This series of questions refers to patient visits to ANY and ALL clinicians in your
practice over the past month.
Please estimate the proportion of patient visits/encounters for which clinicians or
others in your practice use an electronic or hand-held device for each of the
following e-prescribing activities.
0= none
4= all or nearly all

1= about ¼

2= about ½

J.14

3= about ¾

None

About ¼

About ½

About ¾

0

1

2

3

E-prescribing activities:

a. - Identify generic or less expensive brand
alternatives at the time of prescription entry
b. - Reference the drug formularies of the
patient's health plans/pharmacy benefit
manager to recommend preferred drugs at
time of prescribing
c. - Offer guidelines and evidence-based
recommendations when prescribing
medication for a patient
d. - Calculate appropriate dose and frequency
based on patient parameters such as age
and weight
e. - Maintain a list of each patient's current
medications
f. - Screen prescriptions for drug allergies
against the patient's allergy information
g. - Screen new prescriptions for drug-drug
interactions against the patient's list of current
medications
h. - Select individual medication for prescription

i. -

Print prescriptions on a computer printer

j. -

Transmit prescriptions directly to pharmacy
via electronic fax (no paper printed)

k. - Transmit prescriptions directly to pharmacy
via electronic means (without relying on a fax
machine at either clinician’s office or in the
pharmacy)
l. -

Provide patient-friendly information about the
medication to the patient

J.15

All or
nearly all
4

SECTION 7 - DATA ATTESTATION

7.1

I have reviewed the data submitted in this survey and agree that it is a correct
assessment of this practice.
Agree

Disagree

7.2

Name: ____________________________________________________

7.3

Titl

____________________________________________________

Signature:

____________________________________________________

SECTION 8 – Final Comments

8.1 Would you like to include any final comments?
Yes
8.2

No

Comments

Thank you for completing this survey.

J.16

APPENDIX K
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD) PRACTICE
DISCUSSION GUIDES

DISCUSSION GUIDES

This appendix contains the following discussion guides:
A.
B.
C.
D.

Guide for Participating Treatment Group Practices
Guide for Control Group Practices
Guide for Withdrawn Treatment Group Practices
Guide for Community Partner Site Coordinators

In the event that we cannot ask all questions in the following guides during a contact,
question priority is reflected in the question numbering scheme. Numbered questions will always
be asked during the discussion. Lower-case lettered questions are to be asked unless time is
unusually short. Italicized questions are prompts to remind our staff of details to cover during
discussion of the question.

K.3

A. GUIDE FOR PARTICIPATING TREATMENT GROUP PRACTICES

K.5

A1. BACKGROUND OBTAINED DURING SCHEDULING OF PRACTICE CONTACT—TREATMENT
GROUP PRACTICES
[All questions will be pre-filled from the application database where there is overlap (indicated
with a “*”), to provide background information. Thes information will be verified during the
contact.]
1. What year was the practice established?
2. *What is the organizational structure of the practice (e.g. is it part of a larger health
care organization)?
3. *How many locations does the practice have?
4. *How many physicians are in the practice?
5. How many of them are participating in the demonstration?
6. How many and what types of other staff are part of the practice?
7. *How many Medicare FFS beneficiaries does the practice serve?
8. About what percentage of all the practice’s patients are Medicare fee-for-service?
9. Does the practice see Medicare Advantage (MA), that is, Medicare managed care
patients?
10. [If sees MA patients:] What percentage of all patients in the practice are Medicare
managed care?
11. Is the practice participating in CMS’s Physician Quality Reporting Initiative (PQRI)?

K.7

A2. ADMINISTRATIVE STAFF MEMBER OVERSEEING ADOPTION AND IMPLEMENTATION OF
HEALTH SYSTEM—TREATMENT GROUP PRACTICES
a) Practice Perspectives on the Demonstration and Early Response
1. Which features of the demonstration do you and the clinicians particularly like?
Do physicians feel differently about the demonstration from nurses or other clinicians in
the practice?
2. Which if any features of the demonstration do you and the clinicians dislike?
a. More broadly, do you and clinicians in the practice think linking payment to quality
of care through incentives is a good idea?
Do physicians feel differently about this from nurses or other clinicians in the practice?
3. What are the practice’s expectations regarding the incentive payment from the
demonstration—have you estimated how much the practice expects to receive as a
result of participating over the next few years?
a. How much would that be in terms of a percent of revenue?
b. in the next year?
c. over the 5-year demonstration?
d. What do you think will be the key factors in whether these expectations are met?
4. What if anything, has the practice done differently thus far because of thinking about
the incentives in the demonstration?
b) Adaptation of Practice Operations as HIT Is Implemented
1. Do you have an EHR?
2. [If no EHR:] Why not?
3. [If no EHR:] When do you plan to get one?
4. [If no EHR:] What would facilitate your acquiring an EHR?
5. [If no EHR:] Have you started any activities to prepare for an EHR, such as
completing an office readiness assessment, or exploring vendor and product
alternatives?
6. [If has EHR:] Please confirm if you still have [fill vendor and product from
application]?
a. How long have you had that system?
7. Please give us an overview of the health IT you are using for each of the following
functions. [Complete the table. “Using” column will be prefilled with Y/N from
application.]
K.8

8.

[If e-prescribing—yes to p or q:] Is e-prescribing accomplished through your
electronic health record or through a stand-alone system?
a. [If stand-alone system:] Please briefly describe your e-prescribing system.

9. [If registry—yes to f:] Is your disease-specific registry through your EHR or is it a
stand-along registry?
a. [If stand-alone registry:] Please briefly describe your registry.
10. [If EHR:] Are any of the other functions we discussed accomplished outside your
EHR?
11. [If HIT:] On whom did you primarily rely for assistance in implementing the health
IT that you use (QIO, vendor, consultant)?
12. [If HIT:] With implementation of HIT, what changes were made in how the practice
operates day to day?
Were these changes the result of a specific effort to redesign office flow to meet the EHR
process?
13. What other information sources or other factors influenced the practice’s thinking
about what changes it should make with HIT implementation?
c)

[If HIT:] Facilitators and Barriers to Adopting and Implementing HIT
1. Thinking about the health IT functions that you have started using in the past year,
were there particular difficulties in selecting or acquiring the related product and/or
getting it up and running?
2. Thinking about the health IT functions that you started using in the past year, what
factors have been helpful in selecting or acquiring the product and/or getting it up
and running?
3. Are there persistent problems in getting some of the functions to be used routinely in
the practice—either the functions we just talked about or others? What are the issues
you view as most important?
4. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are hey
having success at influencing others? Who is it?

K.9

Fill in this table for question b.7.

Function
a. Electronic patient visit notes
b. Electronic patient-specific
problem lists
c. Electronic patient-specific
medication lists

K.10

d. Automated patient-specific alerts
and reminders
e. Other clinical decision
support/automated references to
best practices
Please describe:
f. Electronic disease-specific
registries—that is, using the EHR
or a stand-alone registry to
identify patients with specific
diagnoses, or to track information
and prompt ordering of tests or
communications for patients with
those conditions
g. Patient e-mail

Using
(Y/N)

Year
started
(mo/yr in
the past
year)

Uses,
Limited

Uses,
Widespread

Timeframe,
if plan to
start using
it

If no plans
to use it,
why not?

Function
h. Patient-specific educational
materials
i. On-line referrals to other
providers
j. Clinical messaging with other
physicians
k. Transmission of records to
hospitals or other facilities
K.11

Laboratory Tests:
l. On-line order entry
m. On-line results viewing
Radiology tests:
n. On-line order entry
o. On-line results viewing;
Specify reports or images or both:
E-Prescribing:
p. Printing and/or faxing Rx;
Computerized faxing?
q. On-line Rx transmission to
pharmacy

Using
(Y/N)

Year
started
(mo/yr in
the past
year)

Uses,
Limited

Uses,
Widespread

Timeframe,
if plan to
start using
it

If no plans
to use it,
why not?

Function
Other:
r. Receipt of electronic clinical
information from hospitals, other
facilities or doctors
Which types of providers?

Using
(Y/N)

Year
started
(mo/yr in
the past
year)

Uses,
Limited

Uses,
Widespread

Timeframe,
if plan to
start using
it

If no plans
to use it,
why not?

K.12

d) Relevant Context—Other Incentives, Reporting Programs, and HIT Initiatives
1. Is the practice participating in any other P4P initiatives/programs? If so, do they
include incentives for adopting or using health IT?
2. Are there any other P4P activities that you know of going on in this area?
3. Have other incentives that the practice faces from other payers or other reporting
programs such as CMS’s PQRI affected how the practice has responded to the
incentives under the demonstration? If so, how?
4. Is the practice participating in any other HIT or EHR initiatives? What are they? Are
there other HIT or EHR activities going on in this area?
e)

Use of HIT for Care Management

Next, we have some specific questions about the extent to which the practice is using HIT to
improve patient care for specific conditions or to ensure recommended services are provided—
we are going to refer to this as “care management.”
1. E-prescribing [if applicable]
a. Do the practice’s e-prescribing activities include using the system to screen
prescriptions for drug allergies, drug-drug interactions, or drug-disease interactions?
b. Is the system used to offer guidelines and evidence-based recommendations when
prescribing medication?
c. To provide patient-friendly information about the medication to the patient?
d. Why does or doesn’t the practice use its system to do these things?
Is function available on the system and turned on?
Any technical issues that discourage use
2. Electronic disease-specific registries [if applicable]
a. Does the practice use its system to generate reminders to patients with certain
diseases about needed or overdue visits or tests?
b. To prompt clinicians to order tests or services?
c. To create, prompt review of, or modify self-management plans for patients with
chronic illness?
d. To print educational information to help patients understand their condition?
e. Why does or doesn’t the practice use its system to do these things?
Is function available on the system and turned on?
Any technical issues that discourage use

K.13

3. Does the practice use its EHR to review and act on reminders for care activities such
as due or overdue health maintenance, that are not specifically focused on people
with a particular disease?
a. Why does or doesn’t the practice use its system for this purpose?
Is function available on the system and turned on?
Any technical issues that discourage use
4

When you were shopping for HIT, how much did the practice care about whether or
how well it could support these types of e-prescribing activities, and tracking and
prompting for patients with specific diseases or more generally?

5. [If they cared about the system supporting e-prescribing, tracking and prompting
during selection:] Is the system living up to your expectations?
6. What if any practice characteristics have influenced the practice’s view on using HIT
for these types of care management activities? For example:
The characteristics of the practice’s patients, e.g. number of elderly with complex
conditions, or that have many physicians?
Your views?
How busy the practice is at present?
How profitable the practice is at present?
Your comfort level with HIT?
The physicians’ comfort level with HIT?
f)

Plans for Change
1. What if any specific plans does the practice have for changing how it uses HIT over
the next few years?
2. [If yes:] What will be the key factors that affect whether the practice is able to make
these changes?
Financial
Knowledge/availability of technical assistance resources/tools

K.14

A3. PHYSICIAN—TREATMENT GROUP PRACTICES
a) Demonstration Participation and Operational Response
1. Who made the decision to participate in the demonstration?
2. What if anything, has the practice done differently thus far due to participating in the
demonstration?
3. [If HIT:] Did participation in the EHR Demonstration influence the practice’s
thinking about making changes when it implemented new HIT?
What other information sources or other factors influenced the practice’s thinking about
what changes it should make with HIT implementation?
b) HIT Experience and Effect on Practice Change
1. [If HIT:] Now that we’ve talked about the changes the practice made specifically in
response to the demonstration, I’d like to ask a more general question—what HIT
functions work best to support clinical care in the practice?
2. [If HIT:] Which if any HIT functions are problematic right now?
3. Have you observed any changes in specific aspects of the practice as a result of using
[name of HIT type]? Such as changes in: [Repeat if multiple HIT types]
Time spent on each patient visit?
Physician time spent on administrative versus clinical functions?
Other clinical staff time spent on administrative versus clinical functions?
Completeness of the practice’s clinical documentation?
Usefulness of the information that is immediately in-hand at the start of patient
appointments?
4. [If switched from paper to electronic in past year:] What have been the effects on the
practice from switching from paper to electronic charts?
5. [If no HIT:] We understand that the practice does not have an EHR or other health IT
in place at the present time. Can you tell us why not, and whether or when you plan
to acquire an EHR and/or other health IT products such as an electronic registry?
6. [If no EHR:] What would facilitate your acquiring an EHR?
7. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are
they having success at influencing others? Who is it?

K.15

c)

Care Management Views/Experience
1. Has participating in the EHR Demonstration affected the practice’s views on care
management, or how easy it has been to implement it? By care management, we
mean routines put in place in order to improve patient care for specific conditions, or
to prompt clinicians or the patients about due or overdue services. This includes new
ways to identify and remind patients needing preventive services or routine tests,
new routines for educating patients about self-care, or new checks in place to better
ensure clinical guidelines are being met for patients with certain chronic conditions.
2. What if any new care management activities has the practice implemented during the
past year?
3. [If new care management:] What if any effects have you seen from these activities,
thus far?
4. What, if any, factors outside the practice have influenced the practice’s view on care
management, its decision to adopt care management processes, or the smoothness of
implementation of the processes?
For example:
Did particular sources of information on care management influence these perspectives
or decisions?
A particular consultant or QIO staff member?
Pay-for-performance programs other than the demonstration?
5. What, if any, practice characteristics have influenced the practice’s view on care
management, or how easy it was to implement it?
For example:
The characteristics of your patients, e.g. lot of complex conditions, tendency to visit
many physicians, tendency to not seek care appropriately?
Your views vs. others in the practice?
How busy the practice is at present?
How profitable the practice is at present?
Your or the office manager’s comfort level with HIT?
6. Is anyone in the practice a “champion” for care management? Are they having
success influencing others? Who?

K.16

d) Quality Measures & Improvement Activities
1. Are clinical measures currently produced for this practice?
[If yes:] At the practice or physician level?
2. [If any measures:] Which ones, and how are the measures used?
3. What benchmarks are available, and how useful are the benchmarks perceived to be?
Why?
4. [If any measures:] Has the frequency with which the physicians review clinical
measures for the practice, or the number of measures available for review changed
since the practice decided to participate in the EHR Demonstration?
5. If data are being used more since the practice decided to participate in the EHR
Demonstration, has this led to any changes in the care process?
6. Moving now to activities that could improve quality, what changes could be made at
least in theory that could further improve the quality and/or safety for patients of the
practice?
a. Using the/an EHR
b. Other types of changes
c. Are any of these changes actually planned?
7. Have we missed anything? Are there any changes the practice has made that we
haven’t discussed yet to improve quality or safety for its patients?
a. [If yes:] What motivated these changes?

K.17

A4. MEDICAL DIRECTOR—TREATMENT GROUP PRACTICES
[For practices with a Medical Director, we will meet with the Medical Director first using the
physician protocol above, then the discussion would continue with this module.]
a) Physicians’ Use of HIT Functions 1
For each of the following functions of health IT, please tell us the extent to which physicians use
them, and if they are using them to some degree, any problems and barriers encountered.
[Talk through a-b for those functions the practice is using.]
EHR and/or registry functions:
1. Recording visit and procedure notes in an EHR
a. Extent used
b. Problems/barriers
2. Clinical reminders of preventive services due/overdue
a. Extent used
b. Problems/barriers
3. Clinical reminders of routine tests for chronic illnesses due/overdue
a. Extent used
b. Problems/barriers
4. Ordering lab and/or radiology tests electronically
a. Extent used
b. Problems/barriers
5. Reviewing lab and/or radiology test results electronically
a. Extent used
b. Problems/barriers

1

This list picks up on some of the same functions in the administrative staff guide, plus more care management
functions; the timeframe does not allow us to probe with the medical director on every possible function.

K.18

6. Generating lists of patients requiring intervention (e.g. list of patients with diabetes
who need an HbA1c monitoring test)
a. Extent used
b. [If uses:] What types of queries are made to generate these lists?
c. What type of follow-up occurs?
d. Problems/barriers
7. Generating educational materials for patients about their conditions and/or about
their medications
a. Extent used
b. Problems/barriers
8. Using the EHR to create written self-management care plans for patients with
chronic illnesses to have, prompt review of the plans, and modify them
a. Extent used
b. Problems/barriers
E-prescribing functions:
9. Screen prescriptions against the patient’s allergy information
a. Extent used
b. Problems/barriers
10. Screen new prescriptions for drug-drug or drug-disease interactions
a. Extent used
b. Problems/barriers
11. Identify generic alternatives at time of prescription entry
a. Extent used
b. Problems/barriers
12. Reference drug formulary of the patient’s health plan/PBM to recommend preferred
drugs at the time of prescribing
a. Extent used, overall
b. Extent used for Medicare patients
c. Problems/barriers

K.19

13. Calculate appropriate dose and frequency based on patient parameters such as age
and weight
a. Extent used
b. Problems/barriers
14. Reference guidelines and evidence-based recommendations when prescribing for a
patient
a. Extent used
b. Problems/barriers
15. Reference patient’s medication history
a. Extent to which other providers’ prescriptions are included
Both inside and outside the practice
[If outside prescriptions included:] For essentially all patients in the practice?
[If outside prescriptions included:] What is your source for this information?
Now back to some more general questions…
1. For the functions that are used now, what if there were no incentive for them in the
future through pay-for-performance, is use likely to drop?
[Select 4 electronic functions from a.1-a.15 that the practice does not do:]
2. What are the problems/barriers associated with
a. [name a function they do not do]?
b. [name a second function they do not do]?
c. [name a third function they do not do]?
d. [name a fourth function they do not do]?
Moving away now from the health IT functions,
b) Other HIT-Related
1. About what percent of your time over say the past six months has been spent
concerned with HIT-related planning/implementation issues?
a. How much does that grow if you add in time spent thinking about quality of care at
the practice level and processes the office might use to improve quality?
2. Please tell us about the range of experience with and attitudes toward HIT among the
physicians and other clinical staff in the practice.
a. How important is that in your thinking about next steps for the practice with HIT?
K.20

3. Did you or do you expect that adoption of health IT will have any effect on
malpractice insurance premiums or related issues for the practice?
c)

Changes in Job Responsibilities or Patient Interface
1. [If new HIT or new care management:] How if at all has implementing either new
HIT or new care management affected staffing of the office?
Number of staff
Which staff
Staff responsibilities
2. Has the way the practice interacts with the patient changed in the past year, due to
either HIT or care management-related changes?

d) Critical Factors for Success & Closing
1. In conclusion, what do you see as the most critical factors that will determine your
success under the demonstration?
2. Is there anything else you would like to convey at this time to CMS about the
demonstration or pay-for-performance policy more generally?

K.21

A5. NURSE—TREATMENT GROUP PRACTICES
[This protocol is for a nurse or other clinical staff member involved in care management.]
a) Effect of New Health IT or Changes in Use on Job Responsibilities
[If nurse is first respondent, ask 1-3. If not, start with #4]
1. Has the practice obtained any new health IT at this practice site in the past year?
What kind?
2. [If yes:] Why was the decision made to obtain it?
3. [If new HIT:] How far along has the practice come in implementing it?
4. [If new HIT:] How if at all has [name of new HIT] affected your daily
responsibilities?
5. [If new HIT:] How if at all has it affected the job responsibilities of others in the
office?
6. Aside from new HIT, has the practice made any significant changes to the way HIT
is used in the past year? What changes?
7. [If yes:] Why were the changes made?
8. [If changes:] How if at all have the changes affected your job responsibilities? The
job responsibilities of others in the office?
9. Has it affected the way a patient experiences care here?
10. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are
they having success at influencing others? Who is it?
b) Adoption of Care Management
Next, we have some specific questions about the extent to which the practice has in place
routines to improve patient care for specific conditions or to ensure recommended services are
provided—we are going to refer to this as “care management.”
1. What care management processes does the practice use? These could include:
Ways to identify and remind patients who are due or overdue for preventive screenings
Ways to identify and remind patients with certain chronic conditions needing routine
tests
Routines for educating patients about self-care
Ways of receiving and using information from a patient’s other providers
Ways to review medications for problems of polypharmacy

K.22

2. How long have these practices been in place?
3. [If more than a year:] Please summarize a few lessons you have learned about how
best to do these things as you grew in your experience with them.
4. Would you describe anyone on the staff as a “champion” for care management? If
yes, are they having success at influencing others? Who is it?
5. Have any new care management processes been established as a result of the
demonstration?
6. What are the “next steps” in implementing [more] care management and what are the
major factors affecting the timing of those steps?
7. What do you and others in the practice perceive as the benefits and costs of adopting
care management routines of the types we have been discussing?
What about the relative benefits and costs of adopting care management for different
conditions?
8. [If implementation of care management for one or more condition:] How smoothly
did implementation go? Why?
9. Has implementation of care management affected the functioning of the practice?
For example, how has it changed the job responsibilities of those involved?
10. Is care management producing any results yet for the patients?
Can you think of any examples?
11. [If HIT] Does the HIT the practice has adopted provide good support for care
management?
12. [If HIT] Are the care management capabilities of your current system being fully
used? What if anything is constraining the practice from fully using them?
13. Has participating in the EHR Demonstration affected the practice’s views on:
a. Care management?
b. Its decision to adopt care management processes?
14 What if any factors outside the practice have influenced the practice’s view on:
a. Care management?
b. Its decision to adopt care management?
15. Did particular sources of information on care management influence these
perspectives or decisions, such as a particular consultant or QIO staff member?
16. What if any practice characteristics have influenced the practice’s view on care
management, or how easy it has been to implement care management?

K.23

For example:
The characteristics of your patients, e.g. number of elderly with complex conditions, or
that have many physicians?
Your views?
How busy the practice is at present?
How profitable the practice is at present?
Your comfort level with HIT?
The physicians’ comfort level with HIT?
c)

Greater Use of Data to Refine the Care Process
[If first respondent, ask 1 & 2, otherwise start with 3]
1. Are clinical measures currently produced at the practice or physician level for this
practice?
[If yes:] [If no, skip to Section D.]
2. Who generates clinical measures for the practice (if used) and what conditions do
they pertain to?
3. Do you routinely see any clinical quality measures for the practice?
4. Has the number of measures available for review changed since you decided to
participate in the demonstration?
5. What benchmarks are available, and how useful are the benchmarks perceived to be?
Why?
6. If data are being used more since the practice decided to participate in the EHR
Demonstration, has this led to any changes in the care process?

d) Enhanced Practice Orientation to Quality and Safety
1. How informed do you feel about the practice’s performance on quality measures?
a. [If well-informed:] Without referencing any documents, can you summarize what you
recall about how well the practice is performing on the quality measures that are
tracked?
b. [If well-informed:] Did you come to this understanding through reviewing tracking
data, discussing this with others in the practice, or some other way?

K.24

2. Moving now to activities that could improve quality, what changes could be made at
least in theory that could further improve the quality and/or safety for patients of the
practice?
a. Using the/an EHR?
b. Other types of changes?
c. Are any of these changes actually planned?
3. Have we missed anything? Are there any changes the practice has made to improve
quality or safety for its patients over the past two years that we have not already
discussed?
4.

[If increased focus on QI:] What has influenced the practice to increase the focus on
quality improvement?

K.25

A6. GROUP DISCUSSION WITH ADMINISTRATIVE PERSONNEL—TREATMENT GROUP
PRACTICES
[CEO, CFO, Marketing Director, as applicable for the practice.]
a) Demonstration’s Fit with Practice Goals
1. Does this practice have specific financial, market position, or clinical goals?
a. [If yes:] How does health IT fit in with those goals?
b. [If yes:] How does increased care management fit in with those goals?
b) Effects of HIT on the Practice
1. [If HIT:] How has the health IT that this practice has implemented thus far affected
the practice?
a. Role of the nurse?
b. Ways information is provided to patients?
c. Communication links between physicians in the practice?
d. Connections with other parts of the health system (e.g. hospitals)?
e. Financial effect?
f. Other aspects of the practice?
c)

Expectations/Thinking Regarding Incentive Payments
1. What are the practice’s expectations regarding the incentive payment from the
demonstration—have you estimated how much the practice expects to receive as a
result of participating over the next few years?
a. What would that be in terms of a percent of revenue?
b. How was that estimate made?
c. Is there an expectation within the practice’s budget that assumes payment of that
amount?
2. Is there anything specific that is contingent on receiving that amount—such as you
would buy X piece of hardware or software or support a specific activity that takes
up staff time only if it is covered by the payment?

Could we talk a little about the competitive environment you operate in….
d)

Market Factors
1. Is this practice on a par with, ahead, or behind other similar practices in the area in
terms of using health IT? Why?
2. Are there any community-wide or provider-specific initiatives to promote health IT
adoption or health information exchange in the market area?
K.26

3. [If yes:] How if at all is that affecting the thinking or actions by this practice?
4. Is there anything going on other than the demonstration with pay-for-performance in
the market area?
5. [If yes:] How if at all is that affecting the thinking or actions by this practice
regarding care process changes that might improve performance?
6. Is there anything else going on in the area that is affecting what this practice is doing
or planning with health IT or care management?
7. Has participation in the demonstration affected whether or how the practice markets
itself?

K.27

B. GUIDE FOR CONTROL GROUP PRACTICES

K.29

B1. BACKGROUND OBTAINED DURING SCHEDULING OF PRACTICE CONTACT—CONTROL
GROUP PRACTICES
1. What year was the practice established?
2. What is the organizational structure of the practice (e.g. is it part of a larger health
care organization)?
3. How many locations does the practice have?
4. How many physicians are in the practice?
5. How many and what types of other staff are part of the practice?
6. How many Medicare FFS beneficiaries does the practice serve?
7. About what percentage of all the practice’s patients are Medicare fee-for-service?
8. Does the practice see Medicare Advantage (MA), that is, Medicare managed care
patients?
9. [If sees MA patients:] What percentage of all patients in the practice are Medicare
managed care?
10. Is the practice participating in CMS’s Physician Quality Reporting Initiative (PQRI)?

K.31

B.2. ADMINISTRATIVE STAFF MEMBER OVERSEEING ADOPTION AND IMPLEMENTATION OF
HEALTH IT SYSTEM—CONTROL GROUP PRACTICES
a) Adaptation of Practice Operations As HIT Is Implemented
1. Do you have an EHR?
2. [If no EHR:] Why not?
3. [If no EHR:] When do you plan to get one?
4. [If no EHR:] What would facilitate your acquiring an EHR?
5. [If no EHR:] Have you started any activities to prepare for an EHR, such as
completing an office readiness assessment, or exploring vendor and product
alternatives?
6. [If has EHR:] What vendor and product do you have?
a. How long have you had that system?
7. Please give us an overview of the health IT you are using for each of the following
functions. [Complete table.]
8.

[If e-prescribing—yes to p or q:] Is e-prescribing accomplished through your
electronic health record or through a stand-alone system?
[If stand-alone system:] Please briefly describe your e-prescribing system.

9. [If registry—yes to f:] Is your disease-specific registry through your EHR or is it a
stand-along registry?
a. [If stand-alone registry:] Please briefly describe your registry.
10. [If EHR:] Are any of the other functions we discussed accomplished outside your
EHR?
11. [If HIT:] On whom did you primarily rely for assistance in implementing the health
IT that you use (QIO, vendor, consultant)?
12. [If HIT:] With implementation of HIT, what changes were made in how the practice
operates day to day?
13. Were these changes the result of a specific effort to redesign office flow to meet the
EHR process?

K.32

Fill in this table for question a.7.

Function
a. Electronic patient visit notes
b. Electronic patient-specific
problem lists
c. Electronic patient-specific
medication lists

K.33

d. Automated patient-specific alerts
and reminders
e. Other clinical decision
support/automated references to
best practices
Please describe:
f. Electronic disease-specific
registries—that is, using the EHR
or a stand-alone registry to
identify patients with specific
diagnoses, or to track information
and prompt ordering of tests or
communications for patients with
those conditions
g. Patient e-mail
h. Patient-specific educational
materials

Using
(Y/N)

Year
started
(mo/yr in
the past
year)

Uses,
Limited

Uses,
Widespread

Timeframe,
if plan to
start using
it

If no plans
to use it,
why not?

Function
i. On-line referrals to other
providers
j. Clinical messaging with other
physicians
k. Transmission of records to
hospitals or other facilities
Laboratory Tests:
l. On-line order entry
K.34

m. On-line results viewing
Radiology tests:
n. On-line order entry
o. On-line results viewing;
Specify reports or images or both:
E-Prescribing:
p. Printing and/or faxing Rx;
Computerized faxing?
q. On-line Rx transmission to
pharmacy
Other:
r. Receipt of electronic clinical
information from hospitals, other
facilities or doctors
Which types of providers?

Using
(Y/N)

Year
started
(mo/yr in
the past
year)

Uses,
Limited

Uses,
Widespread

Timeframe,
if plan to
start using
it

If no plans
to use it,
why not?

14. What other information sources or other factors influenced the practice’s thinking
about what changes it should make with HIT implementation?
b) [If HIT:] Facilitators and Barriers to Adopting and Implementing HIT
1. Thinking about the health IT functions that you have started using in the past year,
were there particular difficulties in selecting or acquiring the related product and/or
getting it up and running?
2. Thinking about the health IT functions that you started using in the past year, what
factors have been helpful in selecting or acquiring the product and/or getting it up
and running?
3. Are there persistent problems in getting some of the functions to be used routinely in
the practice—either the functions we just talked about or others? What are the issues
you view as most important?
4. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are
they having success at influencing others? Who is it?
c)

Relevant Context—Other Incentives, Reporting Programs, and HIT Initiatives
1. Is the practice participating in any other pay-for-performance initiatives/programs? If
so, do they include incentives for adopting or using health IT?
2. Are there any other pay-for-performance activities that you know of going on in this
area?
3. Is the practice participating in any other HIT or EHR initiatives? What are they? Are
there other HIT or EHR activities going on in this area?

d) Use of HIT for Care Management
Next, we have some specific questions about the extent to which the practice is using HIT to
improve patient care for specific conditions or to ensure recommended services are provided—
we are going to refer to this as “care management.”
1. E-prescribing [if applicable]:
a. Do the practice’s e-prescribing activities include using the system to screen
prescriptions for drug allergies, drug-drug interactions, or drug-disease interactions?
b. Is the system used to offer guidelines and evidence-based recommendations when
prescribing medication?
c. To provide patient-friendly information about the medication to the patient?
d. Why does or doesn’t the practice use its system to do these things?
Is function available on the system and turned on?
K.35

Any technical issues that discourage use
2. Electronic disease-specific registries [if applicable].
a. Does the practice use its system to generate reminders to patients with certain
diseases about needed or overdue visits or tests?
b. To prompt clinicians to order tests or services?
c. To create, prompt review of, or modify self-management plans for patients with
chronic illness?
d. To print educational information to help patients understand their condition?
e. Why does or doesn’t the practice use its system to do these things?
Is function available on the system and turned on?
Any technical issues that discourage use
3. Does the practice use its EHR to review and act on reminders for care activities such
as due or overdue health maintenance, that are not specifically focused on people
with a particular disease?
a. Why does or doesn’t the practice use its system for this purpose?
Is function available on the system and turned on?
Any technical issues that discourage use
4. When you were shopping for HIT, how much did the practice care about whether or
how well it could support these types of e-prescribing activities, and tracking and
prompting for patients with specific diseases or more generally?
5. [If they cared about the system supporting e-prescribing, tracking and prompting
during selection:] Is the system living up to your expectations?
6. What if any practice characteristics have influenced the practice’s view on using HIT
for these types of care management activities? For example:
The characteristics of the practice’s patients, e.g. number of elderly with complex
conditions, or that have many physicians?
Your views?
How busy the practice is at present?
How profitable the practice is at present?
Your comfort level with HIT?
The physicians’ comfort level with HIT?

K.36

e)

Plans for Change
1. What if any specific plans does the practice have for changing how it uses HIT over
the next few years?
2. [If yes:] What will be the key factors that affect whether the practice is able to make
these changes?
Financial,
Knowledge/availability of technical assistance resources/tools

K.37

B3. PHYSICIAN—CONTROL GROUP PRACTICES
a.

HIT Experience and Effect on Practice Change
1. [If HIT:]What information sources or other factors influenced the practice’s thinking
about what changes it should make with HIT implementation?
2. [If HIT:] what HIT functions work best to support clinical care in the practice?
3. [If HIT:] Which if any HIT functions are problematic right now?
4. [If HIT:] Have you observed any changes in specific aspects of the practice as a
result of using [name of HIT type]? Such as changes in: [Repeat if multiple HIT
types]
a. Time spent on each patient visit?
b. Physician time spent on administrative versus clinical functions?
c. Other clinical staff time spent on administrative versus clinical functions?
d. Completeness of the practice’s clinical documentation?
e. Usefulness of the information that is immediately in-hand at the start of patient
appointments?
4. [If switched from paper to electronic in past year:] What have been the effects on the
practice from switching from paper to electronic charts?
5. [If no HIT:] We understand that the practice does not have an EHR or other health
IT in place at the present time. Can you tell us why not, and whether or when you
plan to acquire an EHR and/or other health IT products such as an e-prescribing
system or electronic registry?
6. [If no EHR:] What would facilitate your acquiring an EHR?
7. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are
they having success at influencing others? Who is it?

b. Care Management Views/Experience
1. What if any new care management activities has the practice implemented during the
past year? By care management, we mean routines put in place in order to improve
patient care for specific conditions, or to prompt clinicians or the patients about due
or overdue services. This includes new ways to identify and remind patients needing
preventive services or routine tests, new routines for educating patients about selfcare, or new checks in place to better ensure clinical guidelines are being met for
patients with certain chronic conditions.
2. [If new care management:] What if any effects have you seen from these activities,
thus far?

K.38

3. What, if any, factors outside the practice have influenced the practice’s view on care
management, its decision to adopt care management processes, or the smoothness of
implementation of the processes?
For example,
did particular sources of information on care management influence these perspectives
or decisions?
a particular consultant or QIO staff member?
Pay-for-performance programs
4. What, if any, practice characteristics have influenced the practice’s view on care
management , or how easy it was to implement it?
For example
the characteristics of your patients, e.g. lot of complex conditions, tendency to visit
many physicians, tendency to not seek care appropriately?
Your views vs. others in the practice?
How busy the practice is at present?
How profitable the practice is at present?
Your or the office manager’s comfort level with HIT?
5. Is anyone in the practice a “champion” for care management? Are they having
success influencing others? Who?
c.

Quality Measures & Improvement Activities
1. Are clinical measures currently produced for this practice?
[If yes:] At the practice or physician level?
2. [If any measures:] Which ones, and how are the measures used?
3. What benchmarks are available, and how useful are the benchmarks perceived to be?
Why?
4. [If any measures:] Has the frequency with which the physicians review clinical
measures for the practice, or the number of measures available for review changed in
the past year?
5. If data are being used more in the past year, has this led to any changes in the care
process?

K.39

6. Moving now to activities that could improve quality, what changes could be made at
least in theory that could further improve the quality and/or safety for patients of the
practice?
a. Are any of these changes actually planned?
7. Have we missed anything? Are there any changes the practice has made that we
haven’t discussed yet to improve quality or safety for its patients?
a. [If yes:] What motivated these changes?

K.40

B4. MEDICAL DIRECTOR—CONTROL GROUP PRACTICES
[For practices with a Medical Director, we will meet with the Medical Director first, using the
physician protocol above, then the discussion would continue with this module.]
a.

Physicians’ Use of HIT Functions

For each of the following functions of health IT, please tell us the extent to which physicians use
them, and if they are using them to some degree, any problems and barriers encountered.
[Talk through a-b for those functions the practice is using.]
EHR and/or registry functions:
1. Recording visit and procedure notes in an EHR
a. Extent used
b. Problems/barriers
2. Clinical reminders of preventive services due/overdue
a. Extent used
b. Problems/barriers
3. Clinical reminders of routine tests for chronic illnesses due/overdue
a. Extent used
b. Problems/barriers
4. Ordering lab and/or radiology tests electronically
a. Extent used
b. Problems/barriers
5. Reviewing lab and/or radiology test results electronically
a. Extent used
b. Problems/barriers
6. Generating lists of patients requiring intervention (e.g. list of patients with diabetes
who need an HbA1c monitoring test)
a. Extent used
b. [If uses:] What types of queries are made to generate these lists?
c. What type of follow-up occurs?
d. Problems/barriers

K.41

7. Generating educational materials for patients about their conditions and/or about
their medications
a. Extent used
b. Problems/barriers
8. Using the EHR to create written self-management care plans for patients with
chronic illnesses to have, prompt review of the plans, and modify them
a. Extent used
b. Problems/barriers
E-prescribing functions:
9. Screen prescriptions against the patient’s allergy information
a. Extent used
b. Problems/barriers
10. Screen new prescriptions for drug-drug or drug-disease interactions
a. Extent used
b. Problems/barriers
11. Identify generic alternatives at time of prescription entry
a. Extent used
b. Problems/barriers
12. Reference drug formulary of the patient’s health plan/PBM to recommend preferred
drugs at the time of prescribing
a. Extent used, overall
b. Extent used for Medicare patients
c. Problems/barriers
13. Calculate appropriate dose and frequency based on patient parameters such as age
and weight
a. Extent used
b. Problems/barriers
14. Reference guidelines and evidence-based recommendations when prescribing for a
patient
a. Extent used
b. Problems/barriers

K.42

15. Reference patient’s medication history
a. Extent to which other providers’ prescriptions are included
Both inside and outside the practice
b. [If outside prescriptions included:] For essentially all patients in the practice?
c. [If outside prescriptions included:] What is your source for this information?
Now back to some more general questions…
16. For the functions that are used now, what if there were no incentive for them in the
future through pay-for-performance, is use likely to drop?
[Select 4 electronic functions from a.1-a.15 that the practice does not do:]
17. What are the problems/barriers associated with
a. [name a function they do not do]?
b. [second function they do not do]?
c. [third function they do not do]?
d. [fourth function they do not do]?
Moving away now from the health IT functions,
b. Other HIT-Related
1. About what percent of your time over say the past six months has been spent
concerned with HIT-related planning/implementation issues?
a. How much does that grow if you add in time spent thinking about quality of care at
the practice level and processes the office might use to improve quality?
2. Please tell us about the range of experience with and attitudes toward HIT among the
physicians and other clinical staff in the practice.
a. How important is that in your thinking about next steps for the practice with HIT?
3. Did you or do you expect that adoption of health IT will have any effect on
malpractice insurance premiums or related issues for the practice?

K.43

c.

Changes in Job Responsibilities or Patient Interface
1. [If new HIT or new care management:] How if at all has implementing either new
HIT or new care management affected staffing of the office?
Number of staff
Which staff
Staff responsibilities
2. Has the way the practice interacts with the patient changed in the past year, due to
either HIT or care management-related changes?

d. Closing
1. Is there anything else you would like to convey at this time to CMS about pay-forperformance policy?

K.44

B5. NURSE—CONTROL GROUP PRACTICES
[This protocol is for a nurse or other clinical staff member involved in care management.]
a.

Effect of New Health IT or Changes in Use on Job Responsibilities
[If nurse is first respondent, ask 1-3. If not, start with #4]
1. Has the practice obtained any new health IT at this practice site in the past year?
What kind?
2. [If yes:] Why was the decision made to obtain it?
3. [If new HIT:] How far along has the practice come in implementing it?
4. [If new HIT:] How if at all has [name of new HIT] affected your daily
responsibilities?
5. [If new HIT:] How if at all has it affected the job responsibilities of others in the
office?
6. Aside from new HIT, has the practice made any significant changes to the way HIT
is used in the past year? What changes?
7. [If yes:] Why were the changes made?
8. [If changes:] How if at all have the changes affected your job responsibilities? The
job responsibilities of others in the office?
9. Has it affected the way a patient experiences care here?
10. Would you describe anyone on the staff as a “champion” for HIT use? If yes, are
they having success at influencing others? Who is it?

b. Adoption of Care Management
Next, we have some specific questions about the extent to which the practice has in place
routines to improve patient care for specific conditions or to ensure recommended services are
provided—we are going to refer to this as “care management.”
1. What care management processes does the practice use? These could include:
Ways to identify and remind patients who are due or overdue for preventive screenings
Ways to identify and remind patients with certain chronic conditions needing routine
tests
Routines for educating patients about self-care
Ways of receiving and using information from a patient’s other providers
Ways to review medications for problems of polypharmacy

K.45

2. How long have these practices been in place?
3. [If more than a year:] Please summarize a few lessons you have learned about how
best to do these things as you grew in your experience with them.
4. Would you describe anyone on the staff as a “champion” for care management? If
yes, are they having success at influencing others? Who is it?
5. What are the “next steps” in implementing [more] care management and what are the
major factors affecting the timing of those steps?
6. What do you and others in the practice perceive as the benefits and costs of adopting
care management routines of the types we have been discussing?
What about the relative benefits and costs of adopting care management for different
conditions?
7. [If implementation of care management for one or more condition:] How smoothly
did implementation go? Why?
8. Has implementation of care management affected the functioning of the practice?
For example, how has it changed the job responsibilities of those involved?
9. Is care management producing any results yet for the patients?
Can you think of any examples?
10. [If HIT] Does the HIT the practice has adopted provide good support for care
management?
11. [If HIT] Are the care management capabilities of your current system being fully
used? What if anything is constraining the practice from fully using them?
12. What if any factors outside the practice have influenced the practice’s view on:
a. care management?
b. its decision to adopt care management?
13. Did particular sources of information on care management influence these
perspectives or decisions, such as a particular consultant or QIO staff member?
14. What if any practice characteristics have influenced the practice’s view on care
management, or how easy it has been to implement care management?
For example:
The characteristics of your patients, e.g. number of elderly with complex conditions, or
that have many physicians?
Your views?
How busy the practice is at present?

K.46

How profitable the practice is at present?
Your comfort level with HIT?
The physicians’ comfort level with HIT?
c.

Greater Use of Data to Refine the Care Process
[If first respondent, ask 1 & 2, otherwise start with 3]
1. Are clinical measures currently produced at the practice or physician level for this
practice?
[If yes:] [If no, skip to Section D.]
2. Who generates clinical measures for the practice (if used) and what conditions do
they pertain to?
3. Do you routinely see any clinical quality measures for the practice?
4. Has the number of measures available for review changed in the past year?
5. What benchmarks are available, and how useful are the benchmarks perceived to be?
Why?
6. If data are being used more in the past year, has this led to any changes in the care
process?

d. Enhanced Practice Orientation to Quality and Safety
1. How informed do you feel about the practice’s performance on quality measures?
a. [If well-informed:] Without referencing any documents, can you summarize what you
recall about how well the practice is performing on the quality measures that are
tracked?
b. [If well-informed:] Did you come to this understanding through reviewing tracking
data, discussing this with others in the practice, or some other way?
2. Moving now to activities that could improve quality, what changes could be made at
least in theory that could further improve the quality and/or safety for patients of the
practice?
a. Are any of these changes actually planned?
3. Have we missed anything? Are there any changes the practice has made to improve
quality or safety for its patients over the past two years that we have not already
discussed?
4.

[If increased focus on QI:] What has influenced the practice to increase the focus on
quality improvement?

K.47

B.6. GROUP DISCUSSION WITH ADMINISTRATIVE PERSONNEL—CONTROL GROUP PRACTICES
[CEO, CFO, Marketing Director, as applicable for the practice.]
a.

Health IT and Care Management’s Fit with Practice Goals
1. Does this practice have specific financial, market position, or clinical goals?
a. [If yes:] How does health IT fit in with those goals?
b. [If yes:] How does increased care management fit in with those goals?

b. Effects of HIT on the Practice
1. [If HIT:] How has the health IT that this practice has implemented thus far affected
the practice?
a. Role of the nurse?
b. Ways information is provided to patients?
c. Communication links between physicians in the practice?
d. Connections with other parts of the health system (e.g. hospitals)?
e. Financial effect?
f. Other aspects of the practice?
Could we talk a little about the competitive environment you operate in….
c.

Market Factors
1. Is this practice on a par with, ahead, or behind other similar practices in the area in
terms of using health IT? Why?
2. Are there any community-wide or provider-specific initiatives to promote health IT
adoption or health information exchange in the market area?
3. [If yes:] How if at all is that affecting the thinking or actions by this practice?
4. Is there anything going with pay-for-performance in the market area?
5. [If yes:] How if at all is that affecting the thinking or actions by this practice
regarding care process changes that might improve performance?
6. Is there anything else going on in the area that is affecting what this practice is doing
or planning with health IT or care management?
7. [If participating in any P4P:] Has participation in a pay-for-performance program
affected whether or how the practice markets itself?

K.48

C. GUIDE FOR WITHDRAWN TREATMENT GROUP PRACTICES

K.49

GUIDE FOR WITHDRAWN TREATMENT GROUP PRACTICES

1. Why did the practice decide initially to enroll in the EHR Demonstration? What
benefits did it hope to gain?
2. Why did the practice decide to withdraw from the EHR Demonstration? Please
explain if any of the following were factors:
a. Early stage of health IT implementation at the practice and/or inability to make health
IT changes that would help enable high performance/bonus
b. Expected to be high performing but incentive bonus too low to be worth it (explore
why—too few Medicare patients?)
c. Did not expect to be high-performing
d. The practice’s experience with the enrollment process
e. Anticipated burden of reporting (please explain)
f. Informal discussions on the topic with others (who?)
g. Lack of trust or confidence in the data reporting process
h. Lack of confidence in the data processing and reporting by CMS
i. Lack of interest in making changes to the practice that would help enable high
performance
j. Availability of other pay-for-performance or pay-for-reporting programs
k. Other
3. Does the practice participate in any other pay-for-performance programs? If yes,
please describe, and compare/contrast the structure of that program to the EHR
Demonstration.
4. Does the practice participate in any other health IT initiatives? If yes, please
describe, and compare/contrast the structure of that program to the EHR
Demonstration.
5. If no, under what circumstances would you consider participating in a pay-forperformance program in the future?
6. What could CMS or others have done differently that would have prevented your
decision to withdraw?

K.51

D. GUIDE FOR COMMUNITY PARTNER SITE COORDINATORS

K.53

GUIDE FOR COMMUNITY PARTNER SITE COORDINATORS

a.

Experience Recruiting Practices to the Demonstration
1. Please briefly describe the strategy for recruitment.
2. How easy or difficult was it to recruit practices to the demonstration?
3. What were their major questions and concerns?
4. What kinds of practices were more and less interested in participating?
Those at different stages of thinking about and implementing EHRs?
Smaller/larger?
Urban/rural?
Underserved areas/other areas?
Affiliated or not with a larger organization?
5. In the end, what kinds of practices (or physicians) that expressed initial interest
signed on and what kinds decided against participation?
6. If you could do it over, what if anything would you do differently regarding
recruitment?

b. Practice Needs for the Demonstration to be Successful
1. What do the demonstration practices need to be successful under the demonstration?
a. Money? (How much, for what?)
b. Knowledge? (Such as models for implementing EHRs)
c. killed people? (Own staff, availability of consultants)
2. What types of practices have the greatest needs?
c.

Plans for Working With/Facilitating Assistance to Practices
1. What plans does the site coordinator have for working with or otherwise facilitating
assistance to practices in implementing their EHR and using it for care management?
2. How well does the overall level of assistance fit with the overall level of need?
3. To what extent are control group practices also receiving similar assistance?

K.55

d. Perceptions of Practices’ Progress Under the Demonstration
1. Do you have a sense of whether the participating practices that did not yet have
EHRs are making progress in EHR implementation under the demonstration at this
early stage?
2. Do you have a sense for whether participating practices are as yet embracing the
demonstration’s emphasis on improving quality outcomes—that is, are they thinking
in terms of using their EHR for care management functions to improve quality? Are
they implementing care management functions yet?
3. Please tell us any early success stories you know of.
4. Do you see any particular roadblocks ahead that could lessen the demonstration’s
effectiveness?
e.

Other (non-EHRD) Health Information Technology Activities in the Site
1. Are there any community-wide or provider-specific initiatives to promote health IT
adoption or health information exchange in the market area?
2. Is there anything going on other than the demonstration with pay-for-performance in
the market area?
3. [If yes:] How if at all is that affecting the thinking or actions by practices regarding
care process changes that might improve performance?
4. Is there anything else going on in the area that is affecting what practices are doing
or planning with health IT or care management?
5. Has participation in the demonstration affected whether or how the practices market
themselves?

K.56

APPENDIX L
ELECTRONIC HEALTH RECORDS DEMONSTRATION (EHRD) ADVANCE LETTER
FOR DISCUSSIONS WITH PRACTICES

MATHEMATICA LETTERHEAD
EHRD ADVANCE LETTER FOR DISCUSSIONS WITH PRACTICES
[Date], 2010
Lead physician/authorized contact
Practice name
Street address
City, State Zip
Dear [lead physician/authorized contact name]:
This is an invitation to participate in the evaluation of the Electronic Health Records Demonstration
(EHRD) as a site visit practice. With your help, the EHRD evaluation will provide critical information to
CMS to help refine its policies for aligning payment with quality of care. Please see the attached letter of
encouragement to participate from CMS, which was sent to you separately several days ago.
Specifically, we would like to visit your practice during [bold the dates] at a time convenient for
you (may include time before or after office hours). We request a 60-minute interview with the office
manager/administrative person most knowledgeable about the demonstration experience, a 30-minute
interview with a participating physician, and a 30-minute interview with a nurse or other clinical staff
member involved in care management and care coordination. You will not need to make any special
preparations for the visit. We aim to cover the following topics:
• The practice’s experience with and perspectives on the EHRD
• Any changes the practice made as a result of participation
• The practice’s implementation of health information technology (HIT) and how practice
operations have changed as a result
• Context—any other incentives, reporting programs, and HIT initiatives the practice
participates in
• Care management processes at the practice—that is, any routines the practice has put in place
to improve patient care for specific conditions or services (if any); your views on these types
of things and why
• The practice’s interest in and use of clinical data and benchmarks
Ms. Felt-Lisk is the senior team member who will lead the visit, accompanied by [analyst]. Ms. FeltLisk, a senior health researcher at Mathematica, has over 15 years’ experience leading health research
studies, and is known for studies that capture the experience and views of health care organizations for
policymakers, particularly with respect to quality of care. [Analyst] will call you in a day or two to ensure
you received this invitation and begin the scheduling process. In the meantime, please feel free to call or
e-mail [Name of analyst and phone # and e-mail] or Ms. Felt-Lisk at 202-484-4519 or sfeltlisk@mathematica-mpr.com with any questions or to initiate scheduling. Thank you very much in
advance for your assistance—your input into the evaluation is highly valued by CMS.
Sincerely,
Jennifer Schore, Project Director
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 0938-NEW. The time required to complete this information collection is estimated to average 0.75
hours or 45 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: CMS, 7500
Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

L.3

CMS LETTERHEAD
EHRD ENDORSEMENT LETTER FOR DISCUSSIONS WITH TREATMENT
PRACTICES

Lead physician/authorized contact
Practice name
Street address
City, State zip
Dear [lead physician/authorized contact name]:
The Centers for Medicare & Medicaid Services (CMS) would very much appreciate if your
practice would agree to a practice site visit as part of the evaluation of the Electronic Health
Records Demonstration (EHRD). As a practice that is currently participating in EHRD, you not
only have the opportunity to benefit financially from the demonstration, you are also helping to
inform CMS’s longer term development of payment policies for the Medicare program
nationwide.
As you are already aware, CMS has contracted with Mathematica Policy Research, Inc. to
conduct an independent evaluation of the demonstration. Mathematica will be conducting the site
visits in spring 2010. A second round is planned for spring 2014. Interview topics will include
your practice’s experience with and views on health IT, care management processes to improve
care quality for chronically ill patients, and pay-for-performance initiatives. Comments provided
during the site visits will not be attributed to any individual or organization. Mathematica will
synthesize comments across the practices in a report following completion of all site visits.
Mathematica will be contacting you within a few days with more specific information.
Recognizing the many market pressures you operate under day-to-day, please consider making
yourself and your staff available for this brief visit. Your input will be valuable in assisting CMS
in development of the best possible value-based Medicare payment policies for the future. If you
have any questions, please feel free to call me at (410) 786-9457.
Sincerely,
CMS Project Officer

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 0938-NEW. The time
required to complete this information collection is estimated to average 0.75 hours or 45 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:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

L.4

CMS LETTERHEAD
EHRD ENDORSEMENT LETTER FOR DISCUSSIONS WITH CONTROL PRACTICES

Lead physician/authorized contact
Practice name
Street address
City, State zip
Dear [lead physician/authorized contact name]:
The Centers for Medicare & Medicaid Services (CMS) would very much appreciate if your
practice would agree to a practice site visit as part of the evaluation of the Electronic Health
Records Demonstration (EHRD). As a practice that is currently participating in EHRD, you not
only have the opportunity to benefit from the demonstration, you are also helping to inform
CMS’s longer term development of payment policies for the Medicare program nationwide.
As you are already aware, CMS has contracted with Mathematica Policy Research, Inc. to
conduct an independent evaluation of the demonstration. Mathematica will be conducting the site
visits in spring 2010. A second round is planned for spring 2014. Interview topics will include
your practice’s experience with and views on health IT, care management processes to improve
care quality for chronically ill patients, and pay-for-performance initiatives. Comments provided
during the site visits will not be attributed to any individual or organization. Mathematica will
synthesize comments across the practices in a report following completion of all site visits.
Mathematica will be contacting you within a few days with more specific information.
Recognizing the many market pressures you operate under day-to-day, please consider making
yourself and your staff available for this brief visit. Your input will be valuable in assisting CMS
in development of the best possible value-based Medicare payment policies for the future. If you
have any questions, please feel free to call me at (410) 786-9457.
Sincerely,
CMS Project Officer

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 0938-NEW. The time
required to complete this information collection is estimated to average 0.75 hours or 45 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:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

L.5