National Electronic Health Records Survey
Attachment D
OMB No. 0920-0234: Approval expires 12/31/2014NOTICE - Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Information Collection Review Office; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0234). Assurance of Confidentiality - All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347). |
National Electronic Health Records Survey 2013
The National Electronic Health Records Survey is affiliated with the National Ambulatory Medical Care Survey (NAMCS). The purpose of the survey is to collect information about the adoption of electronic health records/electronic medical records (EHRs/EMRs) in ambulatory care settings. Your participation is greatly appreciated. Your answers are completely confidential. Participation in this survey is voluntary. If you have questions or comments about this survey, please call 866-966-1473.
We have your specialty as
Is that correct? |
□1 Yes |
□2 No → What is your specialty? _______________________________ |
This survey asks about ambulatory care, that is, care for patients receiving health services without admission to a hospital or other facility. |
__________ weeks The next set of questions asks about a normal week. We define a normal week as a week with a normal caseload, with no holidays, vacations, or conferences.
__________ locations
__________ office visits |
□1 Private office–based solo or group practice □2 Freestanding clinic/urgicenter (not part of a hospital outpatient department) □3 Community Health Center (e.g., Federally Qualified Health Center (FQHC), federally-funded clinics or “look-alike” clinics) □4 Mental health center □5 Non-federal government clinic (e.g., state, county, city, maternal and child health, etc.) □6 Family planning clinic (including Planned Parenthood) □7 Health maintenance organization or other prepaid practice (e.g., Kaiser Permanente) □8 Faculty practice plan (An organized group of physicians that treat patients referred to an academic medical center) □9 Hospital emergency or outpatient department □10 None of the above If you only answered hospital emergency or outpatient department or none of the above in question 6, skip to question 27. If you checked any of the boxes 1-8 in question 6, continue to question 7.
__________ (For the rest of the survey, we will refer to this as the “reporting location”). |
For the remaining questions, please answer regarding the reporting location indicated in question 7 even if it is not the location where this survey was sent. |
__________ office visits
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10a. How many physicians, including you, work at this practice (including physicians at the reporting location, and physicians at any other locations of the practice)?
__________ mid-level providers
13a. If yes, from those new patients, which of the following types of payment do you accept?
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15a. In which year did you install your current EHR/EMR system? Year: ______________ 15b. Does your current system meet meaningful use criteria as defined by the Department of Health and Human Services?
15c. What is the name of your current EHR/EMR system? CHECK ONLY ONE BOX. IF OTHER IS CHECKED, PLEASE SPECIFY THE NAME.
![]() ![]() 17a. When did you first apply or when do you first intend to apply?
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Yes, used routinely |
Yes, but not used routinely |
Yes, but turned off or not used |
No |
Unknown |
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18a. Recording patient history and demographic information? |
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□3 Skip to 18b |
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□5 Skip to 18b |
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18a1. If yes, does this include a patient problem list? |
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18b. Recording and charting vital signs? |
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18c. Recording patient smoking status? |
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18d. Recording clinical notes? |
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□3 Skip to 18e |
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18d1. If yes, do the notes include a list of the patient’s medications and allergies? |
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18e. Reconciling lists of patient medications to identify the most accurate list? |
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18f. Ordering prescriptions? |
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□ Skip to 18g |
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18f1. If yes, are prescriptions sent electronically to the pharmacy? |
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18f2. If yes, are warnings of drug interactions or contraindications provided? |
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18g. Providing reminders for guideline-based interventions or screening tests? |
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18h. Ordering lab tests? |
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□3 Skip to 18i |
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18h1. If yes, are orders sent electronically? |
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18i. Viewing lab results? |
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□3 Skip to 18j |
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18i1. If yes, can the EHR/EMR automatically graph a specific patient’s lab results over time? |
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18j. Viewing imaging results? |
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18k. Identifying educational resources for patients’ specific conditions? |
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18l. Reporting clinical quality measures to federal or state agencies (such as CMS or Medicaid)? |
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18m. Generating lists of patients with particular health conditions? |
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18n. Electronic reporting to immunization registries? |
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18o. Providing patients with clinical summaries for each visit? |
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18p. Exchanging secure messages with patients? |
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18q. Providing patients with an electronic copy of their health information? |
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18r. Providing patients the ability to view online, download or transmit information from their medical record? |
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The next questions are about sharing (either sending or receiving) patient health information. |
□1 Yes Go to Question 19a □2 No Skip to Question 21 |
19a. How do you electronically share patient health information? CHECK ALL THAT APPLY. □1 EHR/EMR □2 Web portal (separate from EHR/EMR) □3 Other electronic method ________________ |
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Hospitals with which you are affiliated |
Ambulatory providers inside your office/group |
Hospitals with which you are not affiliated |
Ambulatory providers outside your office/group |
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20a. Lab results |
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20b. Imaging reports |
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20c. Patient problem lists |
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20d. Medication lists |
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20e. Medication allergy lists |
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20f. Do you share any of the above types of information using a “Summary Care Record”? [A Summary Care Record is an electronic file that contains the above health data in a standardized format.] |
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□1 Yes |
□2 No |
□3 Unknown |
□1 Yes Go to Question 21a □2 No Skip to Question 22
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21a. Do you receive a report back from the other provider with results of the consultation? ![]() □1 Yes, routinely □2 Yes, but not routinely □3 No Skip to Question 22
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21b. Do you receive it electronically (not fax)? □1 Yes, routinely □2 Yes, but not routinely □3 No |
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□1 Yes Go to Question 22a □2 No Skip to Question 23 |
22a. Do you receive notification of both the patient’s history and reason for consultation? ![]() □1 Yes, routinely □2 Yes, but not routinely □3 No Skip to Question 23
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22b. Do you receive them electronically (not fax)? □1 Yes, routinely □2 Yes, but not routinely □3 No |
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□1 Yes Go to Question 23a □2 No Skip to Question 24 |
![]() 23a. Do you receive all of the information you need to continue managing the patient? □1 Yes, routinely □2 Yes, but not routinely □3 No Skip to Question 24 |
23b. Is the information available when needed? ![]() □1 Yes, routinely ![]() □2 Yes, but not routinely □3 No Skip to Question 24 |
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23c. Do you receive it electronically (not fax)? |
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□1 Yes, routinely |
□2 Yes, but not routinely |
□3 No |
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□1 Yes □2 No □3 Unknown |
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□1 Physician or physician group □2 Insurance company, health plan, or HMO □3 Community health center |
□4 Medical/academic health center □5 Other hospital □6 Other health care corporation □7 Other |
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Deleted Questions from #18 matrix: • Providing standard order sets related to a particular condition or procedure? • Viewing data on quality of care measures? • If yes to (18n) “Electronic reporting to immunization registries? ◦ Delete (18n1) “Reported in standards specified by Meaningful Use criteria”
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Boxes for Admin Use |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Final 2012 EHR Survey |
Author | Timothy Struttmann |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |