NEHRS Survey

Att C - Proposed Instrument

National Electronic Health Records Survey

OMB No. 0920-XXXX
Exp. Date

NOTICE – CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing
instructions, searching existing data/information sources, gathering and maintaining the data/information 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 H21-8, Atlanta, GA 30333, ATTN: PRA (0920-XXXX).
Assurance of Confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a
practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable
form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the
Confidential Information Protection and Statistical Efficiency Act (44 U.S.C 3561-3583). In accordance with CIPSEA, every NCHS employee, contractor, and
agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable
information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151
note) which protects Federal information systems from cybersecurity risks by screening their networks.

National Electronic Health Records Survey 2024
The purpose of the survey is to collect information about the adoption and use of electronic health records (EHRs) and electronic exchange of health information
in outpatient or office-based care settings. Your participation is greatly appreciated. Your answers are completely confidential. Participation in this survey is
voluntary. There are no penalties for nonparticipation. If you have questions or comments about this survey, please call XXX-XXX-XXXX.

1.

We have your specialty as:
Is that correct?

□1 Yes
□2 No

4.

□1
□2
□3

What is your specialty?

______________________________________
This survey asks about outpatient or office-based care, that is,
care for patients receiving health services without admission to
a hospital or other facility.
2.

□4
□5

Do you directly provide outpatient or office-based care?

□1 Yes
□2 No
□3 I am no longer
in practice.

}

□6

Go to Question 3
Please stop here and return
the questionnaire in the
envelope provided. Thank
you for your time.

□7
□8

The next question asks about a normal week.
We define a normal week as a week with a normal caseload,
with no holidays, vacations, or conferences.
3.

Private solo or group practice
Freestanding clinic or Urgent Care Center
Community Health Center (e.g., Federally
Qualified Health Center [FQHC], federally
funded clinics or “look-alike” clinics)
Mental health center
Government clinic that is not federally
funded (e.g., state, county, city, maternal
and child health, etc.)

Overall, at how many office locations (excluding hospital
emergency departments) do you see outpatient or
office-based patients in a normal week?

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

Family planning clinic (including Planned
Parenthood)
Integrated Delivery System, Health
maintenance organization, health system
or other prepaid practice (e.g., Kaiser
Permanente)
Faculty practice plan (an organized group
of physicians that treats patients referred
to an academic medical center)

□9 Indian Health Service
□10 Rural Health Clinic (Federally Qualified)
□11 Hospital outpatient departments
□12 Hospital emergency departments
□13 None of the above

Locations

5.

Do you see outpatient or office-based patients in any of
the following settings? CHECK ALL THAT APPLY.

If you select
only 12 or 13,
go to
Question 33

At which of the outpatient or office-based settings (1-11) in Question 4 do you see the most patients?
WRITE THE NUMBER LOCATED NEXT TO THE BOX YOU CHECKED.
(For the rest of the survey, we will refer to this as the “reporting location.”)

For the remaining questions, please answer regarding the reporting location indicated in Question 5
even if it is not the location where this survey was sent.
1

Att C - Proposed Instrument

National Electronic Health Records Survey

6.

What are the county, state, and zip code of the reporting location? What is the email address of the physician to whom
this survey was mailed?
Country

USA

County

Zip Code
7.

Email address

□4
□5
□6

1 physician
2-3 physicians
4-10 physicians

□2 No

□3 Don’t know

Do you treat patients insured by Medicaid?

□1 Yes

□3 Community health center
□4 Medical/academic health center
□5 Other hospital
□6 Other health care corporation
□7 Other

11-50 physicians
51-100 physicians
More than 100 physicians

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

□1 Yes
9.

State

How many physicians, including you, work at this practice 11. Who owns the reporting location? CHECK ONE.
(including physicians at the reporting location, and
□1 Physician or physician group
physicians at any other locations of the practice)?
□2 Insurance company, health plan, or HMO

□1
□2
□3

8.

OMB No. 0920-XXXX
Exp. Date

12. Does the reporting location use an EHR system? Do not
include billing record systems.

□1 Yes □2 No (Skip to 19)

□2 No (Skip to 10) □3 Don’t know (Skip to 10)

13. Is your EHR system certified to meet U.S. Department of
Health and Human Services requirements? Certified EHRs

9a. Do you accept Medicaid insurance for new patients?

□1 Yes

□2 No

□3 Don’t know

are necessary to meet the objectives of Meaningful
Use/Promoting Interoperability Program. If unsure, see if your
system is listed here: https://chpl.healthit.gov/#/search

10. Do you treat patients insured by Medicare?

□1 Yes

□2 No (Skip to 11) □3 Don’t know (Skip to 11)

□1 Yes

10a. Do you accept Medicare insurance for new patients?

□1 Yes

□2 No

□3 Don’t know (Skip to 19)

□3 Don’t know

□2 No

□3 Don’t know

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

□1 Allscripts
□2 athenahealth
□3 Cerner
□4 eClinical Works

□5 Epic
□6 Meditech
□7 Modernizing Medicine
□8 NextGen

□9 Practice Fusion
□10 Greenway
□11 Other, specify: _______________________
□12 Unknown

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

□1 Very satisfied
□4 Somewhat dissatisfied

□2 Somewhat satisfied
□5 Very dissatisfied

□3 Neither satisfied nor dissatisfied
□6 Not applicable

16. Does your reporting location routinely collect data on individual patients' health-related social needs (often referred to
as social determinants of health) such as transportation access, housing instability, or food insecurity?

□1

Yes, routinely

□2 Yes, but not routinely

□3 No (Skip to 19)

17. How often do you or designated staff document individual
patients’ health-related social needs using…
A screening tool in your EHR (e.g., that is entered from a paper form or by
checking a box/button)?
Free text note written in EHR?
Diagnosis codes entered in EHR (i.e. ICD-10-CM Z codes)?
Non-electronic methods (including paper forms scanned into the EHR)?

2

□4 Don’t know (Skip to 19)

Often

Sometimes

Rarely

Never

Don’t
know

Appendix C2 - Proposed Instrument

National Electronic Health Records Survey

OMB No. 0920-XXXX
Exp. Date

18. How often do you or designated staff use individual patients’
health-related social needs data at your reporting location for…

Often

Sometimes

Rarely

Never

Don’t
know

Referrals to services (e.g., social service organizations)?
Clinical decision making?
Telemedicine
19. Does your practice use telemedicine technology (e.g., audio, audio with video, web videoconference) for patient visits?

□1 Yes (Go to 19a)

□2 No (Skip to 20)

□3 Don’t know (Skip to 20)

19a. What type(s) of telemedicine tools did you use for patient visits? CHECK ALL THAT APPLY.

□1 Telephone audio
□2 Videoconference software with audio (e.g., Zoom, WebEx, FaceTime)
□3 Telemedicine platform NOT integrated with EHR (e.g., Doxy.me)
□4 Telemedicine platform integrated with EHR (e.g., update clinical documentation during telemedicine visit)
□5 Other tools _______________________________________________

Electronic Exchange of Patient Health Information
20. How often do you electronically send patient health information to other providers outside your medical organization
using an EHR (not eFax) or a Web Portal (separate from EHR)?

□1 Often

□2 Sometimes

□3 Rarely

□4 Never

□5 Don’t know

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

□1 Often

□2 Sometimes

□3 Rarely

□4 Never

□5 Don’t know

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

□1 Yes (Go to 22a)

□2 No (Skip to 23)

□3 Don’t know (Skip to 23) □4 Not applicable (Skip to 23)

22a. What types of information do you electronically send or receive? CHECK ALL THAT APPLY.

□1 Syndromic surveillance data
□3 Immunization data

□2 Case reporting of reportable conditions
□4 Public health registry data (e.g., cancer)

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

□1 Often

□2 Sometimes

□3 Rarely

□4 Never

□5 Don’t know

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

□1 Yes

□2 No

□3 Don’t know

□4 Not applicable

25. When treating patients seen by providers outside your medical organization, how often do you or your staff have clinical
information from those outside encounters electronically available at the point of care?
Electronically available does not include scanned or PDF documents.

□1 Often
□2 Sometimes
□3 Rarely
□6 I do not see patients outside my medical organization.

□4 Never

□5 Don’t know

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

□1 Often

□2 Sometimes

□3 Rarely

□4 Never

□5 Don’t know

27. When you access clinical information from outside your organization (e.g. referrals, consult notes, discharge summaries,
patient records) through any means (e.g. fax, phone, EHR, etc.), how easy is it to use the information to effectively care
for your patients?

□1Very

□2 Somewhat

□3 Not at all

3

□4 Not applicable

□5 Don’t Know

Appendix C2 - Proposed Instrument

National Electronic Health Records Survey

OMB No. 0920-XXXX
Exp. Date

28. When you access clinical information about your patients from outside
your organization (e.g. referrals, consult notes, discharge summaries,
patient records), how often is it…

Often

Sometimes

Rarely

Never

Don’t
Know

available as a scanned document?
in an electronic portal (e.g. to a health information exchange) separate from your EHR?
integrated within your EHR (as opposed to a PDF)?

29. When looking for or using clinical information from outside your
organization, to what extent do the following occur:

To a Great
Extent

To Some
Extent

Not at
All

Not
Applicable

Strongly
Disagree

Not
Applicable

Don’t
Know

Not
Applicable

Entire record is not available
Key information within record is missing/not available
Difficulty finding important information due to a large amount of low-value
information
Difficulty finding necessary information within the record for other reasons

30. Electronically exchanging clinical information with
other providers outside my medical organization____.

Strongly
Agree

Somewhat
Agree

Somewhat
Disagree

“…improves my practice’s quality of care.”
“…increases my practice’s efficiency.”
“…prevents medication errors.”
“…enhances care coordination.”
“…reduces duplicate test ordering.”

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

Yes

No

Providers in our referral network lack the capability to electronically exchange (e.g., no EHR
system or health information exchange connection).
We have limited or no IT staff
Electronic exchange involves incurring additional costs.
Electronic exchange involves using multiple systems or portals.

Public Health Exchange
32. For each type of public health reporting, please indicate whether your reporting location uses automated, manual or a
mix of both types of processes to transmit the data. Automated refers to EHR generated data sent electronically or
automatically to the public health agency. Manual refers to chart abstraction with data faxed or re-input into a portal. A mix
of both types of processes refers to files electronically generated from the EHR but manual steps required to transmit to
public health agency.
Fully or
Mix of
Fully or
We do not
Don’t
primarily
automated and
primarily
report this type
Know
automated
manual process
manual
of information
Syndromic surveillance reporting
Case reporting of reportable conditions
Immunization registry reporting
Public health registry reporting

33. Who completed this survey? CHECK ALL THAT APPLY

□1 The physician to whom it was addressed

□2 Office staff

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

4

□3 Other
Box for Admin Use