Form N-SUMHSS EHR Suppl N-SUMHSS EHR Suppl N-SUMHSS EHR Supplement

The next questions ask about electronic health records (EHRs). For the purpose of this survey, EHRs are
an electronic version of a patient's medical history that is maintained by the provider over time, and may
include all of the key clinical data relevant to that person's care under a particular provider.
1.

Does your facility use an EHR system? Do not include billing record systems.
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2
3
4

1a.

Yes, we exclusively use an EHR system. No paper charts.
Yes, we use a combination of an EHR system and paper charts.
No, but we plan to implement an EHR system

SKIP TO QUESTION 13, PAGE 4

No, and we have no plan to implement an EHR system

SKIP TO QUESTION 14, PAGE 4

If your facility is part of a larger organization, please indicate whether EHRs are used across all or
some facilities within your organization.
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2
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2.

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□

□
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All of the facilities within this organization use EHRs.
Some of the facilities within this organization use EHRs.
Don’t know if other facilities within the organization use EHRs.
This is the only facility in this organization.

Please indicate the name of this facility’s EHR system vendor(s).
SELECT ALL THAT APPLY

3.

1

□ Accumedic

15

□ Netsmart (MyAvatar, MyEvolv)

2

□ AMS

16

□ NextGen

3

□ Cerner

17

□ Precision Care

4

□ CCP (Co-Centrix)

18

□ Qualifacts/Credible (CareLogic EHR)

5

□ Core Solutions

19

□ Smart Management

6

□ Echo Group

20

□ SAMMS

7

□ E-Clinical Works (ECW)

21

□ Ten Eleven

8

□ EPIC

22

□ Tower Systems

9

□ Foothold

23

□ Valant

10

□ HiNext

24

□ Welligent

11

□ IMA

25

□ Other

12

□ Methasoft (Netalytics)

13

□ Meditech

d

□ Don’t know

14

□ Methware

Does this facility’s EHR integrate or incorporate any type of clinical information (e.g. medications,
lab test results) that is received electronically from providers outside your organization without the
need for manual entry?
•

This refers to the ability to add or incorporate the information into the EHR without special effort (this
does not refer to automatically adding data without provider review). This could be done using software
to convert scanned documents into indexed, discrete data that can be integrated/included in the EHR.

•

Electronic does not refer to e-Fax or scanned documents.

•

Please consider all organizations outside of your network.
1
0

□
□

Yes
No
1

4.

Do external organization(s) provide this facility with “read only” access to EHR clinical
information?
•

This means that appropriate staff have the ability to view patient health information in a third party’s
EHR in accordance with HIPAA and 42CFR but not modify the record.
1

5.

Yes

0

□

No

d

□

Don’t know

How often do staff at this facility electronically search or query for clients’ health information (e.g.,
medications, outside encounters) from other providers or external sources outside this facility?
•

Electronic does not refer to e-Fax or scanned documents.
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6

6.

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Almost every day
At least once a week
At least once a month
Less than once a month
Never
Staff don’t have capability to search or query

Please indicate if this facility participates in a state, regional, and/or local Health Information
Exchange Organization (HIO).
•

A Health Information Exchange Organization (HIO) is an organization that oversees and governs the
exchange of health-related information among organizations according to nationally recognized
standards.
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d

□
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HIO is available in my area and we are actively exchanging data in at least one HIO
HIO is available in my area but we are not participating
HIO is not available in my area

SKIP TO
Q.7
(BELOW)

SKIP TO
Q.7
(BELOW)

Not familiar with an HIO
Don’t know if this facility participates in an HIO

6a.

Why does this facility not participate in the HIO?

7.

When treating a patient previously seen by another health provider/organization, how often does
your facility have the patient health information (e.g. medication, labs) electronically available from
that provider/organization?

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2
3
4

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Always or often
Sometimes
Rarely
Never

2

8.

Does this facility use your EHR to:
MARK ONE PER ROW
YES

NO

NOT
APPLICABLE

a. Record patient history

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0

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na

□

b. Record patient demographic information

1

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0

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na

□

c.

1

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0

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na

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d. Record patients’ medications

1

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0

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na

□

e. Record patients’ allergies

1

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0

□

na

□

f.

1

□

0

□

na

□

1

□

0

□

na

□

1

□

0

□

na

□

1

□

0

□

na

□

1

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0

□

na

□

1

□

0

□

na

□

1

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0

□

na

□

1

□

0

□

na

□

1

□

0

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na

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o. Order lab tests

1

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0

□

na

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p. View lab results

1

□

0

□

na

□

1

□

0

□

na

□

1

□

0

□

na

□

1

□

0

□

na

□

1

□

0

□

na

□

Record social determinants of health (employment, housing)

Record diagnoses

g. Record problem lists
h. Record behavioral health screenings or tools
i.

Record clinical or progress notes

j.

Record treatment plans

k.

Monitor client progress

l.

Electronically send prescriptions to the pharmacy

m. Review warnings or alerts of medication allergies, drug-drug
interactions or contraindications
n. Reconcile medications when admitting, discharging, and/or
transitioning clients between care settings

q. Record referrals
r.

Record discharge plans

s.

Check state's prescription drug monitoring program (PDMP)
prior to prescribing a controlled substance

9.

Does this facility have an Opioid Treatment Program (OTP)? (Y/N/ N/A)
If yes, does this facility track dispensed medications in its EHR (Y/N)

3

10.

Does this facility’s EHR allow clients to…
MARK ONE PER ROW
YES

11.

12.

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0

□

na

□

b. View their medical record (e.g. health and
behavioral health information) online?

1

□

0

□

na

□

c.

1

□

0

□

na

□

Download their medical record?

Are there any other functionalities that are missing from your EHR system that would be useful to
serving your clients?
1

□

Yes

0

□

No

IF YES, PLEASE SPECIFY BELOW:

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

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Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

SKIP TO Q.15 (NEXT PAGE)

When does this facility plan to implement an EHR system?
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2
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4

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Within the next 6 months
6 months to 1 year
1 to 2 years
More than 2 years

SKIP TO Q.15 (NEXT PAGE)

14.

NOT
APPLICABLE

a. Exchange secure messages with their clinicians,
counselors or other medical staff?

1

13.

NO

Why does this facility not plan to implement an EHR system?

4

15.

Who was primarily responsible for completing this form? This information will only be used if we need
to contact you about your responses. It will not be published.
MARK ONE ONLY
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Ms

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Mrs

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Mr

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Dr

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Other (specify)

Name:
Title:
Phone Number: (|
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Fax Number:

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Email Address:
Facility Email Address:

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