Electronic Health Record (EHR) Adoption

1

Which best describes your role (choose only one)?

Medical professional solo practitioner Medical professional practicing within a group practice of three (3) or fewer providers Medical professional practicing within a group practice of four (4) or more providers Medical professional predominantly practicing in a Federally Qualified Health Center (FQHC), known as a “Centro 330” Medical professional practicing as part of the staff within any department in an inpatient hospital Administrator responding on behalf of a group practice Administrator responding on behalf of a Federally Qualified Health Center (FQHC) Administrator responding on behalf of an inpatient hospital

1a

Which best describes your provider specialty (choose only one)?

Primary care physician (PCP) Pediatrician Dentist Psychiatrist Other medical specialty

1b

Which best describes your provider setting (choose only one)?

Physician group practice Federally Qualified Health Center (FQHC) Acute Hospital Children’s Hospital

2

Does your primary practice location have Internet access (choose only one)?

Yes No

2a

What type of connection does the office have (choose only one)?

High speed/broadband (at least 25 Mbit/s downstream and 3 Mbit/s upstream) Primary rate (at least 1.5 Mbit/s downstream, but lower than High speed/broadband) Other or not sure

2b-d

3

Does your primary practice location use an Electronic Health Record (EHR) (choose only one)?

No, it does not use practice management or EHR systems or any kind No, but it uses a practice management system Yes, it has already implemented and is currently using an EHR

3a-d

3e

What is the certification year/version of your EHR? (choose only one)

2014 2011 Hybrid (some modules are 2011 certified, others are 2014 certified) I don’t know or I’m not sure

3f

Do you know if your EHR vendor offers a complete 2014-certified version? (choose only one)

Yes No I don’t know or I’m not sure

4-4a

5

Have you applied for an incentive in either the Medicare or Medicaid EHR Incentive Programs? (choose only one)

Yes No I don’t know or I’m not sure

5a

Which program(s) have you applied and incentive in? (choose only one)

Medicare Medicaid Both I don’t know or I’m not sure

6

Have you applied for an incentive for the Adopt, Implement, or Upgrade (AIU) phase in the Medicaid EHR Incentive Program? (choose only one)

Yes No I don’t know or I’m not sure

6a

What is your status with regards to the AIU phase incentive? (choose only one)

I have applied for an AIU incentive, but was declared ineligible I have applied for an AIU incentive, but I have not been contacted by ASES regarding my case I have applied for an AIU incentive, and was asked by ASES to submit additional information I have applied for an AIU incentive, submitted additional information, but my case has not been approved or rejected I have applied for an AIU incentive, and I received payment Other status or situation not indicated above

6b

Why have you not applied for an AIU phase incentive? (choose only one)

I am not sure I meet the eligibility criteria I am not sure how to apply for a Medicaid EHR incentive My AIU phase incentive application has been started, but is incomplete I am waiting on getting additional information before I apply I believe I do not meet the eligibility criteria It’s too much of a hassle to apply and submit all the necessary information Other reason not stated above

6c

Are you planning to apply for a Medicaid EHR incentive for Meaningful Use (MU)? (choose only one)

Yes No I don’t know or I’m not sure

7

Have you applied for an incentive for achieving Meaningful Use (MU) in the Medicaid EHR Incentive Program? (choose only one)

Yes No I don’t know or I’m not sure

7a-b

7c

Why have you not applied for an MU incentive? (choose only one)

I am not sure I meet the eligibility criteria I am not sure how to apply for a Medicaid EHR MU incentive My MU incentive application has been started, but is incomplete I am waiting on getting additional information before I apply I believe I do not meet the eligibility criteria It’s too much of a hassle to apply and submit all the necessary information Other reason not stated above

8

Have you enrolled with the Puerto Rico and U.S.V.I Regional Extension Center (REC)? (choose only one)

Yes No I’m not sure I am not aware of who the REC is or their relationship to EHRs

8a

What has been the REC’s greatest value in the process of adoption and meaningful use of EHR? (choose only one)

Selection of an EHR Implementation support for my selected EHR Orientation or education related to the Medicaid EHR Incentive Program Support in registering in the CMS NLR and/or attesting in the Puerto Rico SLR My enrollment with the REC has not been helpful in any tangible manner

8b

Why haven’t you enrolled with the REC? (choose only one)

I am not aware of what the REC is or their relationship to EHRs I have not been contacted by the REC I have internal staff that fulfills a similar role I have retained external consultants that fulfill a similar role I believe I have sufficient knowledge of EHR implementation and EHR incentives I don’t share information with other providers I have engaged other consultants or external resources to support me with EHR incentives Other reasons not stated above

9

Do you share ePHI with other healthcare providers (e.g. hospitals, laboratories, specialists)? (choose only one)

Yes No I don’t know or I’m not sure

9a

With which type of provider do you share health information most often? (choose only one)

Hospitals Laboratories Pharmacies Radiologists Other physicians or specialists State or federal agencies

9b

What has been the most significant barrier to sharing health information? (choose only one)

It has not been necessary or I have not had the opportunity to do so I am not sure how to go about it Incompatibility with other providers’ EHRs Implementation costs HIPAA privacy and security concerns

10

Have you enrolled with the Puerto Rico Health Information Network (PRHIN), the state Health Information Exchange (HIE)? (choose only one)

Yes No I’m not sure

10a

Are you currently exchanging health information with the PRHIN? (choose only one)

Yes No I’m not sure

10b

Which type(s) of information have you exchanged with the PRHIN? (choose as many as applicable)

Laboratory orders and/or results

Electronic prescriptions

Patient encounter information

Secure messaging

Other types of information

10c

What has been the most significant barrier to exchanging health information with the PRHIN? (choose only one)

It has not been necessary or I have not had the opportunity to do so I am not sure how to go about it The PRHIN does not offer the HIE services I need Implementation costs HIPAA privacy and security concerns

11

What can your GHP MCO do to support, facilitate and/or improve your ability to implement Certified EHR technology in your practice setting? (choose as many as applicable)

Perform an assessment of my practice setting and make actionable recommendations

Provide support in selecting Certified EHR technology that is adequate for my practice setting

Offer economic incentives to minimize the costs of implementation

Offer me and my staff training and education on how to use PCs, tablets, laptops or other end user devices

Offer me and my staff training and education how to implement or use EHRs