Schs.dph.ncdhhs.gov



North Carolina Central Cancer Registry

Department of Health and Human Services – Division of Public Health

State Center for Health Statistics

Physician’s Office Electronic Health Record (EHR) Adoption Survey

Date ________________

Please fill out the physician’s office information:

First Name __________________________ Last Name ________________________ MD/DO (circle one)

Name of Practice ______________________________________________________________________

City ____________________________________ State ___________________ Zip ________________

Telephone (Area Code) ________________________Business Email Address ______________________

Preferred primary contact (if different from above):

First Name __________________________ Last Name ________________________ MD/DO (circle one)

Title ______________________________________________

Telephone (Area Code]) ________________________Business Email Address ______________________

1. How would you describe your practice?

(Please check all that apply)

← Solo medical oncology practice ( Freestanding

← Medical oncology group or partnership ( Physician-owned center

← Solo radiation oncology practice ( Hospital-based practice

← Radiation oncology group or partnership

← Multi-specialty group or partnership

← Other (Please specify) ___________________________________________

2. Please provide the following information for the key contact information in your laboratory:

Name: ___________________________________________________________________________

Position: __________________________________________________________________________

Department: _______________________________________________________________________

Phone: ___________________________________________________________________________

Email ID: _________________________________________________________________________

3. Consider all full and part-time clinicians at your main practice. Including you, how many are:

Physicians: ______________________________

Nurse

Practitioners: _____________________________

Physician

Assistants: ________________________________

4. Please estimate the percentage of Medicare and Medicaid patients seen in your practice.

Medicare___________ Medicaid__________

5. What types of tests are performed at your facility?

6. Is your facility part of a multi-facility health system?

← Yes

← No

a) If yes, which health system? _______________________________

b) How many facilities are included in your health system? _______

7. How many primary hospitals do you serve? __________________

8. Please specify the names of the primary hospitals:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. Upon completing a typical office visit, how do you generate medication prescriptions for your patients?

← Handwritten

← Computerized, No Decision Support

← Computerized, With Decision Support (e.g., drug interaction alerts)

← Other, please describe: ___________________________________

Electronic Health Record related questions:

10. Does your primary hospital have an EHR?

← Yes

← No

a) If yes, does your practice connect electronically to the hospital’s EHR?

← Yes

← No

11. Does your practice use a computerized scheduling system?

(IF YES, PLEASE APPROXIMATE THE NUMBER OF YEARS YOU HAVE USED THIS SYSTEM.)

← Yes Years of computerized scheduling:________

← No

12. Does your practice use an electronic billing system?

← Yes If yes, name of billing system: _______________________

← No

13. Does your main practice use the certified EHR system?

← Yes

a) If yes, please name the EHR system:__________________

b) Please specify the name of,

▪ EHR vendor: _______________________________

▪ Product name:_______________________________

▪ Version: ____________________________________

← No

If no, when do you plan to implement an EHR?

← Within the next 12 months

← Within the next one to two years

← No specific plans

← Other, please specify: __________________________

Please proceed to question #14 and #15 if the answer to question #13 is yes:

14. Do you use EHR during patient visit? (i.e., tablets, PDAs, computers on wheels, etc.)?

← Yes

← No

15. Please provide EHR software vendor representative contact information:

First Name: _____________________ Last Name: _______________________

Position: ________________________ Department: ______________________

Telephone (Area Code):____________ Business Email Address: ___________________

16. What would be the greatest help to your practice in moving to an EHR?

← Internet access

← Technical support

← Funding

← Other, please specify:_______________________________

17. What does your practice perceive as benefit(s) of Electronic Health Records?

(PLEASE CHECK ALL THAT APPLY)

← Access to current patient data

← Ability to complete records from remote location

← Accessibility of data regardless of setting or provider (interoperability)

← Office process efficiency

← Reduce administrative costs associated with practice

← Increased communication within the office

← Increased communication with the patient

← Disease management

← Ability to monitor and improve patient/population clinical outcomes

← Cancer Registry reporting

← Meeting Medicare/Medicaid meaningful use objectives

← Cost reduction

← Increased revenue

← No perceived value (Benefits do not justify costs)

← Other, please specify:________________________________

18. How much of a barrier is each of the following to beginning or expanding the use of computer technology in your main practice? (Please circle the number that corresponds with your answer)

| |Not a Barrier |Minor Barrier |Major Barrier |

| |1 |2 |3 |

|Computer skills of you and/or colleagues/staff | | | |

| |1 |2 |3 |

|Computer technical support |1 |2 |3 |

|Lack of time to acquire knowledge about systems | | | |

| |1 |2 |3 |

|Start-up financial costs |1 |2 |3 |

|Ongoing financial costs |1 |2 |3 |

|Training and productivity costs |1 |2 |3 |

|Physician skepticism of EHRs |1 |2 |3 |

|Privacy and security concerns |1 |2 |3 |

|Lack of uniform standards (e.g. multiple systems | | | |

|are used by different providers) | | | |

| |1 |2 |3 |

| | | | |

|Technical limitations of system |1 |2 |3 |

19. What stage has your practice reached with EHR adoption?

← Purchased, but have not started implementing system

← Installed, training in progress

← EHR implemented and in use for less than one year

← EHR implemented and used for greater than one year

Other, please specify: ____________________________________________

20. Please indicate the features of the EHR that you have available in your practice:

| |Yes, But do not |Yes, Use sometime |Yes, Use most of the |No, Not Available |Do Not Know |

| |Use | |time/always | | |

| | |2 |3 |4 |5 |

| |1 | | | | |

| | | | | | |

|Laboratory Results |1 |2 |3 |4 |5 |

| | | | | | |

|PACS |1 |2 |3 |4 |5 |

| | | | | | |

|Electronic Visit Notes |1 |2 |3 |4 |5 |

| | | | | | |

|Electronic medication lists for each |1 |2 |3 |4 |5 |

|patient | | | | | |

| | | | | | |

|Electronic reporting to cancer registry |1 |2 |3 |4 |5 |

|Electronic referral or | | | | | |

|clinical messaging (secure |1 |2 |3 |4 |5 |

|emailing between providers) | | | | | |

| | | | | | |

|Reduce clinical and medication|1 |2 |3 |4 |5 |

|errors | | | | | |

| | | | | | |

|Improve access to medical |1 |2 |3 |4 |5 |

|record information | | | | | |

| | | | | | |

|Improve charge capture |1 |2 |3 |4 |5 |

| | | | | | |

|Improve patient communications|1 |2 |3 |4 |5 |

Have any questions regarding the survey? Please contact:

NCCCRMU2@dhhs.

Phone: (919) 715-97287474

**If you would like to receive this survey in Microsoft Word format, please send email.

THANK YOU!

PLEASE RETURN THE SURVEY IN THE RETURN ENVELOPE OR FAX TO THE FOLLOWING ADDRESS:

NORTH CAROLINA CENTRAL CANCER REGISTRY

STATE CENTER FOR HEALTH STATISTICS

1908 MAIL SERVICE CENTER222 N. DAWSON STREET

RALEIGH, NC 2760327699-1900

FAX: 919-715-72947294

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