Form #2 Form #2 Web-based Questionnaire

Attachment B

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

INPC/Health Information Exchange Questions

Survey Monkey Questionnaire

Salutation

First Name

Last Name

Suffix

Title (Select: CIO, CFO, CMO, Director of Technology, IT Manager, IT Team, Practice Manager, Board of Directors, Physician, Administrative Team, Other)

Organization

Address (City, Zip, County)

Length of time on job

1. Are you familiar with the term Health Information Exchange (HIE)? (Yes or No)

Yes: Nothing happens

No: Either email the individual with information or open window with definition

2. Are you familiar with the Indiana Network for Patient Care (INPC)? (Yes or No)

Yes: Nothing happens

No: Either email the individual with information or open window with information

3. Does your organization participate in any form of electronic health information exchange (local or regional networks of providers, and public health organizations, that facilitate the sharing of client/patient (individual person) information outside of your own organization?

1. If Yes

1. Please check the types of information your organization exchanges electronically.

In addition, for those types of information exchanged, how satisfied are you with the overall results of participating in an electronic health information exchange? (on a 1 to 5 scale, where 1 is Very Unsatisfied and 5 is Very Satisfied)

Type of Information	Satisfaction
ED episodes	1 2 3 4 5
Inpatient episodes (diagnoses, procedures)	1 2 3 4 5
Outpatient episodes	1 2 3 4 5
Laboratory	1 2 3 4 5
Dictation/transcription	1 2 3 4 5
Radiology	1 2 3 4 5
Pathology Cardiology	1 2 3 4 5
GI	1 2 3 4 5
Pulmonary	1 2 3 4 5
Claims: pharmacy, medical, and/or hospital	1 2 3 4 5
Enrollment/eligibility	1 2 3 4 5
Outpatient prescriptions	1 2 3 4 5
Retail pharmacy	1 2 3 4 5
Patient-reported data	1 2 3 4 5
Outpatient laboratory results	1 2 3 4 5
Others (Open Text Box)	1 2 3 4 5

2. Please check the areas in which your organization has benefited from participating in an health information exchange?

• Increased efficiency of healthcare delivery

• Decreased repeat testing

• Improved the quality of care

• Prevented medical errors

• Enhanced Patient Safety

• Reduced malpractice liability

• Streamlined referral process

• Streamlined back office processes

• Reduced time spent on administrative tasks

• Increased ease in pay-for-performance or quality performance data reporting

• Increased ability to study efficacy and cost-reducing strategies

• Increased ability to review information to learn about specific diseases and their treatments

• Reduced delays and costs associated with paper-based ordering and reporting of results

• Better access to patients’ test results over time

• Other (please specify) ___________________________

3. Please check the areas in which your organization has experienced barriers in participating in a health information exchange? (any changes in this section must be made in corresponding section under “b. If No”)

• Awareness of available health information exchanges

• Knowledge of how to implement health information exchange

• Investment costs (infrastructure, software, upgrades)

• Personnel time investment (implementation, training, maintenance)

• Privacy Concerns/HIPAA Compliance

• Patient Disapproval/Public Perception

• Reliability of health information exchange

• Bandwidth capacity (competing priorities and sustained leadership interest)

• IT Personnel and Support (availability, cost) (different from “Personnel” time above)

• Training

• Engaging staff to participate

• Reduced efficiency of healthcare delivery

• Involved in a merger/acquisition

• No return on investment (ROI)

• Concerns about competitive use of data

• Other (please specify) _____________________________

b. If No (Jump to Page using Logic)

1. Have you ever participated in an health information exchange?

• Yes

1. What type(s)?

2. Please elaborate on why you no longer participate

• No

• Not Sure

2. Has your organization been contacted to participate in a health information exchange? If so, who(m)?

• Yes

Who contacted you?

1. Indiana Network for Patient Care

2. Indiana Health Information Exchange

3. South Central Indiana Regional Health Care Network

4. Bloomington eHealth Collaborative/ HealthLink

5. Michiana Health Information Network

6. Indiana State Department of Health (ISDH)

7. Louisville Health Information Exchange, Inc. (LouHIE)

8. HealthBridge

9. Other (Open text field)

• No

• Not Sure

3. What has kept you from participating in an electronic exchange of healthcare information? Please check all that apply.

• Knowledge of available health information exchanges

• Knowledge of the implementation process of health information exchanges

• Initial investment costs (infrastructure, software)

• Expenses associated with a on-going health information exchange

• Personnel time investment (implementation, training, maintenance)

• Privacy Concerns/HIPAA Compliance

• Patient Disapproval/Public Perception

• Not requested by Patient/Staff/Physician

• Reliability

• Bandwidth capacity (connectivity)

• Availability of IT Personnel and Support (cost)

• Training

• Engaging staff to participate

• Reduced efficiency of healthcare delivery

• Other (please specify) _____________________________

Last Updated: 08.11.08 2