Survey Questions Crosswalk

Attachment 3

Research Questions

1. What is the existing Health Information Technology (HIT) infrastructure among SAMHSA grantees?

2. What types of HIT are used by SAMHSA-funded grant programs?

3. What are the barriers of HIT use (e.g. cost, workforce) and facilitators for adopting and sustaining (e.g. efficiency) use of HIT?

4. What types of collaborations exist between local agencies to provide coordinated care using HIT?

5. How does HIT use (accessibility, dosage, engagement) vary between urban, “suburban,” and rural areas?¹

Domains

1. EHRs and practice management systems

2. Interoperability/health information exchange functionality

3. Telehealth

4. Mobile tools

5. Web portals

6. Consumer engagement tools

7. Personal health records

8. Dashboard/ Survey tools for integration of care

Survey Questions

Section 1 Grantee Program Information and Characteristics

1. * Grantee program contact information:

2. * Who is completing this survey?

3. * Your contact information

4. How engaged are the organization’s leaders in planning and implementing the grant? (Please select one the following options)

5. Please identify the types of services provided to individuals and patients participating or enrolled in the grant, either paid for by the grant or by other sources. (Please check all that apply)

6. In what type of geographic setting are most of the grant-funded services provided? (Please select one the following options)

7. Are services provided within the grant-funded program eligible for reimbursement by any of these payer sources? (Please select one service per payer source)

8. You may use the space below to add comments about “Section: Grantee Program Information and Characteristics”

Section 2 Grantee Program Information Technology Infrastructure

1. What percentage of the staff working in the grant-funded program use a work-computer? (Please select one the following options)

2. Do the work-computers used by the grant-funded program staff share printers or access a shared location for storing electronic files and folders (commonly called an Intranet)? (Please select one the following options)

3. Are the work-computers connected to the Internet (i.e., World Wide Web)? (Please select one the following options)

4. When in the office, does the Internet connection used by the grant-funded program staff usually meet the program needs? (Please select one the following options)

5. When “in the field” does the Internet connection used by the grant-funded program staff usually meet the program’s needs? (Please select one the following options)

6. Do most (75% - 100%) or all of the grant-funded program staff have their own work-email account for use in implementing grant- funded program activities? (Please select one the following options)

7. For each of the grant award program-level activities, please indicate the type of data collection instrument(s) program staff use to complete most of their day-to-day activities. (Please check only one answer per activity).

8. You may use the space below to add your comments about “Section 2: Grant-funded Program Information Technology Resources”

Section 3 Use of Certified Electronic Health Record Technology

1. Do the grant-funded program staff who use a computer have access to a certified Electronic Health Record to complete activities? (Please select one the following options)

2. Please select the BEST option below to describe the grant-funded program’s current status in implementing certified Electronic Health Record technology. (Please select one the following options)

3. Why did the organization implementing the grant-funded program decide to implement a certified Electronic Health Record system? (Please check all that apply)

4. Do staff assess Internet-based patient access to their personal health information via the certified Electronic Health Record’s secure patient portal? (Please select one the following options)

5. Do the grant-funded program staff use the certified Electronic Health Record to generate Patient Health Information Summaries? (Please select one the following options)

6. Do grant-funded program staff electronically exchange Patient Health Information Summaries among a network of providers in order to coordinate individual patient care? (Please select one the following options)

7. What method(s) are available to grant-funded program staff to electronically exchange patient health information? (Please check all that apply)

8. Please indicate your use of certified Electronic Health Record technology to implement the processes in the table below. (Please select one response per activity)

9. Please rate the significance of grant-funded program STAFF and PATIENT barriers to adopting certified Electronic Health Record technology. (Please select one response per barrier)

10. You may use the space below to add your comments on STAFF and PATIENT barriers to adopting certified Electronic Health Record technology.

11. Please rate the significance of systemic barriers to adopting certified Electronic Health Record technology encountered by the organization implementing the grant-funded services. (Please select one response per barrier)

12. You may use the space below to add your comments on the SYSTEMIC barriers to adopting certified Electronic Health Record technology.

Section 4 Use of Telehealth

1. Do the grant-funded program staff use telehealth technology to provide patient services? (Please select one of the following options)

2. What types of telehealth technology are used, and for what services? (Please check all that apply)

3. What type of grant-funded program staff may provide these services using telehealth? (Please check all that apply)

4. What are the target population subsets for telehealth services? (Please check all that apply)

5. How does the grant-funded program use telehealth technology to support the delivery of services? (Please check all that apply)

6. What are the barriers to using telehealth within the grant-funded program? (Please check all that apply)

7. You may use the space below to add comments on “Section 4: Use of Telehealth”

Section 5 Use of Mobile Technology

1. Do the grant-funded program staff use mobile technologies to provide patient services? (Please select one the following options)

2. What types of mobile technology tools are used by the grant-funded project staff to support their day-to day work activities? (Please check all that apply)

3. How do grant-funded program staff use mobile technology tools to support the implementation of grant funded program day-to-day activities? (Please check all that apply)

4. How do patients use mobile technology tools to participate in their prevention, treatment, and/or recovery? (Please check all that apply)

5. What types of mobile apps do grant-funded program staff use to monitor and support patient engagement? (Please check all that apply)

6. What are the barriers to using mobile technology tools within the grant-funded program? (Please check all that apply)

7. You may use the space below to add comments on “Section 5: Mobile Technology”

Section 6 Use of Social Media

1. Do the grant-funded program staff use social media in the workplace to support the prevention and treatment of behavioral health disorders?

2. In the table below, please identify the type of social media used by selecting the grant-funded program activities it supports. (Please check all that apply for each activity)

3. You may use the space below to add comments on “Section 3: Social Media”

4. Does the grant-funded program enable technology-based services (i.e., services such as use of certified electronic health information technologies, telehealth, use of mobile technologies and social media) that would not be available without the grant infrastructure)? (Please select one of the following options)

Crosswalk of Survey Domains and Research Questions

Section 1: Grantee Program Information and Characteristics	Research Question #s	Domain #s	Rationale
1	1-5	1-8	Verifies status as SAMHSA –funded grantee – applied to all research questions and domains.
2	1-5	1-8	Confirms appropriate status of respondent – applied to all research questions and domains.
3	1-5	1-8	Confirms contact information for respondent – applied to all research questions and domains.
4	1, 2, 3, 4	1-8	Executive leadership involvement in grant activities supports responsiveness to grantee-program needs
5	1, 2, 3	1, 2, 3, 4, 5	Data collection, reporting and information exchange priorities are defined by treatment setting and services, especially when the information exchange is conducted within the community network of public health care providers, with local law enforcement and with social services
6	1-5	1-8	Geographic area –fundamental to assessing impact of locale on access to and use of health information technology. Applied to all research questions and domains.
7	1,2	1, 2, 8	Implementing third-party payer agreements usually requires the support of information technology.
8	TBD	TBD	Section 1 text field qualitative data. Allows participant to offer additional information, and if offered will be applied to research question and domain.

Section 2 Grantee Program Information Technology Infrastructure	Research Question #s	Domain #s	Rationale
1	2, 3	1, 2, 3	Collects and refines data on program staff access to the essential tools for health information technology. Collects and refines data on program’s ability to provide staff with appropriate tools. Informs skip logic pattern.
2	2, 3	1, 2, 3	Collects and refines data on program staff access to internal organizational resources and barriers for leveraging information technology resources. Collects and refines data on program’s ability to provide staff with appropriate internal resources.
3	2, 3, 4, 5	1, 2, 3	Collects and refines data on program staff access to Internet-based resources and barriers for leveraging program information technology resources. Collects and refines data on organizational ability to provide staff with appropriate Internet-based resources.
4	2, 3, 4, 5	1, 2, 3	Collects and refines data on viability of access to Internet, in the workplace setting.
5	2, 3, 4, 5	1, 2, 3	Collects and refines data on viability of access to Internet, in the field. It is common for grant-funded program staff to conduct work in the field, where access to the Internet may be variable. Added to provide the distinction among various settings for implementing grant-funded program activities.
6	2, 3, 4	1, 2, 3	Collects and refines data on a potential barrier to program staff access to electronic messaging. Collects and refines data on organizational ability to provide staff with appropriate electronic messaging resources.
7	2, 3, 4	1, 2, 3, 4	Collects and refines data on program staff access to information technology tools for the implementation of clinical and practice management workflows, including workflows that implement health information exchange. When combined with data on the availability of information technology resources, it provides data on the utility of these resources.
8	TBD	TBD	Section 2 text field, qualitative data. Allows participant to offer additional information, and if offered will be applied to research question and domain.

Section 3 Certified Electronic Health Record Technology	Research Question #s	Domain #s	Rationale
1	1, 2, 3	1, 2, 5, 6, 7, 8	Collects and refines data on the status of organizational planning re: certified electronic health information technology, and their use of non-certified electronic health record system. These data inform the assessment of grant-funded program and staff level of access to this technology in the near future. PLEASE NOTE that questions related to electronic health record technology apply only to certified technology. Participants who are not using this technology will skip this section.
2	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Provides information on the grant-funded program status re: the potential adoption and use of certified information technology.
3	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Provides information on system drivers for adoption and use of certified information technology.
4	1, 2, 3, 4, 5	1, 2, 5	Collects and refines data on the ability of the patient population to access the Common Meaningful Use data set via the Internet using certified Electronic Health Record technology.
5	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Collects and refines data on the ability to access the essential tools required for patient health information exchange. These summaries adhere to the national data and technology standards and requirements for the effective and efficient exchange of patient health information on a network of providers.
6	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Collects and refines data on the program staff access a network for health information exchange. This is a fundamental requirement for effectively and efficiently collaborating, coordinating and integrating patient health care among a network of providers.
7	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Collects and refines data on the viability (i.e., ability to actually use the network access tools available to program staff) for effectively implementing health information exchange.

8	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Collects and refines data on the viability of exchanging information that populates the Common Meaningful Use data set in the patient record, for example, the ability to receive structured clinical lab test results electronically.
9	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Identifies specific patient and staff level barriers to adopting certified electronic health record technology
10	TBD	TBD	Section 3 text field, qualitative data. Allows participant to offer additional information on barriers, and if offered will be applied to research question and domain.
11	1, 2, 3, 4, 5	1, 2, 5, 6, 7, 8	Identifies specific systemic level barriers to adopting certified electronic health record technology
12	TBD	TBD	Section 3 text field qualitative data. Allows participant to offer additional information on systemic barriers, and if offered will be applied to research question and domain.

Section 4 Use of Telehealth	Research Question #s	Domain #s	Rationale
1	1, 2, 3, 5	3, 6, 8	Confirms survey participant use of telehealth. Informs skip logic pattern.
2	1, 2, 3, 5	3, 6, 8	Provides comprehensive data on the type of telehealth technology the grant-funded program staff are able to access; and how this technology is used to provide patient services.
3	1, 2, 3, 5	3, 6, 8	Identifies the types of behavioral healthcare professionals who use telehealth in the grant-funded program in the provision of patient services.
4	1, 2, 3, 5	3, 6, 8	Identifies the most common behavioral health disorders that identify patient populations, and the types of telehealth services they may receive.
5	1, 2, 3, 5	3, 6, 8	Identifies how staff may use telehealth to support clinical in-house activities related to patient care.
6	1, 2, 3, 5	3, 6, 8	Identifies specific barriers to adopting telehealth technologies.
7	TBD	TBD	Section 4 text field, qualitative data. Allows participant to offer additional information, and if offered will be applied to research question and domain.

Section 5 Use of Mobile Technology	Research Question #s	Domain #s	Rationale
1	1, 2, 3, 5	4, 6, 8	Confirms survey participant use of mobile technology to provide patient services. Informs skip logic pattern.
2	1, 2, 3, 5	4, 6, 8	Identifies types of mobile technology in use
3	1, 2, 3, 5	4, 6, 8	Identifies how patients use mobile technology
4	1, 2, 3, 5	4, 6, 8	Identifies how patients use mobile technology
5	1, 2, 3, 5	4, 6, 8	Identifies and collects data on the types of mobile applications that grant-funded staff may use to monitor and support patient engagement.
6	1, 2, 3, 5	4, 6, 8	Identifies specific barriers to adopting mobile technologies.
7	TBD	TBD	Section 5 text field, qualitative data. Allows participant to offer additional information, and if offered will be applied to research question and domain.

Section 6 Social Media	Research Question #s	Domain #s	Rationale
1	1, 2, 3, 5	5, 6, 8	Confirms survey participant use of social media in prevention and treatment of behavioral health disorders. Informs skip logic pattern.
2	1, 2, 3, 5	5, 6, 8	Identifies and collects data on the use of social media for prevention and treatment.
3	TBD	TBD	Section 6 text field, qualitative data. Allows participant to offer additional information, and if offered will be applied to research question and domain.
4	1-5	1-8	Identifies the role of the grant in enabling services that use the technologies referenced by the survey.

1 United States Census Bureau, Urban and Rural Classifications, 2014. Retrieved December 2014 from https://www.census.gov/geo/reference/urban-rural.html

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