Form 1 Patient Portal Survey for Patients

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

NIH Clinical Center Patient Portal Survey for Patients.v001.08182021 (3)

Health Information Technology Patient Satisfaction Survey (CC)

OMB: 0925-0648

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Shape1

NIH Clinical Center Patient Portal Survey for Patients

Please respond to these prompts as they apply to your experience with the FollowMyHealth® Patient Portal in use at the National Institutes of Health Clinical Center. This survey is anonymous.


NIH Clinical Center Privacy Policy - https://www.cc.nih.gov/disclaimers.html


OMB # 0925-0648, Expiration Date: 06/30/2024


Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

1.How long have you used the NIH Clinical Center Patient Portal?

Shape2 1 year or less

Shape3 2 years

Shape4 3 years

Shape5 4 years or greater

2.How many times have you used the NIH Clinical Center Patient Portal?

Shape6 0

Shape7 1 to 5

Shape8 6 to 10

Shape9 11 to 40

Shape10 41 or more

3.Please indicate your level of agreement with the following statement. The process to create your FollowMyHealth® Patient Portal account was easy.

Shape11 Strongly Disagree

Shape12 Disagree

Shape13 Neutral

Shape14 Agree

Shape15 Strongly Agree

4.In the last 12 months, did you e-mail your NIH care provider with a medical question using the patient portal?

Shape16 Yes

Shape17 No

5.Does the NIH Clinical Center put your lab results on the NIH Clinical Center Patient Portal for you to see?

Shape18 Yes

Shape19 No

Shape20 Don't know

6.In the last 12 months, did you look for your lab results on the NIH Clinical Center Patient Portal?

Shape21 Yes

Shape22 No

7.In the last 12 months, how often was it easy to find these lab results on the NIH Clinical Center Patient Portal?

Shape23 Never

Shape24 Sometimes

Shape25 Usually

Shape26 Always

8.In the last 12 months, how often were these lab results available on the NIH Clinical Center Patient Portal site as soon as you needed them?

Shape27 Never

Shape28 Sometimes

Shape29 Usually

Shape30 Always

9.In the last 12 months, how often were these lab results presented in a way that was easy to understand?

Shape31 Never

Shape32 Sometimes

Shape33 Usually

Shape34 Always

10.Visit notes summarize what was talked about on a visit to a provider. Visit notes may be available on paper, on the patient portal, or by e-mail. Does the NIH Clinical Center provide you with your visit notes?

Shape35 Yes

Shape36 No

Shape37 Don't know

11.In the last 12 months, how did the NIH Clinical Center offer you the visit notes? Mark one or more.

Shape38 On paper

Shape39 In the Patient Portal

Shape40 By e-mail

Shape41 Some other way

12.In the last 12 months, did you look for visit notes in the NIH Clinical Center Patient Portal from your NIH care provider?

Shape42 Yes

Shape43 No

13.In the last 12 months, how often was it easy to find visit notes on the NIH Clinical Center Patient Portal site?

Shape44 Never

Shape45 Sometimes

Shape46 Usually

Shape47 Always

14.In the last 12 months, how often were these visit notes available in the NIH Clinical Center Patient Portal as soon as you needed them?

Shape48 Never

Shape49 Sometimes

Shape50 Usually

Shape51 Always

15.In the last 12 months, how often were the visit notes written in a way that was easy to understand?

Shape52 Never

Shape53 Sometimes

Shape54 Usually

Shape55 Always

16.Does the NIH Clinical Center Patient Portal offer a way to view appointment schedules?

Shape56 Yes

Shape57 No

Shape58 Don't know

17.In the last 12 months, did you check your appointment schedule in the NIH Clinical Center Patient Portal?

Shape59 Yes

Shape60 No

18.In the last 12 months, how often was it easy to view your appointment schedule on the NIH Clinical Center Patient Portal site?

Shape61 Never

Shape62 Sometimes

Shape63 Usually

Shape64 Always

19.In the last 12 months, how often was your appointment schedule presented in a way that was easy to understand?

Shape65 Never

Shape66 Sometimes

Shape67 Usually

Shape68 Always

20.Does the NIH Clinical Center Patient Portal Service Center provide support via phone?

Shape69 Yes

Shape70 No

Shape71 Don't know

21.In the last 12 months, did you call the NIH Clinical Center Patient Portal Service Center?

Shape72 Yes

Shape73 No

22.In the last 12 months, please rate your experience with calling the NIH Clinical Center Patient Portal Service Center.

Shape74

Shape75

Shape76

Shape77

Shape78

Shape79

Shape80

Shape81

Shape82

Shape83

Shape84

Unsatisfactory

Satisfactory

23.What information (notes, results, other) do you feel is missing from the NIH Clinical Center Patient Portal? (If none, you may skip this question.)

Shape85

24.What functionality do you feel is missing from the NIH Clinical Center Patient Portal? (If none, you may skip this question.)

Shape86

25.Do you use the FollowMyHealth® Patient Portal for other healthcare facilities you visit?

Shape87 Yes

Shape88 No

26.Do you enter information from other medical providers into FollowMyHealth® Patient Portal?

Shape89 Yes

Shape90 No

27.What is your age?

Shape91 18 to 24

Shape92 25 to 34

Shape93 35 to 44

Shape94 45 to 54

Shape95 55 to 64

Shape96 65 to 74

Shape97 75 or older

28.Sex:

Shape98 Male

Shape99 Female

Shape100 Unknown

29.What is the highest grade or level of school that you have completed?

Shape101 8th grade or less

Shape102 Some high school, but did not graduate

Shape103 High school graduate or GED

Shape104 Some college or 2-year degree

Shape105 4-year college graduate

Shape106 More than 4-year college degree

30.Are you of Hispanic or Latino origin or descent?

Shape107 Yes, Hispanic or Latino

Shape108 No, not Hispanic or Latino

31.What is your race?

Shape109 American Indian or Alaska Native

Shape110 Asian

Shape111 Black or African American

Shape112 Native Hawaiian or Other Pacific Islander

Shape113 White



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