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Practice Assessment Questionnaire
Health Information Technology
Practice Assessment Questionnaire
Contact Information
* Indicates required field
1. Practice Name
2. First Name*
3. Last Name*
4. Address*
5. City
6. State/Province
id="state" name="state" size="20" type="text">
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Fed. States of Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
7. Zip
8. Email*
9. Phone*
10. Administrator
11. Administrator's Email Address
About Your Practice and Staff
12. Practice Specialty (Select All that Apply.
Hold down the control key to select more than one option.)
Family Practice
Internal Medicine
Allergy & Immunology
Anesthesia
Cardiology
Dermatology
Emergency Medicine
Endocrinology and Metabolism
Gastroenterology
General Practice
Geriatric Medicine
Gynecology
Gynecologic Oncology
Hematology
Hospice and Palliative Medicine
Infectious Diseases
Neonatology
Nephrology
Neurology
Neurological Surgery
Obstetrics and Gynecology
Oncology, Medical
Ophthalmology
Orthopedics
Otorhinolaryngology
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Podiatric Medicine
Preventative Medicine
Psychiatry
Pulmonary Disease
Radiology, Diagnostic
Radiology, Nuclear
Radiation Oncology
Rheumatology
Sports Medicine
Surgery, General
Surgery, Hand
Surgery, Thoracic
Surgery, Vascular
Surgery, Colon and Rectal
Surgery, Urology
Oncology and Hematology
Urology
Other
12-a. Please specify other practice specialty
13. Number of Locations
14. Staffing Levels
Please indicate the numbers of the following staff:
14-A. Physicians
14-B. Other Providers - PA, NP
14-C. Nurses and Other Clinical Staff
14-D. Front Office Staff (Check In/Check Out, Clerical)
14-E. Medical Records Staff
14-F. Billing Staff
14-G. Dedicated Charge Entry Staff
14-H. Dedicated Payment Entry Staff
14-I. Administrative Staff
14-J. Transcription Staff
14-K.
Total Staff
15. What Systems Do You Currently Have In Place?
System
Current System
Reason for Replacement
(Check all that apply. Hold down the control key to select more than one option.)
Timeframe for Replacement
Practice Management and Revenue Cycle Management System(s) (PM-RCM)
Paper Based File System
Advanced Physician Billing, LLC
AdvantEdge Healthcare Solutions
Affiliated Professional Services, Inc.
athenaCollector
Benchmark Systems - MD Navigator
CareCloud Concierge
Centricity Practice Management
Concuity ClearContracts
DAQbilling Practice Mgmt Software
digiChart Net Practice
Dr. Chrono Professional
Dr. MT, Inc.
GE Centricity Practice Solution
Healthfusion Practice Mgmt
Ingenix
McKesson Horizon Enterprise Rev. Mgmt
Medical and Practice Mgmt Suite, LSS
Medical Business Associates
Medical Management Systems
Medisoft/Clinical EMR, McKesson Corp
MGSI
EHRAbsolute Bus. Solutions, Inc.
NueMD Complete
NueMD PM
NueMD,Nuesoft
Origin Healthcare Solutions
Payerpath
PeakPractice, Allscripts
PracticeAdmin
RMK Holdings Inc.
Sage Intergy, Sage Software
SuiteMed IMS
SYBE Medical Management
Other
Please specify other PM-RCM
Too Much Time Doing Paperwork
Billing Too slow
Revenue Cycle
Billing Costs Too High
Storage Space Requirements for Paper
Cost
Coordinating Files in Multiple Locations
Legibility of Paper Records
Time Spent Looking for Paper Charts
Other
Please specify other reason for replacement of PM-RCM
<
Within the Next 30 Days
Within 60 - 90 Days
Within 120 Days
Within the Next 12 Months
Electronic Health Records (EHR)
--None--
2011 Pulse Complete EHR
ABELMed EHR - EMR / PM
Advantage/EHR
Allscripts ED
Allscripts PeakPractice
Allscripts Professional EHR
Aprima
athenaClinicals
Centricity Advance
Cerner Millennium Powerchart, etc.
ChartAccess
ChartLogic EMR
CureMD EHR
Doctations
eClinicalWorks
EpicCare Ambulatory - Core EMR
EpicCare Inpatient - Core EMR
gloEMR
HCS eMR
ifa EMR
IMS
InSync
iPatientCare
MDCare EMR
NeoMed EHR
NexTech Practice 2011
nextEMR, LLC
NextGen Ambulatory EHR
Nortec EHR
PARADIGM
PeriBirth
Physician's Solution
SammyEHR
SuccessEHS
T SystemEV
T SystemEV
UroChartEHR
WebChart EHR
WellCentive Patient Registry
Wellsoft EDIS
Other
Please specify other EHR
Cumbersome
Too Much Time Doing Paperwork
Billing Too slow
Revenue Cycle
Billing Costs Too High
Storage Space Requirements for Paper
Cost
Coordinating Files in Multiple Locations
Legibility of Paper Records
Time Spent Looking for Paper Charts
Other
Please specify other reason for replacement of current EHR
Within the Next 30 Days
Within 60 - 90 Days
Within 120 Days
Within the Next 12 Months
Goals for the Practice
16. What are your short term goals for the practice? (Ex: decrease operational costs) Select all that apply. Hold down the control key to select more than one option.
Increase Revenue
Maintain patient confidentiality
Better Organized Office
More Efficient Billing
Other
16-a. Please specify other short term goals
17. What are your long term goals for the practice? Select all that apply. Hold down the control key to select more than one option.
Grow Practice
Improve quality of care
Enhance patient safety/surveillance
Support health maintenance/instructions
Increase productivity/support
Reduce hassle factors
Support revenue enhancement
Support predictive modeling
Greater Office Efficiency
Greater Coordination w/ Other Providers
More Efficient Patient Visits
Other
17-a. Please specify other long term goals
18. What are the biggest challenges with the current, paper-based workflow? Select all that apply. Hold down the control key to select more than one option.
Cumbersome
Too Much Time Doing Paperwork
Billing Too Slow
Revenue Cycle
Billing Costs Too High
Storage Space Requirements for Paper
Cost
Coordinating Files in Multiple Locations
Legibility of Paper Records
Time Spent Looking for Paper Charts
Other
18-a. Please specify other challenges
Electronic Health Records (EHR)
19. Do you have any concerns with moving to EHR? (Select All that Apply. Hold down the control key to select more than one option.)
Unfamiliar with Technology
Too Many Options
Concern about Life Cycle Costs
Confusion As To Best Product
Confusion As To Best Vendor
Cost of Implementation
Costs Hardware and Maintenance
Expense of Training Staff
Reduced Appointments/Lost Revenue
Transferring Patient Information/Billing
Other
19-a. Please specify other concerns
Current Process and Procedures
20. Describe how a patient moves through the practice � from check in to check out
21. How do the physicians currently document? Select all that apply. Hold down the control key to select more than one option.
Dictation/Transcription
Handwritten
Hand Typed
Other
22. Please specify other way(s) that physicians document
23. Approximately how much do you spend monthly on transcription costs?
24. Approximately how many patients a day does each physician see?
25. Chart pulls per day? (Estimated)
26. Refills per day? (Estimated)
27. Average dollars per visit? (Estimated)
28. Reimbursement for 99213? (Estimated)
(Established Patient Office or Other Outpatient Visits)
29. Reimbursement for 99214? (Estimated)
(New Patient.)
30. How are phone requests routed?
31. How are clinicians alerted that a patient is waiting in the exam room?
32. What primary forms are being used?
33. Who are your lab Vendors? (Select all that apply. Hold down the control key to select more than one option.)
Labcorp
Quest
Public Labs
Other
34. How do you file, report and manage lab results?
35. How do you track/report/alert disease management protocols or risk factors?
36. What data (if any) does your ancillary staff contribute to the note?
37. What are the EHR hot buttons/critical issues?
(Please check all that apply. Hold down the control key to select more than one option.)
Maximize Revenue
Receive Stimulus Dollars
Easy access to information
Medical Audit Protection
Cut Transcription Costs
Communication
Lab result follow-up
Outcome Reporting
Automated alerting/reminders
Research
Other
37-a. Please specify other hot-button/critical issue(s)
Practice Management
38. To whom do you currently transmit electronic claims?
Please check all that apply. Hold down the control key to select more than one option.
Medicare
Medicaid
Blue Cross/Blue Shield
Aetna
Travelers
Other commercial insurance
39. Please specify other electronic claims processor
Centralized Scheduling and Registration
40. Do you use centralized scheduling and registration?
41. Do you require full registration prior to patients being seen?
42. Do you have any special scheduling needs?
Charge Entry and Billing
43. Are charges entered at the time of service?
44. If not, when are they entered?
45. How And When Are Copays/Coinsurance Collected?
45-A. When are copays/coinsurance collected?
<
Check In
Check Out
Billed Later
Other
Please specify other time and for collecting copays/coinsurance
> 45-B. How are copays/coinsurance collected?
At Office
Billed Out
Other
Please specify other way copays/coinsurance are collected
46. Speacial Billing Needs
46-A. Do you have any special billing needs such as UBs, anesthesia or DME?
46-B. Select special billing needs. Select all that apply. Hold down the control key to select more than one option.
UBs
Anesthesia
DME
Other
46-C. Please specify other special billing needs
Billing, Aged Balances, Financial Reporting
47. Do you use centralized billing?
48. How do you currently check eligibility? Select all that apply. Hold down the control key to select more than one option.
By Phone
Website
Fax Request
Other
48-a. Please specify other way of checking eligibility
49. Do you currently utilize electronic posting?
49-a. If you use electronic posting, Which carriers?
50. What is your current clearinghouse for EDI?
51. How do you currently work your aged insurance balances?
52. Do you have a collections process or collections staff?
53. Is your collections process centralized?
54. What is the current process for follow up on aged patient balances?
55. Do you use an outside collection service?
56. What financial reports are you using today to manage your business? Select all that apply.
BIRT
Business Objects
Crystal Reports
IBM Cognos
Logic XML
Micro Strategy
Oracle
SAP
Other
56-a. Please indicate other financial reports you use.
57. Do you have a �wish list� of reports you currently do not have?
58. What reporting tools do you currently use?
59. Do you track and report on productivity utilizing RVU/RBRVS?
RBRVS is the Resource-Based Relative Value Scale.
RVU is the Relative Value Unit used by the RBRVS.
Thank you for taking the time to complete our questionnaire!
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