Practice Readiness Assessment

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1 Practice Demographics Practice Name: Tax ID Number: Practice Address: REC Implementation Agent: Practice Telephone Number: Practice Fax Number: Lead Physician: Project Primary Contact: Lead Physician Address: Primary Contact Address: Number of Physicians in the Practice: Number of Clinical Staff in the Practice: Number of LPN/RN in the Practice: Number of Office Support Staff in the Practice: Additional Affiliations: Preffered Method of Contact: Telephone Fax This material was originally prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services and was revised by the New York ehealth Collaborative in conjunction with the New York State Department of Health. This publication was made possible by Grant/Cooperative Agreement Number 90RC0007/01. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the HHS Office of National Coordinator for Health Information Technology. 8/2011

2 Reason for Participation (check all that apply) Practice is interested in adopting an EHR and other technology Practice is interested in optimizing workflow with use of health technology Practice is interested in support in achieving meaningful use Practice is interested in applying for Patient-Centered Medical Home (PCMH) Practice is interested in qualifying for additional incentive programs offered by Medicare and/or Medicaid Percentage of Patients Seen Daily by the Practice Annually % of Medicare % of Medicaid % of Private Insurance % of Uninsured Patient Population How many patients are seen in your practice on an average day? 0 20 patients >20 patients Of the patients seen daily, what percentage has one or more chronic illnesses (i.e. CAD, diabetes, hypertension, heart failure, or depression)? Of the patients seen daily, what percentage would benefit from smoking cessation assistance? Medical Specialties Family Medicine Internal Medicine Pediatrics Geriatrics Cardiology Endocrinology Podiatry Ophthalmology Dentistry Radiology Oncology Nephrology Practice Workflow Evaluation Please check all the workflow issues that are of the greatest concern in your practice (check all that apply): Unable to stay on office schedule Poor legibility of medical records Patient wait time in the office or on the phone Inefficient use of resources Medical Record Accessibility Health maintenance tracking Handling requests generated by fax or phone Scheduling appointments Medication Prescribing (including refills) Referral and referral tracking p2

3 Practice Workflow Evaluation (continued) Of the patients seen daily, how many are seen without an available medical record? Has the practice implemented any of the following workflow solutions? (check all that apply) Hired a practice management consultant Attended seminars on improving clinical office practice Conducted quality improvement projects (e.g. patient flow studies) Redesigned workflow to address inefficiencies Hired additional clinicians (e.g. NP, PA) Implemented a patient tracking system Automated phone service Changed/added staff to address phone triage Has the practice tried to remedy workflow issues or operational inefficiencies in the past? If, how successful were these efforts? Using a scale of 1-5 for your answer. (1 = very unsuccessful, 3 = neither successful nor unsuccessful, 5 = very successful) Practice Management Does the practice have other projects going on and/or starting soon that might affect the planning for and/or success of the HIT implementation project (e.g. moving to a new location, changing the telephone system)? If, please specify What types of technology is the practice currently using on a regular basis? (check all that apply) (administrative use) Disease/Immunization registries High-speed internet connection Document imaging system RHIO portal (clinical use) E-prescribing Locally networked computers E-lab results Practice website p3

4 Technology Type Vendor Disease Registries E-prescribing Document Imaging E-lab RHIO Portal Please indicate whether the practice has or will have the following systems in place within 6 months: Practice Management System Please specify vendor/system and version Electronic Medical Record (EMR) or Electronic Health Record (EHR) System Please specify vendor/system and version Does the system support disease specific registries (yes/no): Information Technology (IT) system(s) Please specify vendor/system and version Do you currently create reports or use a registry (i.e. patient tracking system) to manage patients with chronic conditions (e.g. diabetes, cardiac, hypertension, immunizations)? If, what do you do with the data? (check all that apply) Share with all clinicians and physicians, either internal or external to your practice Share with your administrative staff Generate reminders for patients Track quality of care (e.g. HbA1C results, eye exams) Identify groups of patients for specific follow-up Plan patient care p4

5 Do you currently provide printed information on drug therapies, disease management, diet, etc.? Does the practice provide interpreter services for non-english speaking patients? Would the practice be interested in learning more about how to provide more culturally responsive care? Do you conduct weekly or monthly staff meetings? (Clinicians & administrative staff) If, what are some of the discussion topics? (check all that apply) Workflow Patient Satisfaction Issues Revised Procedures Interesting Medical Cases Customer Service Management of Chronic Disease If, what is the frequency of the meetings? Once per week Once per month Once per year Once per quarter Laboratory Please estimate the proportion of total lab services generated in your practice that are processed: % by your office % by a community hospital or medical center % by your primary lab (name of laboratory): % by your secondary lab (name of laboratory): % Do you collect blood specimens in your office? Thinking about how your practice receives lab reports, please estimate what percentage is received by each of following methods: % Electronic % Hard Copies (printer in office or delivery) % Fax % On average, about how many calls each week do you or your staff make to the lab about lab reports? ne < >10 p5

6 Prescriptions On average, what number of new (non-refill) prescriptions does your practice write daily? ne < On average, how many refills or renewal requests does your practice process daily? ne < > 60 On average, how many of your practice patients per day need their prescriptions rewritten? ne 5-10 < 5 > 10 On average, please estimate the number of follow-up calls or faxes your practice receives each week for medication prescribing issues (illegible handwriting, drug-drug interactions, allergy alerts, non-formulary): ne < < 60 Are you currently tracking groups of patients taking certain mediations (e.g. patients on Warfarin)? If, what is the method of tracking? Spreadsheet Card file Database EMR PMS ICD 9 abstract Clinical Referrals How many referrals to specialists do you make each week? ne < < 10 Does your practice have a method for tracking referrals to specialists prior to the return of the consultation report? p6

7 Transcription Services Does your practice use transcription services? If, what is your practice s average transcription costs per month? $ Billing What is the practice s current method of billing? (check all that apply) Electronic (Vendor Name Paper-based Contracted external services If you are billing electronically, is your system HIPAA compliant? Does your current system allow you to generate reports sorted by CPT or ICD 9 code? What is your average turnaround time on claims from submission to payment? ne < Do you have any problems with or concerns about your coding? Information Technology Please indicate the current status of the practice s EHR/HIT system implementation efforts: Beginning the process of selecting a system. In the process of implementing a system. Currently live with a system. Which of the following technologies would you be interested in, if you are not using them currently (check all that apply): Electronic Health Record System E-prescribing E-laboratory RHIO/RHIO Portal Disease management systems (administrative/clinical) Document Imaging Patient Portal p7

8 Which staff members have direct access to a computer/terminal? (check all that apply) Physicians Administrative staff Clinicians (e.g., NP, PA, RN) What is the total number of computers currently in your practice? Are your computers connected to a network? Do you share documents or information on your network? Do you communicate within your practice using ? Does your practice have high-speed Internet connection? If, is the Internet connection used by the staff daily? If, what are the primary uses for the Internet connection? (check all that apply) Pub Med (or other online peer-reviewed resources) Hospital/Medical Center (data transfer) Medical Charts Health plan reports E-prescribing Electronic Claim Submission E-lab Transcription Referral request submission Don t know Is your current Practice Management System (PMS)/billing system capable of interfacing with an Electronic Health Record (EHR) system? t Sure Are you interested in upgrading your current PMS? t Sure Are you interested in an integrated solution? t Sure Has your practice explored any EHR systems? If, how have you gone about it? (check all that apply) Read an article in peer-reviewed journal Attended Healthcare technology conference Completed an online vendor return on investment Talked to a colleague who uses EHR Visited colleague s practice to see EHR Read an article in trade/medical magazine(s) Attended a vendor demonstration p8

9 If you have not implemented an EHR system, what barriers are you facing? (please prioritize the top three reasons from the list below) Financial constraints Unable to secure all partners /clinicians commitment to use EHR Vendor support was inadequate for technological needs Initial data entry is too labor intensive Vendor stability and viability Software requires extensive customization to fit into practice Lack of standards Difficult to select a system Do not know where to begin Current EHR Users Only-Answer remaining questions Who was involved in the decision to purchase an Electronic Health Record (EHR) system? One physician Entire staff at the practice All the physicians at the practice Were your partners and staff as eager to progress to EHR as you were? What is the name of the EHR selected? What are your goals (benefits) for using an EHR? (Please prioritize in order with 1 being the most important and 9 being the least important) Reduce transcription costs Reduce paper based medical charts Reduce administrative costs of practice Provide more services to patients per visit Capture all services provided at each visit Improved quality of life Go home earlier Receive return on investment associated with software Increase Patient satisfaction Improve phone and fax processing Timely access to patient records Facilitate Management of chronic conditions Provide better follow-up care to patients p9

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