New Hampshire Medicaid Electronic Health Record Incentive Program Survey. Summary Report FINAL March, 2011

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1 New Hampshire Medicaid Electronic Health Record Incentive Program Survey Summary Report FINAL March, 2011 Commissioned by the New Hampshire Department of Health and Human Services

2 Table of Contents I. Background & Methodology...3 II. Executive Summary...4 III. Survey Demographics...6 IV. Program Eligibility...9 V. Medicaid EHR Program Interest VI. Electronic Health Record Implementation Current Implementation EHR Users Meaningful Use Objectives Future EHR Users Appendix A: Detailed Tabular Results Appendix B: Open ended responses Appendix C: Questionnaire 2

3 Background The New Hampshire Medicaid Electronic Health Record (EHR) incentive program survey was conducted between February 1 through March 3, 2011 to assess interest and potential qualification for the Medicaid EHR incentive program. The survey was administered to New Hampshire Medicaid healthcare providers who potentially met program eligibility criteria as determined by the New Hampshire Department of Health and Human Services Office of Medicaid Business and Policy. The information collected is intended to inform projects associated with the Health Information Technology for Economic and Clinical Health Act (HITECH). This report is a summary of descriptive statistics. No statistical significance has been calculated, nor have confidence intervals been constructed. Methodology The New Hampshire Medicaid EHR incentive program survey was sent to 113 healthcare providers, practice groups, and organizations in New Hampshire as follows: Providers/Provider Group Practices; Dentists/Dental Group Practices; Community Mental Health Centers (CMHCs); Federally Qualified Health Centers (FQHCs); Rural Health Centers (RHCs). The sampling frame for this survey included New Hampshire providers/practices that had filed Medicaid claims from April through June, Prior to conducting the survey, the New Hampshire Institute on Health Policy and Practice personally contacted survey recipients to share information about the survey and obtain recipient contact information (i.e., an address). Providers/Practices were then sent an invitation with instructions asking them to participate in the survey (Appendix C). Most respondents received the invitation on February 1, 2011; however, some respondents were added to the sample at a later date or had surveys resent due to changes in contacts or contact information. Providers/Practices that did not initially complete the survey were sent reminder s every seven days. After the third reminder, organizations that still had not completed the survey were contacted by telephone by an experienced and specially trained interviewer from the UNH Survey Center to remind them to complete the survey and ask if they required any assistance. The survey asked questions regarding practice type; provider type; the number of providers in group practices; volume of encounters with Medicaid patients; interest in the Medicaid or Medicare EHR incentive programs; and current use of, or interest in, EHRs. Current EHR users were asked about their systems including product type and meaningful use functionality. Non EHR users were asked about short and long term plans and barriers to EHR implementation. Of the 113 practices/organizations that received surveys, 82 responded, yielding a response rate of 72.6% and representing 1,734 potentially eligible providers across the state. The survey attempted to include as many practices with potentially eligible providers as possible; however, without a way to identify all potentially eligible providers in the state at an individual or practice level, this survey is an unscientific sample, and its findings cannot be generalized to the entire population of potentially eligible providers in the state. However, the sample is extensive and the findings from this survey represent the best available information on interest and potential eligibility for the Medicaid EHR incentive program. 3

4 Executive Summary This report provides a summary of respondents across all questions including subsets of practices/ organizations with an EHR in place; plans to implement an EHR; and/or an interest in EHRs. It should be noted that charts and graphs reflect the most pertinent unit of analysis; therefore, questions that seek to assess practice/organization level characteristics are reported at the practice/organization level while questions that seek to assess provider characteristics are reported at the provider level. 83% (n=68) of practices/organizations indicated that they had an EHR, planned to acquire one, or expected to have a future interest in EHRs or the Medicaid EHR incentive program. Of the 1,734 providers represented in this survey, 33% of providers (n=579) met the Medicaid patient volume threshold necessary to participate in the Medicaid EHR incentive program as follows: Pediatricians: 69% (n=189) Psychiatrists: 57% (n=76) Dentists: 56% (n=20) Nurse Practitioners: 43% (n=109) Physician Assistants: 1 39% (n=11) Certified Nurse Midwives: 24% (n=12) Other Specialized Physicians: 24% (n=73) OBGYNs: 21% (n=34) Primary Care Physicians: 11% (n=55) 49% (n=284) of eligible and interested providers plan to apply to the Medicaid EHR Incentive program. While 1% (n=6) planned to apply for the Medicare incentive program, the remaining 50% (n=290) were not sure to which program they planned to apply. 86% (n=63) of Other Specialized Physicians, 81% (n=154) of Pediatricians, and 56% (n=19) of OBGYNs were most likely to report that they did not know to which program they would apply. Under the Medicaid EHR incentive program, an Eligible Provider (EP) may voluntarily reassign incentive payments to another person or organization. 77% (n=36) of respondents said that providers at their practice/organization were very likely to reassign payments while 4% (n=2) were somewhat likely. Of 47 eligible and interested practices/organizations, 66% (n=31) currently use EHRs to some extent while 34% (n=16) plan to use EHRs in the future. Of the 31 practices/organizations that currently use EHRs: o 42% (n=13) had Office of the National Coordinator (ONC) certified EHR systems; 39% (n=12) did not; and 19% (n=6) did not know whether their EHR was certified. 48% (n=15) use EHRs exclusively with no paper based records. The remaining 52% (n=16) retain paper based records for some functions. o 78% (n=24) use an EHR to exchange data with external parties while 22% (n=7) reported they did not exchange data outside of their practice/organization. 1 Throughout this report, Physician Assistants refers to Physician Assistant(s) practicing in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) led by a Physician Assistant. 4

5 o o They primarily use EHRs for these meaningful use objectives: demographics; vital signs; and active medication allergy lists. They use EHRs least for these meaningful use objectives: to provide patients with electronic access to their health information; for reminders to patients for follow up care; and to provide patient with patient specific education resources. Of the 16 practices/organizations that are considering implementing an EHR in the future: o 31% (n=5) consider themselves to be very aware of the meaningful use objectives; 50% (n=8) are somewhat aware of the objectives; and 19% (n=3) are not aware of the objectives. Most indicated a need for assistance in acquiring and implementing an EHR. o There are a number of barriers to implementing an EHR. For example, 63% (n=10) felt that lack of capital resources to invest in an EHR was their biggest barrier while 37% (n=6) felt that the recurring costs of an EHR was a major barrier. 5

6 Survey Demographics 82 practices/organizations responded to the survey, representing 1,734 healthcare providers. Most responders are privately owned group (n=23) or solo practices (n=17), followed by hospital owned group practices (n=13), Federally Qualified Health Centers (n=10), Community Mental Health Centers (n=10), some other type (n=5), and Rural Health Centers (n=4). Figure 1: Please indicate your practice/organization type. 12% 6% 5% Privately owned; group practice or partnership 28% Privately owned; solo practice Hospital owned; group practice Federally Qualified Health Center 12% Community Mental Health Center 16% 21% Other Rural Health Center In this survey, practices/organizations could respond on behalf of multiple practice locations. Over half (59%) (n=48) answered on behalf of only one location. The largest number of locations that a single practice reported on was 34 and the mean number of locations was

7 One of the goals of the survey was to assess interest in the Medicaid EHR incentive program and the extent of EHR implementation and adherence to meaningful use objectives. Of the 82 respondents, 83% (n=68) currently have EHRs in place; plan to acquire one in the coming years; or expect to have future interest in acquiring an EHR and/or the Medicaid EHR Incentive Program. Figure 2: Does your practice(s)/organization(s) have an EHR, plan to acquire one in the coming years, or expect to have a future interest in EHRs or this Medicaid incentive program? Yes No 17% 83% 7

8 Practices/Organizations were asked to identify their total number of providers categorized by provider type. Therefore, a hospital owned group practice would have listed all providers throughout the organization. For example, a group practice or Federally Qualified Health Center would have listed all its providers, while solo practitioners would respond only for themselves. Figure 3 depicts the number of each provider type as a percent of the total number of providers. Table 3 shows the counts for each provider type and the type of practice to which they belong. Figure 3: How many of the following professionals who are potentially eligible for the Medicaid EHR incentive program work in your practice(s)/organization(s)? (Combine for all locations as appropriate.) 2% 1% Primary Care Physicians 9% 3% 28% Pediatricians Other Specialized Physicians 10% Nurse Practitioners OBGYNs Psychiatrists 14% Certified Nurse Midwives 17% Dentists 16% Physician Assistants Practicing in a FQHC or RHC Table 1: Eligible Professionals by Practice Type Privatelyowned; Type of Provider Privately owned; solo practice group practice or partnership Hospitalowned; group practice Federally Qualified Health Center Rural Health Center Community Mental Health Center Other Total Pediatricians OBGYNs Primary Care Physicians Psychiatrists Nurse Practitioners Physician Assistants Dentists Certified Nurses/Midwives Other Specialized Physicians Total

9 Program Eligibility Practices/Organizations were then asked to calculate each EP s Medicaid patient volume. Of the 1,734 potential EPs, 33% (n=579) meet the Medicaid patient volume threshold necessary to participate in the Medicaid EHR incentive program. Figure 4 depicts the percentages of providers that meet, or do not meet, the patient volume threshold. Figure 4.2 and Table 4 display the number and percentage of providers meeting the Medicaid patient volume threshold by provider type and by provider type by practice type. Pediatricians, Nurse Practitioners, Psychiatrists, and Dentists met the patient volume threshold in the highest counts. Practices that did not have providers that met the Medicaid patient volume threshold were directed to the end of the survey. Figure 4.1: Please indicate the total number of EPs that meet the patient volume threshold for each EP type. Meet Threshold Did Not Meet Threshold 66% 34% 9

10 Figure 4.2: EPs Meeting Patient Volume Threshold by Provider Type 100% 90% 80% 70% 60% 50% 40% 30% 69% 57% 56% 20% 43% 39% 10% 0% PediatriciansPsychiatrists Dentists Nurse Practitioners Physician Assistants 24% 24% 21% Other Specialized Physician Certified Nurse Midwives OBGYNs 11% Primary Care Physicians Table 2: EPs Meeting Patient Volume Threshold by Provider Type by Practice Type Type of Provider Privatelyowned; solo practice Privatelyowned; group practice or partnership Hospital owned; group practice Federally Qualified Health Center (FQHC) Rural Health Center (RHC) Community Mental Health Center (CMHC) Other Total Pediatricians OBGYNs Primary Care Physicians Psychiatrists Nurse Practitioners Physician Assistants Dentists Certified Nurse Midwives Other Specialized Physicians Total Practices/Organizations were able to calculate the patient volume threshold at the individual or group practice/clinic level. About half (51%) (n=35) used the individual level calculation while the remaining 49% (n=33) used a group practice/clinic level calculation. 10

11 Medicaid EHR Program Interest After determining if any providers within a respondent s practice/organization would be eligible for the Medicaid EHR incentive program, respondents were asked to indicate to which program (Medicaid EHR incentive program, Medicare EHR incentive program, Neither Program, or Unsure) each provider would apply. Respondents indicated that 49% (n=284) of EPs expect to apply to the Medicaid EHR incentive program; 1% (n=6) expect to apply to the Medicare EHR incentive program; and 50% (n=290) do not know to which program they will apply. Table 5 provides the counts of the providers program application intentions. Figure 5: Providers Applying to Medicaid EHR, Medicare EHR, Neither, and Unsure 1% 0% Medicaid EHR 49% 50% Medicare EHR Neither Don t Know Table 3: Providers Applying to Medicaid EHR, Medicare EHR, Neither, and Unsure by Provider Type Type of Provider Medicaid EHR Medicare EHR Neither Don t Know 2 Meeting Threshold Percent Applying to Medicaid Percent Don t Know Physician Assistants % 0% Dentists % 5% Nurse Practitioners % 7% Primary Care Physicians % 24% Certified Nurse Midwives % 25% Psychiatrists % 38% OBGYNs % 56% Pediatricians % 81% Other Specialized Physicians % 86% Total % 50% 2 21 providers met the patient volume threshold but were not assigned to a particular program. These respondents were assigned to the Don t Know option. Respondents that initially indicated they had more providers than those meeting the patient volume threshold were re contacted in order to address these discrepancies. 11

12 Under the Medicaid EHR incentive program, an EP may voluntarily reassign incentive payments to another person or organization. Three quarters of respondents (77%) (n=36) say that providers at their practice/organization are very likely to reassign payments while 4% (n=2) say providers are somewhat likely to reassign payments. 2% (n=1) expect providers to be somewhat unlikely to reassign payments; 6% (n=3) say providers will be very unlikely to reassign payments. 2% (n=1) reported that providers in their practices/organizations were neither likely nor unlikely to reassign payments. 9% (n=4) did not know whether providers would, or would not, reassign payments. Figure 6: How likely do you think your EPs will be to reassign incentive payments back to your practice(s)/organization(s)? 77% 4% 2% 2% 6% 9% Very Likely Somewhat Likely Neither Likely nor Unlikely Somewhat Unlikely Very Unlikely Do Not Know 12

13 Electronic Health Record Implementation Current Implementation In total, there are 47 practices/organizations that currently, or plan to, use EHRs. Of these, 66% (n=31) currently use EHRs to some extent while 34% (n=16) plan to use EHRs in the future. Figure 7: Which statement best describes EPs in your practice(s)/organization(s) with regards to Electronic Health Records? Currently Use EHRs Plan to Use EHRs 34% 66% New Hampshire practices/organizations used a variety of EHR systems. A full list of the EHR vendor names, product names, and version types are available in Appendix B, Q35.a Q35.d. Table 4 shows each vendor name mentioned and the number of practices/organizations that utilize that vendor. Table 4: List of Vendor Names Mentioned Vendor Name GE (n=12) Theramanager (n=1) NextGen (n=4) e MDs (n=1) Patterson Technologies (n=2) Sequest Technologies, Inc. (n=1) Denoptics (n=1) webaisce (n=1) Duke Behavioral Health Informatics (n=1) eclinicalworks (n=1) McKesson (n=1) Henry Schein (n=1) Epic (n=1) Lavender and Wyatt (n=1) The survey asked respondents to provide information on all EHRs at their practice(s)/organization(s). Most had only one EHR; however, three practices/organizations had two EHRs in place. This report only contains information on the first EHR system; however, EHR system vendor names, product names, and version types for the second EHR system are available in Appendix B, Q43.a Q43.d. 13

14 For the Medicaid EHR incentive program, EHRs must be certified by the Office of the National Coordinator (ONC). 3 Of the 31 practices/organizations that currently use EHRs, 42% (n=13) had ONCcertified EHRs; 39% (n=12) did not; and 19% (n=6) did not know whether their EHR was ONC certified. Figure 8: Is your EHR system ONC certified? Yes No Don t Know 19% 42% 39% Of the 31 practices/organizations that currently use EHRs, 48% (n=15) use EHRs exclusively with no paper based records. The remaining 52% (n=16) retain paper based records for some functions. Figure 9: Does your practice/organization use EHRs exclusively or are paper based records still maintained for some functions? EHRs Used Exclusively Some Paper Records Maintained 52% 48% 3 For more information on ONC certification, refer to chpl.force.com/ehrcert 14

15 EHR Users Meaningful Use Objectives The survey queried the 31 practices/organizations with EHRs about the extent of their adherence to meaningful use criteria as outlined under the Medicaid EHR statutes. Practices/Organizations primarily used EHR for the following meaningful use objectives: 1. Demographics (date of birth, race, ethnicity, preferred language, etc.); 2. Vital signs (and changes in vital signs); 3. Active medication allergy list. EHR was least used for these meaningful use objectives: 1. Provide patients with electronic access to their health information; 2. Reminders to patients for follow up care; 3. Provide patient with patient specific education resources. Figure 10 provides the numbers of practices/organizations that use EHRs to achieve each meaningful use objective. 15

16 Figure 10: Please indicate whether your practice/organization uses EHRs for each objective. EHR Used EHR Not Used Do Not Know Does Not Apply Demographics (date of birth, race, ethnicity, preferred language, etc.) Vital signs (and changes in vital signs) Active medication allergy list Problem list of current and active diagnoses Generate lists of patients by specific conditions Medication reconciliation (identifying the most accurate list of all medications a patient is taking) Clinical decision support Referrals/Summary of care record for each transition of care qdrug drug and drug allergy interaction checks Smoking status for patients 13 and over Computerized physician order entry Drug formulary checks Clinical lab tests Clinical summaries for patients for each office visit Electronic prescribing (electronic links to pharmacies) (erx) Clinical information exchange among care providers and patient authorized entities Provide patient with patient specific education resources Reminders to patients for follow up care Provide patients with electronic access to their health information Number of Practices/Organizations 16

17 Over three quarters (78%) (n=24) of practices/organizations use an EHR to exchange data with external parties. 22% (n=7) of practices/organizations reported they did not exchange data outside of their practices/organizations. Figure 11 provides the number and percent of eligible practices/organizations that exchange data with other practices/clinics, hospitals, laboratories, and pharmacies. It also shows the number and percent of practices/organizations that are not connected to other systems. Figure 11: Does your EHR currently exchange data with any of the following? (Check all that apply.) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 39% (n=12) Other practices/clinics 55% (n=17) 55% (n=17) 58% (n=18) 22% (n=7) Hospitals Laboratories Pharmacies None not connected to other systems 17

18 Non EHR Users The survey sought to assess interest, knowledge, and concerns about implementing an EHR among practices/organizations that do not currently have an EHR but plan to implement one in the future. 16 practices/organizations fell into this category. Of the 16 practices/organizations that are considering implementing an EHR, 5 consider themselves to be very aware of the meaningful use objectives; 8 are somewhat aware; and 3 are not aware of the objectives. Figure 12: Are you aware of the Meaningful Use objectives required for the Medicaid EHR Incentive Program (after the first year)? 19% 31% Very Aware Somewhat Aware Not At All Aware 50% The survey also sought to assess the potential needs and barriers that practices/organizations planning to implement EHRs may encounter. Most practices/organizations indicated that they would have a need for assistance in each of the suggested areas. Table 5: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR. Will Have Need Will Not Have Need Do Not Know Advice on purchasing an EHR system Onsite EHR implementation technical assistance Onsite practice and workflow redesign Exchanging health information with external organizations (such as other providers, hospitals, pharmacies, laboratories, etc.) Technical assistance around federal and state privacy and security

19 When asked about barriers to implementation, the lack of capital resources was cited as the most significant problem. Other barriers included the recurring costs of an EHR; short and long term reductions in staff productivity; lack of staff expertise on computers; insufficient benefits (patient outcomes, financial, etc.) from EHR, and liability for security/privacy breaches. Table 6: Please indicate barriers that might impact EHR implementation at your practice(s)/organization(s). Not a problem Minor Problem Major Problem Lack of capital resources to invest in an EHR Recurring costs of an EHR Short and long term reductions in staff productivity; lack of staff expertise on computers Insufficient benefits (patient outcomes, financial, etc.) from EHR Liability for security/privacy breaches Lack of expertise to lead, or organize, the implementation project Practice is too small Plan to retire soon Other please specify

20 Appendix A Detailed Tabular Results

21 NH Department of Health and Human Services A - 1 Medicaid EHR Incentive Program Survey Q6: The Medicaid EHR incentive program is scheduled to run through Eligible providers can register anytime through 2016 and still receive incentive payments of up to $63,750. Does your practice(s)/organization(s) have an EHR, plan to acquire one in the coming years, or expect to have a future interest in EHRs or this Medicaid incentive program? Yes No Number Responding All Practices 82.9% 17.1% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 11.0% 1.2% 12.2% %.0% 8.5% %.0% 12.2% % 9.8% 47.6% % 6.1% 19.5% % 14.6% 58.5% % 2.4% 29.3% Over Five 12.2%.0% 12.2%

22 NH Department of Health and Human Services A - 2 Medicaid EHR Incentive Program Survey Q11: Which formula was used to calculate the Medicaid patient volume for your providers? Individual calculation Group-Practice/clinic level Number calculation Responding All Practices 51.5% 48.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 4.4% 8.8% 13.2% % 7.4% 10.3% % 8.8% 14.7% % 17.6% 45.6% % 5.9% 16.2% % 25.0% 52.9% % 20.6% 32.4% Over Five 11.8% 2.9% 14.7%

23 NH Department of Health and Human Services A - 3 Medicaid EHR Incentive Program Survey Q30: Under the Medicaid EHR incentive program, an EP may voluntarily re-assign incentive payments to another person or organization. How likely do you think your EPs will be to re-assign incentive payments back to your practice(s)/organization(s)? Very Somewhat Neither Likely Somewhat Very Do Not Number Likely Likely nor Unlikely Unlikely Unlikely Know Responding All Practices 76.6% 4.3% 2.1% 2.1% 6.4% 8.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 14.9%.0%.0%.0% 2.1%.0% 17.0% %.0%.0%.0%.0%.0% 6.4% % 2.1% 2.1%.0%.0%.0% 19.1% %.0%.0% 2.1% 2.1% 8.5% 40.4% % 2.1%.0%.0% 2.1%.0% 17.0% % 2.1%.0% 2.1% 2.1% 4.3% 48.9% %.0% 2.1%.0% 4.3% 2.1% 31.9% Over Five 14.9% 2.1%.0%.0%.0% 2.1% 19.1%

24 NH Department of Health and Human Services A - 4 Medicaid EHR Incentive Program Survey Q31&Q32: Which statement best describes EPs in your practice/organization with regards to Electronic Health Records? Currently Use EHRs Plan to use EHRs Number Responding All Practices 66.0% 34.0% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 17.0%.0% 17.0% %.0% 6.4% % 10.6% 19.1% % 17.0% 40.4% % 6.4% 17.0% % 19.1% 48.9% % 12.8% 31.9% Over Five 17.0% 2.1% 19.1% 8 1 9

25 NH Department of Health and Human Services A - 5 Medicaid EHR Incentive Program Survey Q33: How many EHR systems are in place in your practice(s)/organization(s)? One Two Number Responding All Practices 90.3% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0% 25.8% %.0% 9.7% % 6.5% 12.9% % 3.2% 35.5% %.0% 16.1% %.0% 45.2% %.0% 29.0% Over Five 16.1% 9.7% 25.8% 5 3 8

26 NH Department of Health and Human Services A - 6 Medicaid EHR Incentive Program Survey Q36: For the Medicaid EHR incentive program, EHRs must be certified by the Office of the National Coordinator (ONC) as listed on their website at <ONC Website>. Is your EHR system ONC-certified? Yes No Do not know Number Responding All Practices 41.9% 38.7% 19.4% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 12.9% 12.9%.0% 25.8% %.0%.0% 9.7% % 9.7% 3.2% 12.9% % 9.7% 6.5% 35.5% % 6.5% 9.7% 16.1% % 19.4% 12.9% 45.2% % 9.7%.0% 29.0% Over Five 9.7% 9.7% 6.5% 25.8%

27 NH Department of Health and Human Services A - 7 Medicaid EHR Incentive Program Survey Q37: Does your practice/organization use EHRs exclusively or are paper-based records still maintained for some functions? EHRs are used exclusively with Some paper records are still Number no paper records. maintained. Responding All Practices 48.4% 51.6% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 22.6% 3.2% 25.8% % 3.2% 9.7% % 9.7% 12.9% % 22.6% 35.5% % 12.9% 16.1% % 32.3% 45.2% % 6.5% 29.0% Over Five 12.9% 12.9% 25.8% 4 4 8

28 NH Department of Health and Human Services A - 8 Medicaid EHR Incentive Program Survey Q38.a: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Demographics (date of birth, race, ethnicity, preferred language, etc.). EHR Used EHR Not Used Number Responding All Practices 96.8% 3.2% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0% 25.8% %.0% 9.7% %.0% 12.9% %.0% 35.5% % 3.2% 16.1% % 3.2% 45.2% %.0% 29.0% Over Five 25.8%.0% 25.8% 8 0 8

29 NH Department of Health and Human Services A - 9 Medicaid EHR Incentive Program Survey Q38.b: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Vital signs (and changes in vital signs). EHR Used EHR Not Used Does Not Apply Number Responding All Practices 90.3% 3.2% 6.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% %.0%.0% 9.7% %.0% 3.2% 12.9% %.0%.0% 35.5% % 3.2% 3.2% 16.1% % 3.2% 3.2% 45.2% %.0%.0% 29.0% Over Five 22.6%.0% 3.2% 25.8%

30 NH Department of Health and Human Services A - 10 Medicaid EHR Incentive Program Survey Q38.c: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Smoking status for patients 13 and over. EHR Used EHR Not Used Does Not Apply Number Responding All Practices 77.4% 12.9% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% %.0%.0% 9.7% % 3.2% 3.2% 12.9% % 9.7%.0% 35.5% %.0% 6.5% 16.1% % 9.7% 6.5% 45.2% %.0%.0% 29.0% Over Five 19.4% 3.2% 3.2% 25.8%

31 NH Department of Health and Human Services A - 11 Medicaid EHR Incentive Program Survey Q38.d: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Problem list of current and active diagnoses. EHR Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 90.0% 3.3% 6.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 23.3%.0%.0% 23.3% %.0%.0% 10.0% %.0%.0% 13.3% %.0%.0% 36.7% % 3.3% 6.7% 16.7% % 3.3% 6.7% 43.3% %.0%.0% 30.0% Over Five 26.7%.0%.0% 26.7%

32 NH Department of Health and Human Services A - 12 Medicaid EHR Incentive Program Survey Q38.e: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Clinical decision support. EHR Used EHR Not Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 83.9% 3.2% 3.2% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0%.0% 25.8% %.0%.0%.0% 9.7% % 3.2%.0%.0% 12.9% %.0%.0% 3.2% 35.5% %.0% 3.2% 6.5% 16.1% %.0% 3.2% 9.7% 45.2% %.0%.0%.0% 29.0% Over Five 22.6% 3.2%.0%.0% 25.8%

33 NH Department of Health and Human Services A - 13 Medicaid EHR Incentive Program Survey Q38.f: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Clinical lab tests. EHR Used EHR Not Used Does Not Apply Number Responding All Practices 71.0% 16.1% 12.9% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% % 3.2%.0% 9.7% % 6.5% 3.2% 12.9% % 6.5%.0% 35.5% %.0% 9.7% 16.1% % 9.7% 9.7% 45.2% %.0%.0% 29.0% Over Five 16.1% 6.5% 3.2% 25.8%

34 NH Department of Health and Human Services A - 14 Medicaid EHR Incentive Program Survey Q38.g: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Medication reconciliation (identifying the most accurate list of all medications a patient is taking). EHR Used EHR Not Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 83.9% 6.5% 3.2% 6.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 22.6%.0% 3.2%.0% 25.8% %.0%.0%.0% 9.7% % 6.5%.0%.0% 12.9% %.0%.0%.0% 35.5% %.0%.0% 6.5% 16.1% %.0%.0% 6.5% 45.2% %.0% 3.2%.0% 29.0% Over Five 19.4% 6.5%.0%.0% 25.8%

35 NH Department of Health and Human Services A - 15 Medicaid EHR Incentive Program Survey Q38.h: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Active medication allergy list. EHR Used EHR Not Used Does Not Apply Number Responding All Practices 87.1% 6.5% 6.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% %.0%.0% 9.7% % 3.2%.0% 12.9% % 3.2%.0% 35.5% %.0% 6.5% 16.1% % 3.2% 6.5% 45.2% %.0%.0% 29.0% Over Five 22.6% 3.2%.0% 25.8%

36 NH Department of Health and Human Services A - 16 Medicaid EHR Incentive Program Survey Q38.i: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Drug-drug and drug-allergy interaction checks. EHR Used EHR Not Used Does Not Apply Number Responding All Practices 77.4% 12.9% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% %.0%.0% 9.7% % 6.5%.0% 12.9% % 3.2%.0% 35.5% % 3.2% 9.7% 16.1% % 6.5% 9.7% 45.2% %.0%.0% 29.0% Over Five 19.4% 6.5%.0% 25.8%

37 NH Department of Health and Human Services A - 17 Medicaid EHR Incentive Program Survey Q38.j: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Drug formulary checks. EHR Used EHR Not Used Does Not Apply Number Responding All Practices 71.0% 19.4% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% %.0%.0% 9.7% % 6.5%.0% 12.9% % 6.5%.0% 35.5% % 6.5% 9.7% 16.1% % 9.7% 9.7% 45.2% %.0%.0% 29.0% Over Five 16.1% 9.7%.0% 25.8%

38 NH Department of Health and Human Services A - 18 Medicaid EHR Incentive Program Survey Q38.k: The following table contains some of the EHR Meaningful Use objectives. (Not all of these may be applicable to your practice/organization.) Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the 'Comments' section below (for example, if you don t meaningfully use EHRs now but plan to in the future)... Computerized physician order entry. EHR Used EHR Not Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 74.2% 12.9% 3.2% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0%.0% 25.8% % 3.2%.0%.0% 9.7% % 6.5%.0%.0% 12.9% % 3.2%.0%.0% 35.5% %.0% 3.2% 9.7% 16.1% % 6.5% 3.2% 9.7% 45.2% %.0%.0%.0% 29.0% Over Five 19.4% 6.5%.0%.0% 25.8%

39 NH Department of Health and Human Services A - 19 Medicaid EHR Incentive Program Survey Q40.a: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Electronic prescribing (electronic links to pharmacies) (erx). EHR Used EHR Not Used Does Not Apply Number Responding All Practices 70.0% 26.7% 3.3% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 23.3% 3.3%.0% 26.7% %.0%.0% 10.0% % 6.7%.0% 13.3% % 3.3%.0% 33.3% % 13.3% 3.3% 16.7% % 13.3% 3.3% 43.3% % 3.3%.0% 30.0% Over Five 16.7% 10.0%.0% 26.7%

40 NH Department of Health and Human Services A - 20 Medicaid EHR Incentive Program Survey Q40.b: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Clinical summaries for patients for each office visit. EHR Used EHR Not Used Do Not Know If EHR Number Used Responding All Practices 67.7% 29.0% 3.2% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 19.4% 6.5%.0% 25.8% % 6.5%.0% 9.7% % 3.2%.0% 12.9% % 9.7% 3.2% 35.5% % 3.2%.0% 16.1% % 16.1%.0% 45.2% % 6.5%.0% 29.0% Over Five 16.1% 6.5% 3.2% 25.8%

41 NH Department of Health and Human Services A - 21 Medicaid EHR Incentive Program Survey Q40.c: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Provide patient with patient-specific education resources. EHR Used EHR Not Used Do Not Know If EHR Number Used Responding All Practices 58.1% 35.5% 6.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 25.8%.0%.0% 25.8% % 6.5%.0% 9.7% % 6.5% 3.2% 12.9% % 9.7% 3.2% 35.5% % 12.9%.0% 16.1% % 25.8% 3.2% 45.2% % 6.5%.0% 29.0% Over Five 19.4% 3.2% 3.2% 25.8%

42 NH Department of Health and Human Services A - 22 Medicaid EHR Incentive Program Survey Q40.d: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Reminders to patients for follow up care. EHR Used EHR Not Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 48.4% 45.2% 3.2% 3.2% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 19.4% 6.5%.0%.0% 25.8% % 3.2%.0%.0% 9.7% % 6.5% 3.2%.0% 12.9% % 16.1%.0% 3.2% 35.5% % 12.9%.0%.0% 16.1% % 25.8%.0% 3.2% 45.2% % 9.7%.0%.0% 29.0% Over Five 12.9% 9.7% 3.2%.0% 25.8%

43 NH Department of Health and Human Services A - 23 Medicaid EHR Incentive Program Survey Q40.e: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Provide patients with electronic access to their health information. EHR Used EHR Not Used Do Not Know If EHR Does Not Apply Number Used Responding All Practices 22.6% 61.3% 6.5% 9.7% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 6.5% 16.1%.0% 3.2% 25.8% % 6.5%.0%.0% 9.7% % 9.7%.0% 3.2% 12.9% % 19.4% 3.2% 3.2% 35.5% % 9.7% 3.2%.0% 16.1% % 29.0% 3.2% 6.5% 45.2% % 19.4%.0%.0% 29.0% Over Five 6.5% 12.9% 3.2% 3.2% 25.8%

44 NH Department of Health and Human Services A - 24 Medicaid EHR Incentive Program Survey Q40.f: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Clinical information exchange among care providers and patient-authorized entities. EHR Used EHR Not Used Do Not Know If EHR Number Used Responding All Practices 61.3% 35.5% 3.2% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 16.1% 9.7%.0% 25.8% % 6.5%.0% 9.7% % 6.5%.0% 12.9% % 9.7%.0% 35.5% % 3.2% 3.2% 16.1% % 19.4% 3.2% 45.2% % 9.7%.0% 29.0% Over Five 19.4% 6.5%.0% 25.8%

45 NH Department of Health and Human Services A - 25 Medicaid EHR Incentive Program Survey Q40.g: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Generate lists of patients by specific conditions. EHR Used EHR Not Used Do Not Know If EHR Number Used Responding All Practices 86.7% 10.0% 3.3% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 26.7%.0%.0% 26.7% %.0%.0% 10.0% % 3.3%.0% 13.3% %.0%.0% 33.3% % 6.7% 3.3% 16.7% % 6.7% 3.3% 43.3% %.0%.0% 30.0% Over Five 23.3% 3.3%.0% 26.7%

46 NH Department of Health and Human Services A - 26 Medicaid EHR Incentive Program Survey Q40.h: Meaningful Use objectives (cont'd). Please indicate whether your practice/organization uses EHRs for each objective. Note any additional information in the Comments section below... Referrals/Summary of care record for each transition of care. EHR Used EHR Not Used Do Not Know If EHR Number Used Responding All Practices 77.4% 16.1% 6.5% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 22.6% 3.2%.0% 25.8% %.0%.0% 9.7% % 3.2% 6.5% 12.9% % 6.5%.0% 35.5% % 3.2%.0% 16.1% % 9.7%.0% 45.2% % 3.2%.0% 29.0% Over Five 16.1% 3.2% 6.5% 25.8%

47 NH Department of Health and Human Services A - 27 Medicaid EHR Incentive Program Survey Q42: Does your EHR currently exchange data with any of the following? (Check all that apply.) Other Hospitals Laboratories Pharmacies Not Connected to Number Practices/Clinics Other Systems Responding All Practices 38.7% 54.8% 54.8% 58.1% 22.6% 100.0% Practice Type FQHC RHC CMHC Practice Dentist Number of location One Two to Five 3.2% 22.6% 22.6% 16.1%.0% 25.8% % 3.2% 6.5% 6.5%.0% 9.7% % 6.5%.0% 6.5% 6.5% 12.9% % 16.1% 22.6% 25.8% 9.7% 35.5% % 6.5% 3.2% 3.2% 6.5% 16.1% % 19.4% 22.6% 22.6% 9.7% 45.2% % 22.6% 22.6% 22.6%.0% 29.0% Over Five 12.9% 12.9% 9.7% 12.9% 12.9% 25.8%

48 NH Department of Health and Human Services A - 28 Medicaid EHR Incentive Program Survey Q60: What is the degree of EHR implementation at your practice? Please provide associated information. We have purchased an EHR. We are considering an EHR Number but have made no specific Responding purchase All Practices 37.5% 62.5% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 31.3%.0% 31.3% % 50.0% 50.0% % 12.5% 18.8% % 50.0% 56.3% % 12.5% 37.5% Over Five 6.3%.0% 6.3% 1 0 1

49 NH Department of Health and Human Services A - 29 Medicaid EHR Incentive Program Survey Q63: Are you aware of the Meaningful Use objectives required for the Medicaid EHR incentive program (after the first year)? Very aware Somewhat aware Not aware at all Number Responding All Practices 31.3% 50.0% 18.8% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 18.8% 12.5%.0% 31.3% % 25.0% 12.5% 50.0% % 12.5% 6.3% 18.8% % 31.3% 12.5% 56.3% % 12.5% 6.3% 37.5% Over Five.0% 6.3%.0% 6.3%

50 NH Department of Health and Human Services A - 30 Medicaid EHR Incentive Program Survey Q64.a: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR?... Advice on purchasing an EHR system Will Have Need Will Not Have Need Do Not Know Number Responding All Practices 56.3% 31.3% 12.5% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 6.3% 25.0%.0% 31.3% % 6.3% 6.3% 50.0% %.0% 6.3% 18.8% % 6.3% 6.3% 56.3% % 18.8% 6.3% 37.5% Over Five.0% 6.3%.0% 6.3%

51 NH Department of Health and Human Services A - 31 Medicaid EHR Incentive Program Survey Q64.b: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR?... Onsite EHR implementation technical assistance. Will Have Need Will Not Have Need Do Not Know Number Responding All Practices 62.5% 12.5% 25.0% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 12.5% 6.3% 12.5% 31.3% % 6.3% 6.3% 50.0% %.0% 6.3% 18.8% % 6.3% 6.3% 56.3% % 6.3% 12.5% 37.5% Over Five.0%.0% 6.3% 6.3%

52 NH Department of Health and Human Services A - 32 Medicaid EHR Incentive Program Survey Q64.c: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR?... Onsite practice and workflow redesign. Will Have Need Will Not Have Need Do Not Know Number Responding All Practices 62.5% 18.8% 18.8% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 12.5% 12.5% 6.3% 31.3% % 6.3% 6.3% 50.0% %.0% 6.3% 18.8% % 6.3% 6.3% 56.3% % 6.3% 12.5% 37.5% Over Five.0% 6.3%.0% 6.3%

53 NH Department of Health and Human Services A - 33 Medicaid EHR Incentive Program Survey Q64.d: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR?... Exchanging health information with external organizations (such as other providers, hospitals, pharmacies, laboratories, etc.). Will Have Need Do Not Know Number Responding All Practices 75.0% 25.0% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 18.8% 12.5% 31.3% % 6.3% 50.0% % 6.3% 18.8% % 6.3% 56.3% % 18.8% 37.5% Over Five 6.3%.0% 6.3% 1 0 1

54 NH Department of Health and Human Services A - 34 Medicaid EHR Incentive Program Survey Q64.e: Please indicate any needs you anticipate in your practice(s)/organization(s) over the next two years with regards to EHR?... Technical assistance around federal and state privacy and security. Will Have Need Will Not Have Need Do Not Know Number Responding All Practices 62.5% 6.3% 31.3% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 12.5%.0% 18.8% 31.3% % 6.3% 6.3% 50.0% %.0% 6.3% 18.8% % 6.3% 6.3% 56.3% %.0% 18.8% 37.5% Over Five.0%.0% 6.3% 6.3%

55 NH Department of Health and Human Services A - 35 Medicaid EHR Incentive Program Survey Q65.a: Please indicate barriers that might impact EHR implementation at your practice(s)/organization(s)... Lack of capital resources to invest in an EHR. Not A Problem Minor Problem Major problem Number Responding All Practices 12.5% 25.0% 62.5% 100.0% Practice Type CMHC Practice Dentist Number of location One Two to Five 6.3% 6.3% 18.8% 31.3% % 12.5% 31.3% 50.0% % 6.3% 12.5% 18.8% % 12.5% 37.5% 56.3% % 12.5% 25.0% 37.5% Over Five 6.3%.0%.0% 6.3%

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