APPENDIX A
Contents
1. _ j p pm a Maintained by vendor 4 d Hours of live contact Why should we select your company Ne u u s i fo Pf How can you improve some of our office inefficiencies problems Did the vendor offer options and solutions to our problems J Additional Comments APPENDIX B Michigan Primar Care nsortium APPEXDIX B Practice Assessment for EHR Acquisition Assessment Demographics and Implementation of Electronic Health Records Clinic Acumentra Health Consultant if appropriate Date of Completion Assessment Completed By Title Phone Clinic Medical Director Email Clinic Executive Director Email Clinic Office Manager Email Clinic Phone Number Clinic Fax Number Clinic UPIN Clinic Address Physical Champion who will Lead your EHR Effort Physician Participates Name UPIN Name UPIN Name UPIN Name UPIN Answer all questions from the perspective of the entire patient population Estimated number of active patients 2 Average number of patient visits per day for entire clinic Medicare FFS Managed care Commercial 3 Average number of patient visits per day per provider 4 Estimated percentage of patients with chronic disease s 5 Are there any unique characteristics about the patients seen in your clinic Example large obstetrical patients2. Hired additional clinicians e g PA Changed workflow Reorganized supplies in exam room office Automated phone Implemented patient tracking system service Changed staffing to address phone triage Other Average number of laboratory orders per day 2 Do you order laboratory tests using electronic laboratory system Yes If yes which system 3 Thinking about how your practice receives lab reports estimate the percentage received by each of the following methods Electronic Hard copies Other Do you have an electronic radiology system Yes No If yes which system Do you order prescriptions using an electronic pharmacy system Yes No If yes which system Average number of REFILLS per day for the entire clinic None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 11 Average number of follow up calls or faxes your clinic receives each week for prescription issues None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 4 On average how many calls each week do you or your staff make to the lab about lab reports None 5 10 Less than 5 Greater than 10 6 Average number of radiology orders per day None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 8 Average number of new non refill prescriptions per day None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 10 Average num
3. How often Other please specify Other please specify If yes to 14 what are some of the discussion topics check all that apply Workflow Revised procedures Patient satisfaction Customer Service Interesting media cases Chronic disease Other Patients seen without the medical chart How much time is spent daily on inefficient tasks estimate in minutes or percentage of time for each Number of patients category Percentage of patients By administration By clinical staff 3 Telephone calls to patients per day 4 Telephone calls to patients per day by MD NP PA Number of calls initiated per day Percentage that require chart pull Number of calls initiated by MD NP PA Percentage that require chart pull 5 Telephone calls to patients per day by nursing staff 6 Workflow issues that cause the greatest problems in your office check all that apply Number of calls initiated by nurses Medical records unavailable Percentage that requires pull chart Chart chasing Unable to stay on office schedule Phone fax processing Poor legibility of medical records Results tracking e g lab Patients unable to access provider Patient satisfaction Medication refills Patient wait Inefficient use of resources Timely referrals Other 7 What workflow and or staffing solutions have you implemented or considered check all that apply Hired a practice management consultant Outsourced billing
4. have problems or concerns around coding On average how many referrals are made to a speicalist eack week What types of manual referrals logs if any are maintained by the clinic Do you currently create reports or use a registry method to manage patients with similar conditions Yes No If yes what is the source of information If yes what do you do with the data 3 What reports would you like to see generated from an EHR 6 What are other reasons aside from above that cause a chart to be pulled 2 How does the referral process work in your clinic Do you generate key clinical reports to help providers manage their practice Yes No Describe the type of clinical reports What is the source of information Are there any plans for significant change with the clinic in 2 Is there any other information you feel the Acumentra the next few years e g growth new providers or specialty Health team should know about your clinic operation to anyone retiring soon new affiliations moves help inform EHR planning implementation and optimization Yes No If yes what are they Have you explored any EHR systems 2 Do you want assistance in selecting an EHR Yes No Yes No If yes how have you gone about it Check all that apply Pu What is your greatest need Read an article in peer reviewed journal Read an article in a trade or medical magazine Attended vendor demonstration s Comp
5. x are ESL patients etc Number of exam rooms Number of exam rooms per provider Physicians FTEs Number Total number of mid level professionals by category Nurse practitioners Physician assistants Other e g nurse specialists pharmacists Medical records staff FTEs Number Who supports it In house staff External IT support 2 Number of treatment procedure rooms 2 Which specialists are represented and how many physicians in each Primary care internists Family physicians Other Mid level professionals NP PA FTEs Number Medical assistants FTEs Reception staff FTEs Number 10 In house IT staff if applicable Name Main job description Number of hours Other arrangement External IT support if applicable 12 Other staff positions please enter all that apply Do you use a company An individual Administration FTEs Number Company name Medical records FTEs Number Service arrangement hours or specific services Billing FTEs _____ Number Transcription FTEs Number Insurance FTES Number Laboratory FTEs Number X ray FTEs Number Phyical therapy FTEs 2 Other FTEs Number Do you routinely have residents Do you conduct staff meeting meetings of doctors other clinical staff support staff administration Yes No Yes No If yes in average how many at a time If yes Weekly Bi monthly Monthlp _
6. APPENDIX A APPEXDIX A Vendor Evaluation Comprehension Vendor Demo Evaluation pes p B PP PP L j BWem j fawn J Jj asan _ L j i IU j paara 2 _ L Jj Bo Ramsar L ESL PP Awe L j E Meceasa Ree E EL 2 4 r pes Ne EL Set new insurance company Ju L L A C cosmic cureview pewter PP compere 8 Recent H amp P d c summary x rays NEN S o 9 General search for information 22020 Mee E order labs and x rays a EL a Cananeo EL EL f Normal letter request 222210501 T EL 4 Meiste Bo meme s EL E a osmano LLL BM s Evene s emend B xm C ECCE Demo d Comments ee j s hanayman J J Jj x hewmen EL i assenchagespereneomme
7. a Deme lame I L T zase L L E eco computer inan drehte tan L E Si down te empusa EL nateastorantwoapoganetedsteep L dT Wwe Ta mew L L E Set up a page in portrait or landscape form and use the header and footer function C ELE EL T Er sma 2 J Bem _ J Feedmaesme T Set up an address book and send email to more than one address simultaneously Word Processing Functions can am able to FFOGO6 I I Create and save a new document Save a document to a different drive Save a document as a different file type Check spelling and grammar in a document Internet Use can am able to Use and change search engines and search using keywords Print the screen Save an image to file download and save a file Reload a page Reference Duvel C amp Pate S 2003 Computer knowledge Report from a Student Self Evaluation Journal of Industrial Technology 20 1 1 16
8. ber of REWRITTEN prescriptions per day e g for change of pharmacy or drug coverage None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 12 To what extent are any of the above order and or results automated through an interface 13 What is your biggest challenge with pharmacy services 14 Does your practice use an electric registration Laboratory services Radiology services scheduling and or billing system Pharmacy Electronic patient registration Yes No If yes which system Radiology Electronic scheduling Yes Laboratory If yes which system Electronic system Yes If yes which system Which systems interface with an EHR Registration Scheduling 15 If you do not have an electonic billing system what is your current method of billing Average claims turnaround time from submission to payment Average time from billing to payment What is the average time it takes to pull a chart 2 Who pulls the charts 3 What is the process for locating a lost or misplaced chart 4 Average number of calls from others e g other physicians pharmacists insurers per day requiring a chart pull None 30 39 Less than 10 40 49 10 29 50 59 20 29 Greater than 59 5 Do you employ or contract for a transcription service Yes No If yes what is the average turn around time for a dictation to be translated If yes what are your monthly transcription costs Do you
9. leted an online vendor return on investment Talked to a colleague who uses an EHR Visited colleagues practice to see EHR they use Other Do you want assistance in implementing an EHR Do you want assistance in optimizing the EHR once it is in place Yes No Yes No What is your greatest need What is your greatest need 5 What are the reasons you have not implemented an EHR Please prioritize in order using for the most important and 10 for the least important Financial constraints Unable to gain partner commitment Vendor support was inadequate Initial data entry is too labor intensive Could not find a viable stable vendor Could not find software that worked for practice Could not see spending additional Found it difficult to select an EHR system hours at the office each day Do not know where to begin Other This material was prepared by Acumentra Health Oregon s Medicare Quality Improvement Organization under contract with the Centers for Medicare amp Medicaid Services CMS an agency of the U S Department of Health and Human Services The contents presented do not necessarily reflect CMS policy 8SOW OR DOQIT 05 02 9 2 05 APPENDIX A AT APPENDIX C Computer Knowledge Evaluation Form Computer Knowledge Evaluation Tool for Physician Staff puran II I T L L L sean CS Fee Wee teen I L L L T inpr wawaw
10. r PP x si EL 7 _ I c B eere EL B sapaqa EL EL a Peine EL s Asana EL c ora CP LLL EL mme s Meiner Ress Bom EL j L T T Jj Mee 8 Flag active vs inactive 9 Example of aged insurance list 10 Generate collection letters DW EL Fiona RN E DR Wimmer EE sassa DES wesmns aS j ___ m J J j PP 3 Hmm a LLL a EL s Cynara LLL e A A oi emend 700 CELL ok emer CELL mansana EL nmpas o Piensa eng EL 6 Set up 1 Jj j Jj sqan _ j Rj e mee _ _ j Pj _ j 1 samasaa j mnao _ LLL B LLL EL CS Z uen x T B _ I B Canons CP m 7 _ j sam _ J Jj J Rj J Rj 2 panes j j j j 7 _
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