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1. Electronic Health Records (EHR) Survey

The State of Alaska intends to participate in the Electronic Health Record (EHR) incentive program that was authorized under the HITECH provisions of the American Reinvestment & Recovery Act.

The program offers incentive dollars to qualifying hospitals. Prior to implementing the program, the state is required to determine readiness for meaningful use and anticipated numbers of eligible hospitals.

Your participation is appreciated


* 1. National Provider Identifier (NPI) number

* 2. Please enter the name of the individual responding to this survey.

The incentive is available to each qualifying hospital for a single location. Please enter the following information for the location you would use in applying for the incentive.

* 3. Hospital

In order to qualify for Medicaid EHR Incentives you must meet a minimum Medicaid patient percentage. Please answer the following questions to assist in determining the best method of calculating Medicaid patient volume.

4. Estimate the percentage of your active patients that are Medicaid eligible.

* 5. Which of the following did you use in determining the percentage?

* 6. If you meet the EHR incentive program eligibility criteria do you intend to participate?

* 8. What type of internet connection do you have at your location?

* 9. Does your organization use an EHR?

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