Health Technology Alliance

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* 1. Of which of the following organizations are you a member? Check all that apply.

AAMI

ACCE

HIMSS

Other (please specify, and list more than one if you wish)

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* 2. Please indicate your level of agreement with each statement below.

	Strongly agree	Agree	Neutral	Disgree	Strongly disagree	N/A
My job has changed significantly in the past 3 years due to the convergence of medical and information technologies	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies Strongly agree	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies Agree	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies Neutral	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies Disgree	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies Strongly disagree	My job has changed significantly in the past 3 years due to the convergence of medical and information technologies N/A
I am involved in the medical equipment acquisition process	I am involved in the medical equipment acquisition process Strongly agree	I am involved in the medical equipment acquisition process Agree	I am involved in the medical equipment acquisition process Neutral	I am involved in the medical equipment acquisition process Disgree	I am involved in the medical equipment acquisition process Strongly disagree	I am involved in the medical equipment acquisition process N/A
I am involved in the IT equipment acquisition process	I am involved in the IT equipment acquisition process Strongly agree	I am involved in the IT equipment acquisition process Agree	I am involved in the IT equipment acquisition process Neutral	I am involved in the IT equipment acquisition process Disgree	I am involved in the IT equipment acquisition process Strongly disagree	I am involved in the IT equipment acquisition process N/A
My role includes the investigation of medical device-related incidents	My role includes the investigation of medical device-related incidents Strongly agree	My role includes the investigation of medical device-related incidents Agree	My role includes the investigation of medical device-related incidents Neutral	My role includes the investigation of medical device-related incidents Disgree	My role includes the investigation of medical device-related incidents Strongly disagree	My role includes the investigation of medical device-related incidents N/A
My role includes medical device cybersecurity	My role includes medical device cybersecurity Strongly agree	My role includes medical device cybersecurity Agree	My role includes medical device cybersecurity Neutral	My role includes medical device cybersecurity Disgree	My role includes medical device cybersecurity Strongly disagree	My role includes medical device cybersecurity N/A
I interact routinely with medical device manufacturers	I interact routinely with medical device manufacturers Strongly agree	I interact routinely with medical device manufacturers Agree	I interact routinely with medical device manufacturers Neutral	I interact routinely with medical device manufacturers Disgree	I interact routinely with medical device manufacturers Strongly disagree	I interact routinely with medical device manufacturers N/A
I would like to participate in a forum to share best practices and lessons learned with colleagues	I would like to participate in a forum to share best practices and lessons learned with colleagues Strongly agree	I would like to participate in a forum to share best practices and lessons learned with colleagues Agree	I would like to participate in a forum to share best practices and lessons learned with colleagues Neutral	I would like to participate in a forum to share best practices and lessons learned with colleagues Disgree	I would like to participate in a forum to share best practices and lessons learned with colleagues Strongly disagree	I would like to participate in a forum to share best practices and lessons learned with colleagues N/A
I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.)	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) Strongly agree	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) Agree	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) Neutral	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) Disgree	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) Strongly disagree	I interact regularly with our organization’s C-Suite (CEO, CIO, COO, etc.) N/A
I routinely interact and work cross-departmentally between HTM and IT	I routinely interact and work cross-departmentally between HTM and IT Strongly agree	I routinely interact and work cross-departmentally between HTM and IT Agree	I routinely interact and work cross-departmentally between HTM and IT Neutral	I routinely interact and work cross-departmentally between HTM and IT Disgree	I routinely interact and work cross-departmentally between HTM and IT Strongly disagree	I routinely interact and work cross-departmentally between HTM and IT N/A
Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.)	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) Strongly agree	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) Agree	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) Neutral	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) Disgree	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) Strongly disagree	Professional certifications are recognized by my employer (my employer provides tuition reimbursement, pay increases, promotions, etc.) N/A
I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP)	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Strongly agree	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Agree	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Neutral	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Disgree	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Strongly disagree	I am currently certified as one of the following: a BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) N/A
I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP)	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Strongly agree	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Agree	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Neutral	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Disgree	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) Strongly disagree	I am interested in becoming certified as one of the following: BMET (CBET), Radiology Equipment Specialist (CRES), Lab Equipment Specialist (CLES), Healthcare Technology Manager (CHTM), clinical engineer (CCE), professional in healthcare information & management systems (CPHIMS), associate in healthcare information & management systems (CAHIMS), or Quality Systems Manager (CQSM), healthcare information security & privacy practioner (HCISSP), information systems security professional (CISSP) N/A
I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering Strongly agree	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering Agree	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering Neutral	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering Disgree	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering Strongly disagree	I am interested in receiving information about continuing education opportunities in IT or HTM/clinical engineering N/A

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* 3. Please select the three topics of greatest interest to you:

How to improve collaboration between Information Technology and Healthcare Technology Management

Acquisition of new devices and technologies

Installation and deployment of medical and information technology devices and systems

Upgrading systems

Departmental/reporting structures

Standards and regulations

Cybersecurity

Best practices

Wireless technology

Integration of medical and information technology systems (including electronic medical records)

Improving clinical workflows using technology

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* 4. I prefer to receive educational information through:

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Print media (Professional books, manuals, journals, etc.)	Print media (Professional books, manuals, journals, etc.) Strongly agree	Print media (Professional books, manuals, journals, etc.) Agree	Print media (Professional books, manuals, journals, etc.) Neutral	Print media (Professional books, manuals, journals, etc.) Disagree	Print media (Professional books, manuals, journals, etc.) Strongly disagree
Free online sources	Free online sources Strongly agree	Free online sources Agree	Free online sources Neutral	Free online sources Disagree	Free online sources Strongly disagree
Online subscription services	Online subscription services Strongly agree	Online subscription services Agree	Online subscription services Neutral	Online subscription services Disagree	Online subscription services Strongly disagree
Webinars and online events	Webinars and online events Strongly agree	Webinars and online events Agree	Webinars and online events Neutral	Webinars and online events Disagree	Webinars and online events Strongly disagree
Conferences/symposiums	Conferences/symposiums Strongly agree	Conferences/symposiums Agree	Conferences/symposiums Neutral	Conferences/symposiums Disagree	Conferences/symposiums Strongly disagree
Classroom-based education	Classroom-based education Strongly agree	Classroom-based education Agree	Classroom-based education Neutral	Classroom-based education Disagree	Classroom-based education Strongly disagree
Professional certification	Professional certification Strongly agree	Professional certification Agree	Professional certification Neutral	Professional certification Disagree	Professional certification Strongly disagree
Advanced academic degrees	Advanced academic degrees Strongly agree	Advanced academic degrees Agree	Advanced academic degrees Neutral	Advanced academic degrees Disagree	Advanced academic degrees Strongly disagree
Participating in standards development	Participating in standards development Strongly agree	Participating in standards development Agree	Participating in standards development Neutral	Participating in standards development Disagree	Participating in standards development Strongly disagree
Conferences	Conferences Strongly agree	Conferences Agree	Conferences Neutral	Conferences Disagree	Conferences Strongly disagree

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* 5. Briefly describe the first source you check when looking for guidance or best practices related to healthcare technology or healthcare-related IT issues:

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* 6. Briefly describe your biggest healthcare IT-related challenge, and how could the HTA community help address it?

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* 7. Please enter the requested contact information below. (Optional)

Name

Company

Country

Email Address

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* 8. May HTA contact you for further information or to determine your willingness to volunteer in activities where you have indicated an interest?

Yes

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* 9. What is your professional role?

Clinical engineer

BMET

Clincial systems engineer

Healthcare technology manager

Clinical informatics/healthcare IT professional

Clinical informatics/healthcare IT manager

Clinician (e.g., physician, nurse)

C-suite (CIO, CTO, CISO, CMIO, CEO, COO etc.)

HTM consultant

Other (please specify)

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* 10. Please describe your work site.

Academic

Manufacturer/supplier

Hospital/health system

Consultant

Self-employed

Other (please specify)

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* 11. Which of the following would you consider yourself to be?

Early career

Mid career

Senior level