This survey will help Adirondack Health Institute and Fort Drum Regional Health Planning Organization to gain further insights from partners in the North Country regarding telehealth utilization and trends, identified barriers, technical assistance, and educational needs.

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* 1. Name:

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* 2. Title:

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* 3. Organization:

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* 4. E-mail:

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* 5. Phone:

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* 6. Counties Served:

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* 7. Is your organization currently offering telehealth and/or telephonic services?

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* 8. If yes, approximately what percentage of your organization’s total encounters are conducted via telehealth platform at this time?

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i We adjusted the number you entered based on the slider’s scale.

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* 9. If yes, approximately what percentage of your organization’s total encounters are conducted via telephonic platform at this time?

0% 50% 100%
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i We adjusted the number you entered based on the slider’s scale.

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* 10. If no, have any of the following barriers impacted your organization’s decision to not provide telehealth services? Check all that apply.

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* 11. Please select which telehealth/telephonic services your organization is currently offering:

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* 12. Is your organization tracking telehealth data in-house? Check all tracked data that apply.

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* 13. Does your organization have protocol to triage failed telehealth visits?

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* 14. Which telehealth platform does your organization utilize?

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* 15. Has your organization integrated telehealth into your EHR or patient portal?

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* 16. Does your organization offer language interpretation integrated with telehealth services?

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* 17. Would education or resources in any of the following subjects benefit your organization?

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* 18. Is there anything else regarding this topic that you would like to mention that we haven't addressed?

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