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 Medicaid providers. Prior to implementing the program, the state is required to determine provider’s readiness for meaningful use and anticipated numbers of eligible providers. The information provided by this survey will assist in developing program guidelines that support health care providers practicing in varied and unique Alaskan circumstances.

Your participation is appreciated

* 1. Individual National Provider Identifier (NPI) number

* 2. Please provide your group NPI if applicable.

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

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

* 4. Provider

Incentive funds are going to be made available to assist federally designated medical professionals in adopting, implementing or upgrading electronic health records systems to meet federal requirements.

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.

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

* 6. On average, approximately what percentage of your weekly office visits are for Medicaid eligible patients?

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

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

* 10. What type of internet connection do you have at your practice?

* 11. Does your practice setting use an EHR?