Practice Survey

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* 5. Please indicate practice ownership (Select all that apply):

Hospital or health system owned practice (non-rural health clinic)

Independent, private practice (non-rural health clinic)

Provider-based rural health clinic

Independent rural health clinic

Federally Qualified Health Center

Free medical clinic

Other (please specify)

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* 6. Please indicate how many FTE providers are in your practice:

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* 7. Please indicate the percentage of patients by demographic characteristic:

Hispanic

Non-Hispanic

Black

White

Other

Female

Male

Primary Language English

Primary Language Spanish

I cannot provide this type of information on my patient population.

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* 8. Please estimate the number of patients that are covered by:

Medicare (Traditional Only)

Commercial Insurance

Medicaid (Plain Only)

Uninsured/Self-Pay

Other

Do not know

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* 9. What is your average daily visit count?

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* 10. Please select all patient demographic characteristics that are required to be collected by your practice:

Date of birth

Ethnicity

Race

Gender

Primary language

Language proficiency

Disability

Sexual orientation

Gender identity

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* 11. Please indicate if you use the following data categories when collecting ethnicity data:
Categories: Hispanic or Latino; Not Hispanic or Latino

Yes

No, we do not collect ethnicity data from our patients

Do not know

No, we collect ethnicity data, but use the following categories:

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* 12. Please indicate if you use the following data categories when collecting race data.
Categories: Black or African American; White; Asian; American Indian or Alaska Native; Native Hawaiian, or Other Pacific Islander

Yes

No, we do not collect race data from our patients

Do not know

No, we collect race data but use the following categories:

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* 13. Do you classify patients as multi-racial?

Yes

Do not know

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* 14. Does your practice have a standardized written process for collecting patient demographic data?

Yes

Do not know

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* 15. Indicate when the patient's race and ethnicity data is collected (Select all that apply.)

By registration staff, during initial patient registration for new patients at initial patient visit only

By registration staff, during patient registration at each patient visit

By nursing staff, during patient intake prior to initial patient visit

By nursing staff, during patient intake at each visit

By patient, during pre-registration either in person or online

Do not know

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* 16. How is the patient's race and ethnicity data collected? (Select all that apply.)

Patient verbally self-reports their race and ethnicity and the data is recorded by the office staff

Patient self-reports their race and ethnicity through paper forms

Patient self-reports their race and ethnicity through online forms

Office staff observes patient race and ethnicity and records their observations

Data collection process varies as there is no standard process for collecting patient race and ethnicity

Do not know

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* 17. How is the patient's race and ethnicity data recorded? (Select all that apply.)

Patient self-reported data is recorded through completion of an online form

Patient self-reported data is abstracted from paper form and inputted into practice management system/electronic health record

Office staff directly inputs data into practice management system/electronic health record during the registration process

Do not know

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* 18. Does your practice monitor clinical performance measures? (Select all that apply.)

Yes, we review clinical performance measures generated from our EHR on a monthly basis

Yes we review clinical performance measures generated from our EHR on a quarterly or semi-annual basis

Yes, we review clinical performance measures generated from our EHR on an annual basis

Yes, we review clinical performance measures in reports provided by a managed care organization or other payer

Yes, we review clinical performance measures in reports provided by our ACO or health system

No, we do not monitor clinical performance measures (If selected, skip questions 19-22)

Do not know

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* 19. Select the type of clinical performance measurements that you collect and review. (Select all that apply.)

Chronic disease (i.e., blood pressure control)

Preventive (i.e., breast cancer screening)

Behavioral health (i.e., depression screening)

Care coordination (i.ee., referral loop closure)

Safety (i.e., fall risk)

Cost of care (i.e., hospital readmissions)

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* 20. Do you currently stratify clinical performance measures by patient demographic data? Select the answer that best reflects current practice.

Yes, we stratify all clinical performance measures by patient demographic data

Yes, we stratify selected clinical performance measures by patient demographic data

No, we do not stratify clinical performance measures by patient demographic data but, we have the capability to run these reports

No, we do not stratify clinical performance measures by patient demographic data because we do not currently have the capability to run these reports (If selected, skip Question 21).

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* 21. If you stratify clinical performance measures by patient demographic data, please select which patient demographic category is used to stratify.

Race

Ethnicity

Gender

Language proficiency

Language preference

Disability

Sexual orientation

Gender identity

Other (please specify)

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* 22. If you do NOT stratify clinical performance measures by patient demographic data, please select any barriers you have for generating these reports.

EHR has limited reporting capabilities and cannot generate these types of reports.

EHR can generate these types of reports, but they are difficult to produce.

EHR can generate these types of reports, but they require an additional module.

Additional data analysis is needed and practice does not have required expertise.

Health system IT/Clinical informatics does not provide these types of reports.

Patient demographic data stratification reports are not prioritized in our performance monitoring strategy.

Patient demographic data stratification reports are not required to fulfill the requirements of our value-based payer contracts.

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* 23. Describe your practice capabilities related to performance improvement.

We have a dedicated person who is charged with performance improvement activities.

We have a provider/staff person who has a portion of their time dedicated to performance improvement activities.

Performance improvement is a shared responsibility among several staff providers/members.

We do not have any specific person who is charged with performance improvement.

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* 24. Describe your practice capabilities related to health informatics/EHR optimization and reporting.

We have a dedicated person who is charged with health information/EHR optimization and reporting, and they have formalized training in this area.

We have a dedicated person who is charged with health information/EHR optimization and reporting, and they have on-the-job training and experience in this area, but no formalized training.

We have a superuser(s) that assists with health informatics/EHR optimization and reporting.

We receive support from an external consultant.

We do not have any specific support for health informatics/EHR optimization and reporting.

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* 25. Thank you for completing this survey. The SC Office of Rural Health is offering opportunities for practices to receive funding to classify patient data. Would your practice be interested in learning more about this opportunity? If so, please click here to learn more.

Yes

Practice Survey - EHR

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* 1. Name of practice

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* 2. Name of person completing this survey

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* 3. Position/Title of person completing this survey

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* 4. Email of person completing this survey

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* 5. Please indicate practice ownership (Select all that apply):

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* 6. Please indicate how many FTE providers are in your practice:

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* 7. Please indicate the percentage of patients by demographic characteristic:

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* 8. Please estimate the number of patients that are covered by:

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* 9. What is your average daily visit count?

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* 10. Please select all patient demographic characteristics that are required to be collected by your practice:

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* 11. Please indicate if you use the following data categories when collecting ethnicity data: Categories: Hispanic or Latino; Not Hispanic or Latino

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* 12. Please indicate if you use the following data categories when collecting race data. Categories: Black or African American; White; Asian; American Indian or Alaska Native; Native Hawaiian, or Other Pacific Islander

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* 13. Do you classify patients as multi-racial?

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* 14. Does your practice have a standardized written process for collecting patient demographic data?

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* 15. Indicate when the patient's race and ethnicity data is collected (Select all that apply.)

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* 16. How is the patient's race and ethnicity data collected? (Select all that apply.)

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* 17. How is the patient's race and ethnicity data recorded? (Select all that apply.)

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* 18. Does your practice monitor clinical performance measures? (Select all that apply.)

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* 19. Select the type of clinical performance measurements that you collect and review. (Select all that apply.)

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* 20. Do you currently stratify clinical performance measures by patient demographic data? Select the answer that best reflects current practice.

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* 21. If you stratify clinical performance measures by patient demographic data, please select which patient demographic category is used to stratify.

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* 22. If you do NOT stratify clinical performance measures by patient demographic data, please select any barriers you have for generating these reports.

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* 23. Describe your practice capabilities related to performance improvement.

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* 24. Describe your practice capabilities related to health informatics/EHR optimization and reporting.

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* 25. Thank you for completing this survey. The SC Office of Rural Health is offering opportunities for practices to receive funding to classify patient data. Would your practice be interested in learning more about this opportunity? If so, please click here to learn more.

* 11. Please indicate if you use the following data categories when collecting ethnicity data:
Categories: Hispanic or Latino; Not Hispanic or Latino

* 12. Please indicate if you use the following data categories when collecting race data.
Categories: Black or African American; White; Asian; American Indian or Alaska Native; Native Hawaiian, or Other Pacific Islander