eHealthCT Needs Assessment

Please take a few minutes to complete this brief survey which will help guide us as we organize eHealthConnecticut for the future. Your feedback is important to us in how we can better improve our service.

This survey should only take a few minutes of your time. All respondents will be entered into a drawing for a Google Chromecast.

If you have any questions about the survey, please contact us at info@ehealthconnecticut.org or call 860-240-5617.

eHealthConnecticut Regional Extension Center is funded by the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (90RC0053)

Question Title

* 1. Are you a healthcare provider?

	No I am not	MD	DO	PA	NP	APRN	CNMW	DDM
Please select one:	Please select one: No I am not	Please select one: MD	Please select one: DO	Please select one: PA	Please select one: NP	Please select one: APRN	Please select one: CNMW	Please select one: DDM

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* 2. If you are a healthcare provider, what is your specialty:

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* 3. If you are not a healthcare provider, are you a:

Healthcare Administrator

Healthcare Support Staff

Other (please specify)

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* 4. Where do you work?

Private Outpatient Practice

FQHC or other Outpatient Clinic

Behavioral Health Organization

Long Term Care Facility

Home Care Agency

Care Management Agency

Hospital based Outpatient Practie

Hospital Inpatient Services

Other (please specify)

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* 5. Is your practice or organization currently an eHealthCT Regional Extension Center customer?

Yes

I don't know

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* 6. If you are a healthcare provider (if not skip to question 8):

	Yes	No	Don't Know
Are you using an electronic health record (EHR) system?	Are you using an electronic health record (EHR) system? Yes	Are you using an electronic health record (EHR) system? No	Are you using an electronic health record (EHR) system? Don't Know
Have you attested to Stage 1 Meaningful Use?	Have you attested to Stage 1 Meaningful Use? Yes	Have you attested to Stage 1 Meaningful Use? No	Have you attested to Stage 1 Meaningful Use? Don't Know
Is your EHR certified for Stage 2 Meaningful Use?	Is your EHR certified for Stage 2 Meaningful Use? Yes	Is your EHR certified for Stage 2 Meaningful Use? No	Is your EHR certified for Stage 2 Meaningful Use? Don't Know

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* 7. If you are using an EHR, what system and version are you using?

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* 8. Would you be interested in the following services from eHealthCT? (check all that apply)

Stage 1 Meaningful Use

Stage 2 Meaningful Use

Health Information Exchange capability such as Direct Secure email

Unalterable Digital Signature technology with secure end-to-end communication

ICD-10 Assistance

Privacy and Security Assistance

Patient Centered Medical Home Assistance

Population Health Tools and Training

Patient Portal and Communications tools

Membership Model (annual fee for services/discounts)

Other (please specify)

Question Title

* 9. Contact info (optional):

Name

Practice or Organization

Telephone