VistA EHR Assessment Form Provider Organization Technology Survey Sample Hospital Clinic1 Hospit - E - Excel

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VistA EHR Assessment Form Provider Organization Technology Survey Sample Hospital Clinic1 Hospit - E - Excel Powered By Docstoc
					VistA/EHR Assessment Form
Provider Organization/Technology Survey
                                                                                         Sample           Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…



                          Demographics
 1                                                             Facility Name:          Presbyterian

 2               Facility Type (Acute, Long Term, Outpatient, Physican Office)        Acute: Hospital

 3                                                            Number of Beds:

 4                                                     Numboer of Outpatients

 5                                                           Number of Clinics

 6                                                    Number of Beds in Clinic

 7                                                       Number of Physicians

 8                                                           Number of Nurses

 9                                Number of Other Clinical Staff to use System

10                                                           Number of IT Staff
                                                                                     11211 Waples Mill
11                                                                   Address:
                                                                                      Road, Fairfax VA
12                                                Department Contact Name:             John Williams

13                                                                Contact Title:         Manager

14                                                      Department Phone #:            421-389-8700

15                                                            Contact Phone #:         421-389-8702
                                                                                   WilliamsJ@msx.pmc.ed
16                                                              Contact email:
                                                                                             u
17                                                            Date Completed:           10/11/2001

18                             What type of Network (LAN/WAN) do you have?                 LAN

                 What type of outside connection do you have (T1, T10, dial up)             T1

19                                                          Need for Hardware              Yes

20                                                     Platform Currently Used          MS 20003

21   How many PC Workstations are in your dept./office (Enter approximate #)?               9

22   How many Printer devices are in your dept./office (Enter approximate #)?               3

23   Are PC Workstations located in clinical/patient care areas (Yes or No)?               Yes




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Provider Organization/Technology Survey
                                                                                         Sample                Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…


24   Does your dept./office use any handheld or wireless devices (Yes or No)?               Yes

25   If yes, please list handheld or wireless devices used.                          Cordless Phones
     If yes, What key business processes are performed on handheld or
26                                                                                     Phone Calls
     wireless devices?
                                                                                  Customer looking for a
                                                                                    reliable, highly cost
                                                                                  effective solution that is
                                                                                      scalable for their
                                                                                      environment and
                                                                                         delivers the
                                                                                 same/similar capabilities
                                                                                    of the McKesson or
                                                                                       Cerner but with
                                                                                   significantly reduced
                                                                                     cost to deploy and
27   Overall Description of enviroment
                                                                                          maintain.

                                                                                 Customers environment
                                                                                        includes:
                                                                                      • Campus A
                                                                                      • Campus B
                                                                                      • Campus C
                                                                                        • Clinic A
                                                                                        • Clinic B



                                   Training
28   How many individuals would require EHR training?                                       Yes
     Please provide a list of each of their clinical area and title within the
29                                                                                     See attached
     organization
30   How many indiviiduals would require clincal IT training?


Admissions, Discharge and Transfers (PIMS)
31   Are admissions to the facility usually scheduled ahead of time?                        Yes
32   If yes, Is there a waiting list?                                                       Yes
33   Where is the medical decision made to admit a patient?                                Need
34   Please provide a list of the names of your wards or bedsections.                  see attached
35   Please provide a list of treating specialties that are used.                      see attached
36   Please provide a list of room and bed numbers for each ward.                      see attached




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37   How do you handle transfers of patients from one ward to another and from one room-bed to another?
                                                                                      N/A
38   What types of discharges from the home do you have, i.e. discharged to family, transferred to public or private hospital, left AMA?
                                                                                      Family
39                                                                                  Yes
     Do you have a HIMS department/coders for managing the patient records upon discharge?




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Provider Organization/Technology Survey
                                                                                   Sample   Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…



                        Scheduling (PIMS)
31   Do you schedule patients in your dept./office (Yes or No)?                     Yes
     Do you use an automated/computer system to schedule patients (non-
32                                                                                  Yes
     manual/paper system) (Yes or No)?
     If yes, what system(s) do you use?
     A EPIC
     B Medipac
33   C SMS                                                                           A
     D Paper
     E Other: _______

     Is centralized scheduling used (Yes or No)?
34   NOTE: Centralized scheduling is defined as scheduling that occurs for           No
     multiple resources and locations/offices at one particular geographic site.
     If yes, is it for:
     A Single Facility/Practice, Single Department
35   B Single Facility/Practice, Multiple Departments                                No
     C Multiple Facilities/Practice Locations, Single Department
     D Multiple Facilities/Practice Locations, Multiple Departments
36   What depts/offices schedule for you?                                           None
37   What other depts/offices schedule appointments within your depts/offices?      None
     Within your dept/office, who does your scheduling (more than 1 answer
     allowed)?
     A Administrative Staff
38   B Secretarial Staff                                                            B, C
     C Nurse
     D Other: _______




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                                                                                              Sample                Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…

      What resources do you schedule (more than 1 answer allowed)?
      A Physician
      B Fellow
      C Resident
      D Nurse
      E Technician                                                                       A, B, D, I, J
 39
      F Room                                                                         (CRNP and Dieticians)
      G Equipment
      H Therapists
      I Physician Assistant
      J Other: ____________
      Does your dept./office schedule:
      A Inpatients Only
 40                                                                                               B
      B Outpatients Only
      C Inpatients and Outpatients
      Does your dept./office schedule by visit type (e.g. New, Consult, etc.) (Yes
 41                                                                                             Yes
      or No)?
      Does your dept./office schedule by procedure (e.g. Colonoscopy) (Yes or
 42                                                                                             Yes
      No)?
 43   Does your dept./office perform a "check in" function (Yes or No)?                          Yes
 44   Does your dept./office perform a "check out" function (Yes or No)?                         Yes
 45   Does your dept./office utilize a "no show" function/option (Yes or No)?                    Yes
                                                                                      Physicians schedule at
                                                                                       off-site locations, but
Scheduling - Additional Comments:
                                                                                     that is on those facilities'
                                                                                              schedule




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                        Registration (PIMS)
46   Do you register patients at your location (Yes or No)?                    Yes
     If yes, does your dept./office register:
     A Inpatients Only
47                                                                              B
     B Outpatients Only
     C Inpatients and Outpatients
     If yes, does your dept./office register:
     A Institutional Accounts
48   B Research Accounts                                                      None
     C Other: __________

     If yes, what system(s) do you use?
     A EPIC
     B Medipac
49   C SMS                                                                      B
     D Paper
     E Other: _______

     If yes, who registers patients for your area (more than 1 answer
     allowed)?
     A Administrative Staff                                                     B
50   B Secretarial Staff                                                (from Central Reg)
     C Nurse
     D Other: _______

51   If yes, what are the required fields to do a full registration?    (see Central Reg)
52   Do you perform "Mini" or "Emergency" Registrations (Yes or No)?    (see Central Reg)
53   If yes, what are the required fields to do these registrations?    (see Central Reg)




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                                                                                            Sample              Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…


      Is centralized registration used (Yes or No)?
 54   NOTE: Centralized registration is defined as registration that occurs for               Yes
      multiple resources and locations/offices at one particular geographic site.
      If yes, is it for:
      A Single Facility/Practice, Single Department
 55   B Single Facility/Practice, Multiple Departments                                         D
      C Multiple Facilities/Practice Locations, Single Department
      D Multiple Facilities/Practice Locations, Multiple Departments
      Does your dept./office request patient charts from hospital medical records
 56                                                                                            No
      (Yes or No)?
 57   If yes, is there an automated system for these requests (Yes or No)?                     No

 58   If yes, what system is used?                                                             No

                                                                                    All registrations done by
                                                                                        staff from Central
Registration - Additional Comments:
                                                                                     Registration, not from
                                                                                            Clinic staff




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                         Clinic Operations
     Does your dept./office utilize any electronic health record systems (Yes or
59                                                                                              No
     No)?
     If yes, what system do you use?
     A Cerner PowerChart Office
60   B EpicCare                                                                                 No
     C Other: __________

     If yes, what other systems and applications integrate with your electronic
61                                                                                              No
     health record system?
     If yes, please list the electronic health record functionality you are currently
     using:
62                                                                                              No



63   Does your dept./office utilize any ancillary clinical systems (Yes or No)?                Yes
64   If yes, what clinical ancillary system(s) are used?                                 Diabetes Registry
     If yes, what key business process do these clinical ancillary system(s)            Document diabetes
65
     perform?                                                                           patient management
     Does your clinical ancillary system(s) integrate with other applications and
66                                                                                              No
     information system(s) (Yes or No)?
     If yes, please list interfaces:

67                                                                                         Manual entry



                                Pharmacy
     Is your dept. supplied with medications for patient administration from the
68                                                                                             Yes
     Hospital Pharmacy (Yes or No)?
     Does your dept. write a medication prescription for your patient to take with
69                                                                                             Yes
     them (Yes or No)?
     Who in your dept./office currently writes, calls in or enters medication
     orders?
     A Physician
     B Registered Nurse
70   C LPN                                                                                     A, B
     D Medical Assistant
     E Clerical Staff
     F Other: __________




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                                                                                              Sample             Hospital/Clinic1    Hospital/Clinic2   Hospital/Clinic3   etc…

     Is there sufficient credentialed (MD, RN, PA) staff available in your clinic to
71   enter medication orders when this process is available on-line (Yes or                     Yes
     No)?

     What does your dept. use to generate prescriptions:
     A Hand-written prescription
72   B Computer/Handheld generated prescription - no interaction checking                        A
     C Computer/Handheld generated prescription with interaction checking
     D Other __________

     Does your dept./office receive calls from patients requesting medication
73                                                                                              Yes
     prescription refill or medical information (Yes or No)?
     For Pharmacy which packages do you intend to use?

     A. Automatic Replenishment/Ward Stock.
     B. Bar Code Management Administration
74   C. Controlled Substances                                                            A, B, C, D, E and F
     D. Pharmacy Data Management/Pharmacy Ordering Enhancement/CPRS
     E. Drug Accountability
     F. Inpatient Pharmacy
     G. Outpatient Pharmacy



                               Laboratory
75   Does your dept./office order Laboratory testing (Yes or No)?                               Yes
     What other diagnostic testing or procedures does your dept./office order
     (please list)?
76                                                                                     Anything and Everything




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Provider Organization/Technology Survey
                                                                              Sample   Hospital/Clinic1     Hospital/Clinic2   Hospital/Clinic3   etc…

     Where are your Laboratory tests performed?
     A In this dept./office
     B Hospital Lab (Sunquest)
77                                                                              B
     C Reference Lab (Quest)
     D Other Lab (please list): _________

     Does your dept./office write prescriptions for Laboratory orders to be
80                                                                             Yes
     performed elsewhere (Yes or No)?


                               Radiology
78   Does your dept./office order Radiology exams (Yes or No)?                 Yes




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                                                                                           Sample             Hospital/Clinic1     Hospital/Clinic2   Hospital/Clinic3   etc…

     Where are your Radiology exams performed?
     A In this dept./office
     B Hospital Radiology (IDXrad)
79                                                                                            B
     C Other Hospital Radiology (SMS Rad)
     D Other (please list): _________

     Does your dept./office write prescriptions for Radiology orders to be
80                                                                                           Yes
     performed elsewhere (Yes or No)?
     Does your dept./office write a prescription for tests/procedures other than
81                                                                                           Yes
     Lab or Rad to be performed elsewhere (Yes or No)?
     Does your dept./office perform testing or procedures, such as endoscopy,
82                                                                                            No
     breathing treatments, chest tube insertion, etc (Yes or No)?
     Does your dept./office perform testing or procedures ordered in other
83                                                                                            No
     dept./office/patient care areas (Yes or No)?
     If yes, how do you receive notification?

84                                                                                            No


85   Does your dept./office utilize "order-sets" or "care-sets"(Yes or No)?                   Yes
                                                                                    Attached - need Dietary
86   If yes, please attach copies.
                                                                                            Forms
87   Does your dept./office currently use a transcription service (Yes or No)?               Yes
88   If yes, what transcription service is your practice currently using?               Hospital Dolby
     If yes, please list any integration/interfaces between your system and other
     systems:
89



     Does your dept./office keep patient medical records or "shadow charts" on
90                                                                                           Yes
     site (Yes or No)?




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91   If yes, can you estimate the number of charts that are currently active?        5,000
     If yes, do you maintain a summary sheet of problems, medications,
92                                                                                   Yes
     allergies, immunizations and procedure history (Yes or No)?
     Does your dept./office see:
     A Mostly/Exclusively Inpatients
93   B Mostly/Exclusively Outpatients                                                 B
     C Balance of Inpatients/Outpatients

     Do you refer patients to other departments/offices within the UPMC Health
94                                                                                   Yes
     System (Yes or No)?
     Do you refer patients to other departments, offices or facilities outside of
95                                                                                    No
     the UPMC Health System (Yes or No)?
     Does your dept./office receive calls to follow-up on lab or other diagnostic
96                                                                                   Yes
     testing results (Yes or No)?
     Does your dept./office perform callbacks that will become a part of the
97                                                                                   Yes
     medical record (Yes or No)?




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                                                               Sample              Hospital/Clinic1     Hospital/Clinic2   Hospital/Clinic3   etc…


                                                        Maintain 2 chart systems
                                                         for both Diabetes and
                                                               Endocrine;
Clinic Operations - Additional Comments:
                                                           Mary Korcowski?
                                                          Contact for Diabetes
                                                                Registry




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                        Charge Services
     Is ABN (Advanced Beneficiary Notification - Medicare guidelines) an issue
98                                                                                        No
     that you manage in your department (Yes or No)?
     If yes, what system is impacted?
     A Epic
     B Clinipac/Medipac
99   C SMS                                                                                No
     D Paper (sent where?):___________________________________
     E Other system:________________________________________

100 Do APCs affect your charges (Yes or No)?                                             Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
101 C SMS                                                                                 B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

102 Does your clinic charge professional fees (Yes or No)?                               Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac                                                                   D, A
103 C SMS
                                                                                 UPP for entry to Epic
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

104 Does your clinic charge clinic fees (Yes or No)?                                     Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
105 C SMS                                                                                 B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

106 Does your clinic charge professional and clinic fees together (Yes or No)?           Yes




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                                                                                  Sample          Hospital/Clinic1     Hospital/Clinic2   Hospital/Clinic3   etc…

    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac                                                             B, A
107 C SMS
                                                                              UPP bills in Epic
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

108 Does your clinic charge for vaccines and/or immunizations (Yes or No)?          Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
109 C SMS                                                                            B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

    Does your clinic charge for the vaccine/immunization administrative fee
110 (Yes or No)?                                                                    Yes

    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
111 C SMS                                                                            B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

112 Does your clinic charge for medical surgical supplies (Yes or No)?              Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
113 C SMS                                                                            B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

114 Does your clinic charge for medications (Yes or No)?                            Yes
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
115 C SMS                                                                            B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

116 Does your clinic charge for tests and/or procedures (Yes or No) ?               Yes




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    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
117 C SMS                                                                                 B
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

      Please attach copies of encounter forms, charge forms or any other form/
118                                                                                    Attached
      document used in the billing process.
                                                                                   Charge tickets are
Charge Services - Additional Comments:                                           routed to Medipac and
                                                                                      UPP (Epic)




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               Scanning/Document Imaging
      Do you perform any type of scanning in your clinic/physician office (Yes or
119                                                                                     No
      No)?
      If yes, then what system do you use?
      A Epicare
      B Odie
120                                                                                     No
      C Paperclip
      D SMS
      E Other: _______
121   If yes, what equipment do you have?                                               No
122   If yes, do you perform selective or entire chart scanning?                        No
      If yes, do you scan test results, letters or other outside source information
123                                                                                     No
      (Yes or No)?
      If yes, please list:
124                                                                                     No


      Please prepare sample copies of chart/documents from your clinic/office
125                                                                                     No
      for our site visit.
Scanning/Document Imaging - Additional Comments:                                        No




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                          Demographics
 1                                                             Facility Name:

 2               Facility Type (Acute, Long Term, Outpatient, Physican Office)

 3                                                            Number of Beds:

 4                                                     Numboer of Outpatients

 5                                                           Number of Clinics

 6                                                    Number of Beds in Clinic

 7                                                       Number of Physicians

 8                                                           Number of Nurses

 9                                Number of Other Clinical Staff to use System

10                                                           Number of IT Staff

11                                                                   Address:

12                                                Department Contact Name:

13                                                                Contact Title:

14                                                      Department Phone #:

15                                                            Contact Phone #:

16                                                              Contact email:

17                                                            Date Completed:

18                             What type of Network (LAN/WAN) do you have?

                 What type of outside connection do you have (T1, T10, dial up)

19                                                          Need for Hardware

20                                                     Platform Currently Used

21   How many PC Workstations are in your dept./office (Enter approximate #)?

22   How many Printer devices are in your dept./office (Enter approximate #)?

23   Are PC Workstations located in clinical/patient care areas (Yes or No)?




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24   Does your dept./office use any handheld or wireless devices (Yes or No)?

25   If yes, please list handheld or wireless devices used.
     If yes, What key business processes are performed on handheld or
26
     wireless devices?




27   Overall Description of enviroment




                                   Training
28   How many individuals would require EHR training?
     Please provide a list of each of their clinical area and title within the
29
     organization
30   How many indiviiduals would require clincal IT training?


Admissions, Discharge and Transfers (PIMS)
31   Are admissions to the facility usually scheduled ahead of time?
32   If yes, Is there a waiting list?
33   Where is the medical decision made to admit a patient?
34   Please provide a list of the names of your wards or bedsections.

35   Please provide a list of treating specialties that are used.

36   Please provide a list of room and bed numbers for each ward.




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37   How do you handle transfers of patients from one ward to another and from one room-bed to another?

38   What types of discharges from the home do you have, i.e. discharged to family, transferred to public or private hospital, left AMA?

39   Do you have a HIMS department/coders for managing the patient records upon discharge?




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                        Scheduling (PIMS)
31   Do you schedule patients in your dept./office (Yes or No)?
     Do you use an automated/computer system to schedule patients (non-
32
     manual/paper system) (Yes or No)?
     If yes, what system(s) do you use?
     A EPIC
     B Medipac
33   C SMS
     D Paper
     E Other: _______

     Is centralized scheduling used (Yes or No)?
34   NOTE: Centralized scheduling is defined as scheduling that occurs for
     multiple resources and locations/offices at one particular geographic site.
     If yes, is it for:
     A Single Facility/Practice, Single Department
35   B Single Facility/Practice, Multiple Departments
     C Multiple Facilities/Practice Locations, Single Department
     D Multiple Facilities/Practice Locations, Multiple Departments
36   What depts/offices schedule for you?
37   What other depts/offices schedule appointments within your depts/offices?
     Within your dept/office, who does your scheduling (more than 1 answer
     allowed)?
     A Administrative Staff
38   B Secretarial Staff
     C Nurse
     D Other: _______




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      What resources do you schedule (more than 1 answer allowed)?
      A Physician
      B Fellow
      C Resident
      D Nurse
 39   E Technician
      F Room
      G Equipment
      H Therapists
      I Physician Assistant
      J Other: ____________
      Does your dept./office schedule:
      A Inpatients Only
 40
      B Outpatients Only
      C Inpatients and Outpatients
      Does your dept./office schedule by visit type (e.g. New, Consult, etc.) (Yes
 41
      or No)?
      Does your dept./office schedule by procedure (e.g. Colonoscopy) (Yes or
 42
      No)?
 43   Does your dept./office perform a "check in" function (Yes or No)?
 44   Does your dept./office perform a "check out" function (Yes or No)?
 45   Does your dept./office utilize a "no show" function/option (Yes or No)?


Scheduling - Additional Comments:




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VistA/EHR Assessment Form
Provider Organization/Technology Survey



                        Registration (PIMS)
46   Do you register patients at your location (Yes or No)?
     If yes, does your dept./office register:
     A Inpatients Only
47
     B Outpatients Only
     C Inpatients and Outpatients
     If yes, does your dept./office register:
     A Institutional Accounts
48   B Research Accounts
     C Other: __________

     If yes, what system(s) do you use?
     A EPIC
     B Medipac
49   C SMS
     D Paper
     E Other: _______

     If yes, who registers patients for your area (more than 1 answer
     allowed)?
     A Administrative Staff
50   B Secretarial Staff
     C Nurse
     D Other: _______

51   If yes, what are the required fields to do a full registration?
52   Do you perform "Mini" or "Emergency" Registrations (Yes or No)?
53   If yes, what are the required fields to do these registrations?




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Provider Organization/Technology Survey



      Is centralized registration used (Yes or No)?
 54   NOTE: Centralized registration is defined as registration that occurs for
      multiple resources and locations/offices at one particular geographic site.
      If yes, is it for:
      A Single Facility/Practice, Single Department
 55   B Single Facility/Practice, Multiple Departments
      C Multiple Facilities/Practice Locations, Single Department
      D Multiple Facilities/Practice Locations, Multiple Departments
      Does your dept./office request patient charts from hospital medical records
 56
      (Yes or No)?
 57   If yes, is there an automated system for these requests (Yes or No)?

 58   If yes, what system is used?



Registration - Additional Comments:




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Provider Organization/Technology Survey



                         Clinic Operations
     Does your dept./office utilize any electronic health record systems (Yes or
59
     No)?
     If yes, what system do you use?
     A Cerner PowerChart Office
60   B EpicCare
     C Other: __________

     If yes, what other systems and applications integrate with your electronic
61
     health record system?
     If yes, please list the electronic health record functionality you are currently
     using:
62



63   Does your dept./office utilize any ancillary clinical systems (Yes or No)?
64   If yes, what clinical ancillary system(s) are used?
     If yes, what key business process do these clinical ancillary system(s)
65
     perform?
     Does your clinical ancillary system(s) integrate with other applications and
66
     information system(s) (Yes or No)?
     If yes, please list interfaces:

67




                                Pharmacy
     Is your dept. supplied with medications for patient administration from the
68
     Hospital Pharmacy (Yes or No)?
     Does your dept. write a medication prescription for your patient to take with
69
     them (Yes or No)?
     Who in your dept./office currently writes, calls in or enters medication
     orders?
     A Physician
     B Registered Nurse
70   C LPN
     D Medical Assistant
     E Clerical Staff
     F Other: __________




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Provider Organization/Technology Survey


     Is there sufficient credentialed (MD, RN, PA) staff available in your clinic to
71   enter medication orders when this process is available on-line (Yes or
     No)?

     What does your dept. use to generate prescriptions:
     A Hand-written prescription
72   B Computer/Handheld generated prescription - no interaction checking
     C Computer/Handheld generated prescription with interaction checking
     D Other __________

     Does your dept./office receive calls from patients requesting medication
73
     prescription refill or medical information (Yes or No)?
     For Pharmacy which packages do you intend to use?

     A. Automatic Replenishment/Ward Stock.
     B. Bar Code Management Administration
74   C. Controlled Substances
     D. Pharmacy Data Management/Pharmacy Ordering Enhancement/CPRS
     E. Drug Accountability
     F. Inpatient Pharmacy
     G. Outpatient Pharmacy



                               Laboratory
75   Does your dept./office order Laboratory testing (Yes or No)?
     What other diagnostic testing or procedures does your dept./office order
     (please list)?
76




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Provider Organization/Technology Survey


     Where are your Laboratory tests performed?
     A In this dept./office
     B Hospital Lab (Sunquest)
77
     C Reference Lab (Quest)
     D Other Lab (please list): _________

     Does your dept./office write prescriptions for Laboratory orders to be
80
     performed elsewhere (Yes or No)?


                               Radiology
78   Does your dept./office order Radiology exams (Yes or No)?




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Provider Organization/Technology Survey


     Where are your Radiology exams performed?
     A In this dept./office
     B Hospital Radiology (IDXrad)
79
     C Other Hospital Radiology (SMS Rad)
     D Other (please list): _________

     Does your dept./office write prescriptions for Radiology orders to be
80
     performed elsewhere (Yes or No)?
     Does your dept./office write a prescription for tests/procedures other than
81
     Lab or Rad to be performed elsewhere (Yes or No)?
     Does your dept./office perform testing or procedures, such as endoscopy,
82
     breathing treatments, chest tube insertion, etc (Yes or No)?
     Does your dept./office perform testing or procedures ordered in other
83
     dept./office/patient care areas (Yes or No)?
     If yes, how do you receive notification?

84


85   Does your dept./office utilize "order-sets" or "care-sets"(Yes or No)?
86   If yes, please attach copies.

87   Does your dept./office currently use a transcription service (Yes or No)?
88   If yes, what transcription service is your practice currently using?
     If yes, please list any integration/interfaces between your system and other
     systems:
89



     Does your dept./office keep patient medical records or "shadow charts" on
90
     site (Yes or No)?




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Provider Organization/Technology Survey



91   If yes, can you estimate the number of charts that are currently active?
     If yes, do you maintain a summary sheet of problems, medications,
92
     allergies, immunizations and procedure history (Yes or No)?
     Does your dept./office see:
     A Mostly/Exclusively Inpatients
93   B Mostly/Exclusively Outpatients
     C Balance of Inpatients/Outpatients

     Do you refer patients to other departments/offices within the UPMC Health
94
     System (Yes or No)?
     Do you refer patients to other departments, offices or facilities outside of
95
     the UPMC Health System (Yes or No)?
     Does your dept./office receive calls to follow-up on lab or other diagnostic
96
     testing results (Yes or No)?
     Does your dept./office perform callbacks that will become a part of the
97
     medical record (Yes or No)?




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Clinic Operations - Additional Comments:




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                        Charge Services
     Is ABN (Advanced Beneficiary Notification - Medicare guidelines) an issue
98
     that you manage in your department (Yes or No)?
     If yes, what system is impacted?
     A Epic
     B Clinipac/Medipac
99   C SMS
     D Paper (sent where?):___________________________________
     E Other system:________________________________________

100 Do APCs affect your charges (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
101 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

102 Does your clinic charge professional fees (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
103 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

104 Does your clinic charge clinic fees (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
105 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

106 Does your clinic charge professional and clinic fees together (Yes or No)?




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Provider Organization/Technology Survey


    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
107 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

108 Does your clinic charge for vaccines and/or immunizations (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
109 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

    Does your clinic charge for the vaccine/immunization administrative fee
110 (Yes or No)?

    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
111 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

112 Does your clinic charge for medical surgical supplies (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
113 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

114 Does your clinic charge for medications (Yes or No)?
    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
115 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

116 Does your clinic charge for tests and/or procedures (Yes or No) ?




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    If yes, what system is impacted?
    A Epic
    B Clinipac/Medipac
117 C SMS
    D Paper (sent where?):___________________________________
    E Other system:________________________________________

      Please attach copies of encounter forms, charge forms or any other form/
118
      document used in the billing process.

Charge Services - Additional Comments:




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Provider Organization/Technology Survey



               Scanning/Document Imaging
      Do you perform any type of scanning in your clinic/physician office (Yes or
119
      No)?
      If yes, then what system do you use?
      A Epicare
      B Odie
120
      C Paperclip
      D SMS
      E Other: _______
121   If yes, what equipment do you have?
122   If yes, do you perform selective or entire chart scanning?
      If yes, do you scan test results, letters or other outside source information
123
      (Yes or No)?
      If yes, please list:
124


      Please prepare sample copies of chart/documents from your clinic/office
125
      for our site visit.
Scanning/Document Imaging - Additional Comments:




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                                                                 Instructions
                                                             VistA Assessment Survey
Attached on the following Survey tab below, you will find the survey designed to gather information from your organization (hospital,
clinic, outpatient, physician office, safety net provider) as a health care provider. This information will be critical to the potential
implementation of VistA or an EHR in your facility. Please work with your organization to complete this as throughly as possible.
Further, a subset of this assignment will be to developed as a MSProject workplan/schedule. The more information you collect, the
easier it will be to develop your second assignment. For the class, please complete and provide to Farrokh Alemi at falemi@gmu.edu
by February 24th.

Farrokh Alemi, PhD
Professor for Management of Health Information Systems
George Mason University

1) To view the survey, click on the Survey Tab below

2) As listed in the cover email, a representative from our team will work with you to complete this survey. If you desire to get a head start of this
process, please begin in the Site 1 column and the Facility Name row. If you are the contact person for multiple departments or locations,
answers for each area will be placed in separate columns. Example entries are in the Sample Input column.

3) At the end of each section there is a "Comments Section". This section should be used to comment on any information that is pertinent to
understanding the business processes for that particular section (ex. Scheduling, Registration, etc.), but not answered in the listed questions.


5) In some questions there is a request for copies of forms, reports or other materials. Your assistance in securing copies of appropriate forms
and reports is appreciated.

6) If you need to send follow-up information, please email a message and any applicable file attachments to claudine.d.beron@accenture.com
,making sure to save an electronic copy for yourself. Hard-copy printouts or copies of forms, reports, etc. may also be brough to class if
electronic is not available.

7) If there are any questions, please contact Claudine Beron 703-599-1203 at your earliest convenience.




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VistA   Foundation (Mandatory)




        Foundation
        FileMan
        Health Level Seven (HL7)
        Kernel
        Kernel Installation and Distribution System (KIDS)
        Kernel ToolKit
        List Manager
        MailMan
        National On-Line Information Sharing
        Patch Module
        Patient Data Exchange
        Remote Procedure Call (RPC) Broker
        SQL Interface (SQLI)
Basic                                            Standard




Accounts Receivable
Consolidated Mail Outpatient Pharmacy
Controlled Substances
Current Procedural Terminology (CPT)
Diagnostic Related Group (DRG) Grouper
Drug Accountability/Inventory Interface          Adverse Reaction Tracking
Duplicate Record Merge: Patient Merge            Authorization/Subscription Utility
Event Capture                                    Automated Information Collection System
Inpatient Medications                            (AICS)
Inpatient Medications - Intravenous              Automated Medical information Exchange
Inpatient Medications - Unit Dose                (AMIE)
Integrated Billing                               Automatic Replenishment/Ward Stock
Laboratory                                       Clinical Reminders
Laboratory Electronic Data Interchange           Consults/Request Tracking
Lexicon Utility                                  CPRS
Master Patient Index                             Dietetics
Master Patient Index/Patient Demographics        Generic Code Sheet
National Drug File                               Health Summary
Outpatient Pharmacy                              Integrated Funds Distribution, Control
Patient Information Management Systems           Point Activity, Accounting and Procurement
(Admission, Discharge, Transfer, Registration)   (IFCAP)
Pharmacy Benefits Management                     Patient Care Encounter
Pharmacy Data Management                         Problem List
Radiology/Nuclear Medicine                       Text Integration Utilities
Scheduling                                       Vitals/Measurements
May select based on serviced provided today      May select based of specialized services
Additional Modules(Lab)
Anatomic Pathology                         Extended
Automated Safety Incident Surveillance
Tracking System (ASISTS)
Clinical Monitoring System
Decision Support System (DSS) Extracts
Dentistry
Engineering
Equal Employment Opportunity (EEO)
Equipment/Turn-In Request
Fee Basis
Hepatitis C Extract
Home Based Primary Care
Immunology Case Registry
Incident Reporting
Intake and Output
Library
Medicine Clinical Services
Mental Health
Minimal Patient Dataset
Network Health Exchange
Nursing
Occurrence Screen
Oncology
Patient Identification Card
Personnel and Accounting Integrated Data
Pharmacy Prescription Practices
Police and Security
Primary Care Management Module
Prosthetics
Quality: Audiology And Speech Analysis     Bar Code Medication
And Reporting                              Administration (BCMA)
Record Tracking                            Imaging & Multimedia
Resident Assessment Instrument/Minimum     Wireless Handheld Devices
May select based of specialized services   Cannot be implemented until VistA is fully implemented

				
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Description: Sample Hospital Bills document sample