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Enterprise eHealth Interoperability
According to the Centers for Medicare and Medicaid Services CMS, e-health refers to the use of web-enabled systems and processes to accomplish some combination of the following goals: Improve or enhance medical care, improve patient involvement in their medical care and
their overall satisfaction with the health care experience, streamline operations and business practices, control expenditures.
This eHealth Portal Functionality Questionnaire is divided into (8) Health Web Site Domain Sections and can be completed one
domain at a time. Hospital client information is automatically populated based on the facility provider number for accurate client
identification and characteristics from CMS recent Cost Report HCFA 2552-83. Factoid: Number of hospitals submitting 2006
CMS Cost Reports = 3737
Section 5: Patient Portal Domain
Demographics
Portal Inventory
Consumer Portal
Employee Portal
Patient Portal
Physician Portal
Web Standards Survey
Enterprise Site Assessment - Marketing
S5 Center for Evidence Based eHealth
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1) Verify %q528%
Yes
Patient Portal Domain
Survey Administrator:
You are about to administer the Consumer Portal Survey. Please record the responses to the
best of the client-respondent's ability to answer.
2) Does your organization have a Patient Portal?
Yes
No
3) Does your organization have any plans to deploy a Patient Portal?
Yes
No
4) What is your timeline for deployment of a Patient Portal?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
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None of the above
Other (please specify)
If you selected other, please specify:
5) What is the progress of the budget process for the Patient Portal?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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6) How many patient registrations (enrollments) do you currently have?
100 - 999
1000 - 4999
5000 - 9999
10000 - 14999
15000 - 19999
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20000 - 25000
> 50000
> 100,000
Other (please specify)
If you selected other, please specify:
7) Does the patient portal feature health related content resources within the portal?
Yes
No
8) Does your organization have any plans for health related content resources?
Yes
No
9) What is your timeline for deployment of health related content resources?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
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If you selected other, please specify:
10) What is the progress of the budget process for health related content resources?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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11) Are patients allowed to personalize the content to meet their specific health needs?
Yes
No
12) Are patients allowed to download health content from the site?
Yes
No
13) Are patients allowed to email content to friends and/or family?
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Yes
No
14) Does the Patient Portal allow patients to personalize other site features or site pages?
Yes
No
15) Does your organization plan to deploy patient personalization site features or site pages?
Yes
No
16) What is your timeline for deployment of a patient personalization feature?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
17) What is the progress of the budget process for the patient personalization feature?
You may select more than one response
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Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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18) Does patient portal offer secure messaging between patients & organizational resources?
Yes
No
19) Secure messages between patient and whom?
You may select more than one response
Between patient and physicians
Between patient and nurses or other clinicians
Between patient and general administrative staff
Between patient and others
Other (please specify)
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If you selected other, please specify:
20) Does the Patient Portal incorporate organizational policies ensuring timely response to
patient inquiries?
Yes
No
Other (please specify)
If you selected other, please specify:
21) Does Secure Messaging include a Rules/Workflow Engine for routing messages to
appropriate resources?
Yes
No
Other (please specify)
If you selected other, please specify:
22) Does the organization have the capability to send patient personalized broadcast messages (targeted messaging)?
Yes
No
Other (please specify)
If you selected other, please specify:
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23) Can personalized broadcast messages be grouped and generated by patient demographic
data?
Yes
No
Other (please specify)
If you selected other, please specify:
24) Are patients required to register to gain access to the Patient Portal?
Yes
No
Other (please specify)
If you selected other, please specify:
25) Does your Patient Portal registration process feature the following activities?
You may select more than one response
Online registration form
Printable registration for submitted to snail mail or fax
Online registration approval
Telephone or snail mail approval
Other (please specify)
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If you selected other, please specify:
26) Does the Patient Portal connect the user with the use of a Medical Record Number (MRN)?
Yes
No
Other (please specify)
If you selected other, please specify:
27) Who has ultimate responsibility for Patient Portal approval of the online registration process?
You may select more than one response
Quality Oversight Committee
Admissions Department
Business Office
Other (please specify)
If you selected other, please specify:
28) As part of the process, are patients required to view and agree to terms and conditions in order to register for access to the patient portal?
Yes
No
29) Are patients required to provide electronic consent as part of registering for patient portal
access?
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Yes
No
30) Does the organization make the privacy policy available for viewing during the registration
process?
Yes
No
31) Does the organization provide any opt-in/opt-out features during the registration process?
Yes
No
32) What is the primary form of patient identifier utilized?
SSN Social Security Number
MRN Medical Record Number
PII Personally identifiable information
Other (please specify)
If you selected other, please specify:
33) Does the Patient Portal require patients to credential themselves in order to gain access?
Yes
No
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34) Does the Patient Portal have any of the following features provided?
You may select more than one response
Login
Forgot Password
Forgot Username
Other (please specify)
If you selected other, please specify:
35) Does your organization plan to deploy the above Login features for your Patient Portal?
Yes
No
36) What is your timeline for deployment of the above Login features for your Patient Portal?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
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37) What is the progress of the budget process for the patient personalization feature?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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38) Does the Patient Portal allow patients to access and maintain Personal Health information (PHI)?
Yes
No
39) Which of the following Patient Health Information elements are accessible on your Patient Portal?
Demographic information
Insurance information
Financial information such as credit card, financial responsibility, etc.
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Employer information
Provider information
Medication List
Health History & Physical
None
Other (please specify)
If you selected other, please specify:
40) Does your organization have any plans to offer access to PHI elements on your Patient
Portal?
Yes
No
41) What is your timeline for deployment of access to PHI elements on your Patient Portal?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
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If you selected other, please specify:
42) What is the progress of the budget process for access to PHI elements on the Patient Portal?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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43) Does your organization integrate PHI data with back-end Administrative and Clinical
Systems for your Patient Portal?
Yes
No
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44) Does your organization have any plans to offer PHI data with back-end Administrative &
Clinical Systems for your Patient Portal?
Yes
No
45) What is your timeline for deployment of PHI data for back-end Administrative & Clinical Systems?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
46) What is the progress of the budget process for PHI data for back-end Administrative &
Clinical Systems?
You may select more than one response
Zero progress
Preliminary research
Presented budget
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Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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47) Does your Patient Portal allow patients to electronically Pre-register for services?
Yes
No
48) Which services are available for Pre-registration on your Patient Portal?
You may select more than one response
Surgical Inpatient Admission
Maternity Inpatient Admission
Other Inpatient Admission
Ambulatory Pre-visit Interview
Ambulatory Surgical Pre-registration
Other Ambulatory pre-registration
Other (please specify)
If you selected other, please specify:
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49) Does the Pre-registration process integrated with your back-end ADT or pre-registration
system on your Patient Portal?
Yes
No
50) Does your organization have any plans to integrate Pre-registration process with your back-
end ADT or pre-registration system on your Patient Portal?
Yes
No
51) What is your timeline for deployment of Pre-registration integration with your back-end ADT or pre-registration system on your Patient Portal?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
52) What is the progress of the budget process for back-end integration on the Patient Portal?
You may select more than one response
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Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
53) Does your Patient Portal allow new patients to request appointments online without first establishing a relationship with a physician or your organization?
Yes
No
54) Are established patients the only type of patients allowed to request appointments online?
Yes
No
55) Does your Patient Portal allow patients the ability to schedule their appointments online?
Yes
No
56) Does your organization have any plans for patients to schedule their appointments online?
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Yes
No
57) What is your timeline for deployment of the online patient appointment scheduling
function?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
58) What is the progress of the budget process for online patient appointment scheduling function?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
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Other (please specify)
If you selected other, please specify:
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59) Are patients able to request or receive test results via the Patient Portal?
Yes
No
60) On average, how many test results communications are generated per month on the Patient
Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5000
> 10,000
Other (please specify)
If you selected other, please specify:
61) Does your Patient Portal display patient test results that follow CLIA regulations reporting units of measurement for the analyte, reference ranges and optional out-of-range alerts?
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Yes
No
Not sure
62) Does the Patient Portal display general information about the test results communicated via free form text messaging?
Yes
No
63) Are actual test results or an annotated version of the test results communicated to the
patient?
You may select more than one response
Actual test results directly from testing laboratory
Annotated version of test results from the hospital HIS/LIS
Electronically scanned copy of test results in communiqué
Other (please specify)
If you selected other, please specify:
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64) Does your Patient Portal have educational content relevant to the test result attached for
viewing by the patient?
Yes
No
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65) Does your organization have any plans to offer educational content relevant to the test
result attached for viewing by the patient?
Yes
No
66) What is your timeline for deployment of educational content relevant to the test result
attached for viewing by the patient?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
67) What is the progress of the budget process for educational content relevant to the test
result attached for viewing by the patient?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
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Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
[page break]
68) Are patients able to view their patient financial account information online?
Yes
No
69) On average how many statements are viewed each month on your Patient Portal?
1 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5000
> 10,000
Other (please specify)
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If you selected other, please specify:
70) What types of Statements can patients view online on the Patient Portal?
You may select more than one response
All Statements
Inpatient Statements
Ambulatory Statements
Other (please specify)
If you selected other, please specify:
71) On average how much revenue is collected each month from online payments on Patient
Portal?
$1000 - $4999
$5000 - $9999
$10000 - $14999
$15000 - $19999
$20000 - $29000
$30000 - $39000
$40000 - $49999
> $50,000
> $100,000
Other (please specify)
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If you selected other, please specify:
72) Does your organization have data to support the reduction in A/R cycle days resulting from
offering the services above to patients online?
Yes
No
73) Can patients send secure messages to patient financial accounting staff or other organizational resources regarding questions about their Statements or Accounts?
Yes
No
74) Is the view statements and payment workflow integrated with your back-end financial system?
Yes
No
75) Is the online patient financial accounting workflow integrated with your paper billing
workflow?
Yes
No
76) Does your organization have any plans to offer online patient financial accounting workflow integrated with your paper billing workflow?
Yes
No
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77) What is your timeline for deployment of online patient financial accounting workflow
integrated with your paper billing workflow?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
78) What is the progress of the budget process for online patient financial accounting workflow integrated with your paper billing workflow?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
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79) Does your organization offer patients the opportunity to conduct electronic online office
visits (eVisits)?
Yes
No
80) On average how many eVisits are generated per month on your Patient Portal?
1 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5000
> 10,000
Other (please specify)
If you selected other, please specify:
81) For what types of symptoms, problems, or services are offered on eVisits function? You may select more than one response
Any Symptom
New Symptoms or Problems
Follow-up care for existing Symptoms or Problems
Chronic diseases
Other (please specify)
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If you selected other, please specify:
82) Are new patients allowed to conduct eVisits without first establishing a relationship with a
physician or your organization?
Yes
No
83) Are patients charged a fee for eVisits on your Patient Portal?
Yes
No
84) Are physicians reimbursed for eVisits on your Patient Portal?
Yes
No
85) Is the Patient Portal eVisit workflow integrated with your back-end Clinical System or EMR?
Yes
No
86) Does your organization have any plans to offer eVisit workflow integrated with your back-
end clinical system or EMR?
Yes
No
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87) What is your timeline for deployment of eVisit workflow integrated with your back-end
Clinical System or EMR?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
88) What is the progress of the budget process for eVisit workflow integrated with your back-end clinical system or EMR?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
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If you selected other, please specify:
89) Does your organization offer patient the opportunity to refill their prescriptions online?
Yes
No
90) On average how many Rx refills are generated per month on your Patient Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Other (please specify)
If you selected other, please specify:
91) Are these Rx requests triaged through an administrative or clinical workflow process?
Yes
No
Other (please specify)
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If you selected other, please specify:
92) Does the Patient Portal Rx refill workflow provide electronic connectivity to pharmacies?
Yes
No
93) Does your organization have any plans to offer Patient Portal Rx refill workflow to provide
electronic connectivity to pharmacies?
Yes
No
94) What is your timeline for deployment of Patient Portal Rx refill workflow to provide
electronic connectivity to pharmacies?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
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95) What is the progress of the budget process for Patient Portal Rx refill workflow to provide
electronic connectivity to pharmacies?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
[page break]
96) Does your organization offer patients the opportunity to renew their prescriptions online?
Yes
No
97) On average how many Patient Portal Rx renewals are generated per month?
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1 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Other (please specify)
If you selected other, please specify:
98) Are these Patient Portal Rx requests triaged through a clinical workflow process?
Yes
No
99) Is the Patient Portal Rx renewal process integrated with your back-end clinical system or
EMR?
Yes
No
100) Is the Patient Portal Rx renewal workflow integrated with an e-prescribing tool?
Yes
No
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101) Does your organization have any plans to offer Patient Portal Rx renewal workflow
integrated with an e-prescribing tool?
Yes
No
102) What is your timeline for deployment of Patient Portal Rx renewal workflow integrated with an e-prescribing tool?
You may select more than one response
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
103) What is the progress of the budget process for Patient Portal Rx renewal workflow
integrated with an e-prescribing tool?
You may select more than one response
Zero progress
Preliminary research
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Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
[page break]
104) Does your organization offer patients the opportunity to request referrals online?
Yes
No
105) On average, how many referral requests are generated per month on your Patient Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Other (please specify)
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If you selected other, please specify:
106) Is the Patient Portal referral process integrated with your back-end clinical system or
EMR?
Yes
No
107) Is the Patient Portal referral workflow integrated with back-end eligibility and health plan processes?
Yes
No
108) Does your organization have any plans for Patient Portal referral workflow integrated with
back-end eligibility and health plan processes?
Yes
No
Additional comments:
109) What is your timeline for deployment of Patient Portal referral workflow integrated with
back-end eligibility and health plan processes? You may select more than one response
FY 2007
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FY 2008
FY 2009
FY 2010
FY 2011
None of the above
Other (please specify)
If you selected other, please specify:
110) What is the progress of the budget process for Patient Portal referral workflow integrated
with back-end eligibility and health plan processes?
You may select more than one response
Zero progress
Preliminary research
Presented budget
Approved
Funded to allocation
Do not know
Other (please specify)
If you selected other, please specify:
111) In last 12 months, what is the number of Prescription request made on your Patient
Portal?
01 - 99
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100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Do not have this functionality
Other (please specify)
If you selected other, please specify:
112) In last 12 months, what is the number of Secured Messages made on your Patient Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Do not have this functionality
Other (please specify)
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If you selected other, please specify:
113) In last 12 months, what is the number of Appointments made on your Patient Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
> 5,000
> 10,000
Do not have this functionality
Other (please specify)
If you selected other, please specify:
114) In last 12 months, what is the number of Consults made on your Patient Portal?
01 - 99
100 - 499
500 - 999
1000 - 1499
1500 - 1999
2000 - 2500
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> 5,000
> 10,000
Do not have this functionality
Other (please specify)
If you selected other, please specify:
115) Is there any visible or countable revenues steams from Prescription, Messaging,
Appointments, and Consults functionality on your Patient Portal?
Yes
No
Additional comments:
Survey Administrator: You have completed the Patient Portal Domain
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116) Which Domain would you like to administer? You can select only one Domain at a time for now
Demographics
Portal Inventory
Consumer Portal
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Employee Portal
Patient Portal
Physician Portal
eHealth Web Standards
Enterprise Site Assessment
[page break]
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