HIE/Network Survey Questions<br />This survey is about your health information exchange (HIE) network, the mechanism that conducts the transfer patient data electronically between health organizations and agencies (providers, payers/insurers, state/federal agencies, other parties). The term “HIE” is used in the questions in this survey refers to any type of electronic exchange network, whether it is used to share information between different geographic locations for a single organization; among the different provider organizations within a single care or delivery network; or is broadly available to a variety of organizations, agencies, and networks. <br />Organization Information<br />Contact information for the individual to whom questions about this survey should be directed:<br />Organization Name:<br />Network name:<br />Survey Contact:<br />Title:<br />Email Address: Phone Number: <br />Does/will the HIE operate<br />Within a single state<br />Across multiple contiguous states (please specify which states)<br />Across multiple non-contiguous states (please specify)<br />When did/will the HIE begin exchanging information?<br />Go live month/year: <br />Being implemented but not yet fully operational<br />In development but not yet implemented<br />In planning stages <br />What were the primary reasons for developing the HIE? Please rank from most (5) to least (1) important. <br />Very unimportant1Somewhat unimportant2Neutral3Somewhat important4Very important5Save money1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Improve efficiency1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Standardize practices 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Improve communications1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Improve patient care/care coordination1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Funding availability1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Project participation (state/federal, pilot, NHIN)1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Improve patient safety1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX Other (describe)1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX <br />Is your HIE network<br />Intra-organizational only<br />Inter-organizational only (different locations)<br />Single integrated care network (providers, facilities)<br />Multiple care networks<br />Other (please describe)<br />Please provide any documents you can share which explain your HIE functional and technical models and operational strategy (hyperlink or e-document).<br />Governance Model<br />Is your HIE organization<br />Public <br />Private<br />Public/private<br />Other (describe)<br /> <br />Is the HIE organization’s tax status<br />For-profit<br />Non-profit (please specify; 501(c)(3), etc.) <br />Government (describe)<br />Other (describe)<br />What type of body governs/will govern the HIE?<br />Part of normal organizational management structure<br />If so, under what part of the organization is it managed?<br />Organizational board (all in house members)<br />Independent board (internal and external members)<br />Other (describe)<br />What types of stakeholders participate/will participate in the governing body? Which types (and how many) use/plan to use the HIE? How many view information on the HIE? How many submit data to the network/network repository? <br />StakeholdersGoverning Body (Y/N)User(# of Entities)View?(# of Entities)Submit data?(# of Entities)Exchange directly with other HIE members?(# of Entities)HospitalsPrimary Care PhysiciansSpecialty Care PhysiciansAmbulatory Care/Outpatient ClinicsNursing HomesRehabilitation/Long Term Acute Care FacilitiesBehavioral Health Providers/FacilitiesEmergency Medical Services/Ambulance /FireLaboratoriesRadiology CentersPharmaciesPharmacy Benefit Managers (PBMs)Federally Qualified Health Centers (FQHCs)Other Community and/or Public Health ClinicsVeterans Administration or Dept of Defense Hospitals/Medical FacilitiesMedicare OrganizationsMedicaid OrganizationsIndian Health Services ProvidersPrivate Payer/Health PlansOther Local, State or Federal Governmental Agencies or Entities (please specify)Employers/Healthcare PurchasersQuality Improvement OrganizationsPatient or Consumer GroupsOther (please specify)<br />Legal Issues/Marketing<br />What HIE characteristics/benefits did you use to market the service to potential users? Which characteristics/benefits were important drivers for participation? <br />Characteristic/BenefitMarketedReason for Participation(Rank from 1-least important to 5-most important)Required by organization/IDNDecrease reimbursement timeSave moneyMore complete/faster access to patient informationImprove efficiencyStandardize practices Improve communicationsImprove patient care/care coordinationFunding availabilityProject participation (state/federal, pilot, NHIN)Improve patient safetyOther (describe)<br />Are HIE members required to sign an agreement to participate? Y/N<br />If Yes, note the specific areas that the agreement includes below. If possible, please provide an electronic copy of your agreement.<br />ProvisionIn agreement(Y/N)Agreement sets minimum requirements?Key provisions/requirements (specify)Liability/indemnityPrivacy/securityOwnershipHardware/software requirementsData policyFee schedulesEnforcement and penaltiesOther key provisions (describe)<br />Financial Model<br />If the HIE is fully operational, what are the annual costs to operate and maintain it?<br />Please list if possible all the revenue sources that support your HIE operations.<br />Revenue sourceUsePercent of revenuesSubscription feesMaintenance feesHardware/storage feesTransaction fees Training feesImplementation fees Services fees for added value services (i.e., data provision and analysis, statistics and reporting , research and studies, other) please specify Fees for business services EHR functionality (i.e., billing, analysis/decision support, reporting, PHRs, CPOE, other)please specify belowLicensing fees (i.e., concurrent, named user, limited, unlimited, role-based, other ) please specify belowUnbundled additional costs (i.e., third party products/support, etc) please specify belowOther (i.e., advertising placement, sponsorship, etc) please specify below<br />If the HIE uses a participation fee model (ex., transaction or subscription fees), describe the model, which stakeholders pay, how fees are assessed, and if stakeholders participate in revenue sharing. <br />Fee ModelStakeholders AssessedHow Fee is AssessedRevenue share w/Stakeholders? Y/N<br />
What is/will be the HIE’s mechanism for exchange? <br />Government hub<br />Private hub<br />Public utility<br />Blended (uses multiple mechanisms) - please specify<br />Other (please specify)<br />What type of technical architecture does/will the HIE use?<br />HIE Architecture TypeUseWill UseFederatedCentralizedHosted HybridOther (please specify)<br />
Please list the software and security applications/product(s) and version/release used to support HIE operations. If custom/proprietary, please note.
EHR VendorNameProduct/VersionNameCertified? (Y/N/Don’t Know)COTS, Custom/Proprietary, or Open SourceBi- or Uni-DirectionalExchange Capability<br />Does/will the HIE utilize NIST 1 standards? (Y/N) NIST 2? (Y/N)<br />Please list all EHR vendors with which the HIE currently exchanges clinical data. <br />EHR VendorNameInterfacing Product/VersionNameCertified? (Y/N/Don’t Know)Bi- or Uni-DirectionalExchange Capability<br />Which of the following architectural elements does/will the HIE support? <br />Architectural ElementHave in the HIE (Yes/No)Planned (Yes/No)COTS, Custom/Proprietary, or Open SourceCentral registry of participating entitiesCentral registry of users (centralized user authentication and authorization)Central patient index/Master patient index (central patient identity resolution)Record locator serviceClinical data repository (clinical data on patients stored centrally)Patient consent managementTransaction logs (logs of who requested data and what data was provided)Portal for authorized viewing of dataDocument registry (locator of documents in federated systems)Drug references/formularies/interactionsStandard code setsHIE policies/privacy and security policiesStandard forms (please specify)Other (please specify)<br />Can/will patients/consumers access and use the HIE? (Y/N)<br />If Yes, can patients: opt-in/opt-out/NA<br />Which of the following formats/services does/will the HIE support? <br />Service/FormatAvailable (Yes/No)Users (number)Clinical Services Computerized physician order entry Clinical summaries (Can include ER summary, discharge summary, referral summary, history and physical, etc) Clinical patient notes/problem lists Family/medical history Assessments Vital signs Lab results Radiology/imaging documents Other ancillary results (please specify) Digital chart information (describe the type of digital information supported; e.g., radiology images, EKG readings, fetal monitoring results, smoking status, etc) Electronic prescribing (e-Rx) Device monitoring Medication tracking/reconciliation Other (please specify)Administrative/Support Services Scheduling functions Billing functions Reference sources (coding manuals, drug reference manuals, etc.) Conversion to standard formats Scanning to convert paper records Other (please specify)Patient Communications and Services Patient messaging/alerts/reminders Patient authorizations Personal health record Patient readable clinical health record/summary Patient consent management Patient appointments and scheduling Other (please specify)Reporting Reporting/receiving immunization data Provider alerts to and from public health Other population health/public health reporting Disease management reporting Quality measures Other (please specify)Standard Transactions Claims (Professional/Institutional) Dental Claims Claim Attachments Claim Status Payment Advice Eligibility inquiry/response Referrals and Prior Authorization Other standard transactions (please specify) Other non-standard transactions (please specify)Standard Formats Continuity of Care Document (CCD) Continuity of Care Record (CCR) Other (please specify)Exchange Services Exchange with integrated delivery network(s) Exchange with external private entities Exchange with state payer programs Exchange with state/local public health agencies Exchange with federal agencies Other (please specify)<br />Does the HIE follow/use national standards? Check all that apply.<br />StandardUse in the HIEPlannedICD-9-CM ICD-9-CM Procedure CodesICD-10-CMICD-10-CM Procedure CodesNCPDP Script Version 8.1 and 10.6NCPDP Formulary & Benefits Standard 1.0NCPDP Version 5.1 and Version DSOAP V 1.2 (Simple Object Access Standard)XML (Extensible Markup Language)HTTP (HyperText Transer Protocol)RxNormLOINCCPT-4SNOWMED CTHIPAA Adopted transaction standards--4010HIPAA Adopted transaction standards--5010CMS PQRI 2008 Registry XMLHL7 2.3.1HL7 2.5.1HITSP adopted interoperability standardsOther (please specify)<br /> Is service-oriented architecture (SOA) used? (Yes/No/Don’t know)<br /> <br />If possible, please provide a technical architecture diagram (hyperlink or e-document).<br />Describe the software, hardware or communication requirements that HIE participants/providers must purchase/use in order to interface successfully with your HIE. If custom/proprietary, please note.<br />Software ProductName/VersionHardware ProductName/VersionCommunication ProductName/VersionSecurity ProductName/VersionOther ProductName/Version<br />Is your physical data model <br />Centralized<br />Federated<br />Hosted<br />Hybrid<br />Other (describe)<br />
Is your organization aware of/participate in any of the following national activities?
National ActivityAware of? (Yes/No)Participate? (Yes/No)If Participate, How/What Role?Certification Commission for Health Information Technology (CCHIT)Office of the National Coordinator for Health Information Technology (ONCHIT)National Health Information Network (NHIN)Other HIE Communities, Councils, Task Forces, Commissions, etc. (please specify)Other national standards activities: HITSP, HL7, IHE, etc. (please specify)<br />VI. Data Exchange Information<br />List below the data exchange purposes your organization does/will support and the average number of daily transactions. Indicate “n/a” if not supported. <br />Purpose for Data ExchangeAverage Daily TransactionsAdditional Description/Comments (500 character max)Clinical PurposesSend/receive requested patient information to/from other providers for treatmentSend/receive requested patient information to/from other providers for consultations and referralsPhysician Order entry (specify order types; pharmacy, lab, radiology, etc.)Results delivery (specify results types; pharmacy, lab, radiology, etc.)E-prescribing (e-Rx)Device monitoringMedication tracking/reconciliation Send/receive patient consents to other providers Send/receive patient authorizations to other providersOther clinical/care delivery purposes (please specify)Administrative PurposesAppointments and scheduling Claims tracking and submissionReimbursement receiptEligibility inquiry/responseReferrals/Prior Authorization (with payers)Send patient information (other than claims) to payers for paymentCare coordination with insurersAccess clinical/administrative resources on or via the exchangeOther administrative purposes (please specify)Patient Communications Patient messaging/alerts/reminders Send/receive patient consents to patients Send/receive patient authorizations to patients Access personal health record Patient appointments and scheduling Other (please specify)Reporting Reporting/receiving immunization data Provider alerts to and from public health Other population health/public health reporting Disease management reporting Quality measures Other reporting (please specify)Convert to/Exchange Standard Formats: Continuity of Care Document (CCD) Continuity of Care Record (CCR) Other formats (please specify)Exchange Services: Exchange with integrated delivery network(s) Exchange with external private entities Exchange with state payer programs Exchange with state/local public health agenciesOther exchange services (please specify)<br />
Please list your 5 most important “lessons learned” in planning, implementing, operating and sustaining your HIE.