ICD-10 Needs Assessment Survey for Western NC

This questionnaire was revised with permission from one previously disseminated to the members of the North Carolina Health Information and Communications Alliance, Inc. (NCHICA) in the Spring of 2011. Last year, Crescent Health Solutions, in partnership with the American Academy of Professional Coders, provided several well-attended educational events around ICD-10 Implementation. In an effort to ascertain the value of a second series of offerings on ICD-10 or other topics, please designate an individual within your organization to complete this brief survey. Responses are due by January 31, 2012. Complete and submit the survey by following the link as indicated on the fax you received from Crescent, or by visiting our website at www.crescenths.com. All respondents will be automatically registered in a drawing for a Kindle® Book Reader to be held on February, 2012.

Please provide the following (*required)

First Name*

Last Name*

Email*

Organization*

Work Phone*

Organization Information

1.	Organization Type

	(Select all that apply.)
	hospital
	physician office
	ambulatory care
	hospice
	long term care/skilled nursing facility
	government agency
	health department
	rural health center
	tribal health facility/provider
	urgent care
	Other:

2.	Number of Physicians/Health Care Providers

	not applicable
	less than 10
	11-50
	51-200
	201-500
	more than 500

3.	Number of Employees

	less than 20
	21-100
	101-500
	more than 500

4.	Title/Role/Dept of Person(s) Filling out Survey

	(Select all that apply.)
	Chief Information Officer
	ICD-10 Project Manager
	Health Information Manager
	Chief Executive Officer
	upper management
	middle management
	Coder
	Compliance Officer
	responsible for HIPAA
	Practice Administrator
	Nurse
	Physician
	Designated IT personnel
	Other:

Questions

5.	Is Executive Management within your organization aware of the impact of ICD-10 to your organization?

	yes
	no
	unknown

6.	Have you formed a cross functional team or taskforce within your organization to address ICD-10 implementation?

	yes
	no
	unknown

7.	Have you begun any planning or training within your organization to better understand the magnitude of impact/implementation?

	yes
	no
	unknown

8.	If you answered "yes" to question 7, please list educational events attended.

9.	Have you identified additional educational needs for 2012?

	yes
	no

10.	If you answered "yes" to question 9, please describe.

11.	Please indicate your interest in the following possible 2012 educational programs:

	(Select all that apply.)
	Introduction to ICD-10: "ICD-10 Will Change Everything"
	ICD-10 Code Set Training
	Anatomy and Physiology in Preparation for ICD-10
	Documentation Requirements for ICD-10
	Certified Professional Coder Exam prep
	Medical Chart Auditing
	Other:

12.	Which option below do you prefer for educational programs?

	(Select all that apply.)
	half day morning
	half day afternoon
	full day courses
	online
	Best day of week:

13.	Do continuing education credits contribute to your decision to attend educational programs?

	yes
	no

14.	Who in your practice will ensure that ICD-10 is implemented?

	(Select all that apply.)
	Practice Administrator
	Physician
	Project Manager/Outside Consultant
	Certified Coding Professional
	Designated IT Staff Member
	Other:

15.	What best describes your ICD-10 training budget for 2012?

	$0 -- this will not impact our practice
	$1 - $100 per impacted employee
	$101 - $500 per impacted employee
	Other:

16.	Has your software vendor demonstrated ability to implement ICD-10?

	yes
	no

17.	If you answered "yes" to question 16, please name the vendor (optional).

18.	Within your organization, do available CME credits influence physician/provider attendance at educational programs?

	yes
	no
	unknown

19.	Within your organization, what days and times seem to work best for physician/provider educational evens outside of the office?

20.	Is ICD-10 implementation in your overall strategic plan?

	yes
	no
	unknown

21.	Please add any additional topics of interest for 2012 educational programs.