EMR Survey

Confidential Provider Survey

I am a conducting an independent study regarding the awareness of electronic medical records in St. Lucia. Choosing to transition from paper charts to electronic medical records requires an understanding of the benefits and the willingness to change certain business processes. This survey will help identify the need for such system in St. Lucia as well as their viability.

Practice Name:_________________________ Speciality:_____________________

Practice Phone: _______________ Address:____________________

Provider Name: ________________ Provider Type (e.g. MD): __________________

Phone:________________ E-Mail:__________________

* 1. What is your date of birth?

Month	Day	Year

* 2. What year did you graduate from medical/professional school?

Month	Day	Year

* 3. How long have you been associated with your practice/practice group?

* 4. What is your sub-specialty?

* 5. In a typical week, how many different outpatient offices do you see patients?

One

Two

Three or More

* 6. What percent of your outpatient clinic time is spent at your practice?

< 25%

25-49%

50-75%

> 75%

* 7. Are you a physician owner of your own practice?

Yes

* 8. Number of hours spent seeing patients at your office per week?

* 9. How many patients do you see per day? (average)