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August 2022 - Feb 2023

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* 2. Have at least 80 percent of your patients used integrated digital health tools between in-person visits to communicate health information with the PHC? (Count only if a patient have used a digital health tool at least once between visits).

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* 3. Has your PHC implemented formally defined and secure health information and technology policies and practices that advance security to protect individual privacy and organizational access in at least two of the following areas: protection from misuse, threats like cybersecurity attacks, fraud, or other harms?

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* 4. Does your organization use health IT to share social risk factor data with care teams and use this data to inform care plan development? (e.g., care teams use patient reported data on food insecurity or other social risk factors to better tailor care plans/interventions and community referrals to improve chronic disease management and outcomes).

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* 5. If yes, does your PHC facilitate closed-loop referrals on at least 75 percent of patients identified as having a risk factor?

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* 6. Has your PHC sent successful test messages for electronic clinical quality measures (eCQM) and UDS+ data fields using Fast Health Interoperability Resources (FHIR) based application programming interfaces (APIs)?

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* 7. Has your PHC integrated data into structured EHR fields (i.e., not free text or attachments) from at least three external clinical and/or non-clinical sources?

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* 8. Has your PHC used advanced data strategies, such as predictive analytics with data visualization, natural language processing, and machine learning to present useful data to inform performance improvement and value-based care activities? (e.g., improve clinical quality, cost-efficient care).

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* 9. Does your PHC provide at least two formal trainings annually, along with routine support (e.g., on-demand reference materials, regular communications sharing tips or best practices, help desk) to providers and staff that promote proficiency in the use of digital health tools?

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* 10. Has your PHC reduced operational barriers to health IT usability and adoption through implementation of at least one health IT facilitated intervention annually that focuses on topics such as aligning EHRs with clinical workflows, improving structured data capture in and/or outside of EHRs, regular EHR support and trainings, or use of metadata to improve EHR user experience?

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* 11. Do your health centers currently partner with at least two community-based organizations to address health equity for your patient population?

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* 12. Does your health center receive notifications from the state HIE system when patients seek emergency medical services in an Emergency Room setting?

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* 13. What percentage of patients have used a digital tool (e.g., electronic messages sent through the patient portal to providers, remote monitoring) between visits to communicate health information with the PHC since 8/1/2022?

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* 14. What integrated digital health tools are available to patients?

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* 15. Since 8/1/2022, this PHC has implemented secure health information practices that protect patient privacy in the following areas:

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* 16. Were these practices implemented in response to a data breach, ransomware or other event?

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* 17. What secure health information practices have been implemented?

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* 18. Since 8/1/2022, what percentage of patients identified as having a risk factor has this PHC used health IT data to inform care plan development and, if applicable facilitate closed-loop referrals?

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* 19. What health IT tools did this PHC use to share social risk factor data with care teams?

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* 20. Since 8/1/2022, how many successful test messages for electronic clinical quality measures (eCQM) and UDS+ data fields using Fast Health Interoperability Resources (FHIR) based application programming interfaces (APIs) has this PHC sent? (Answer in number format)

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* 21. Since 8/1/2022, from how many external clinical and/or non-clinical sources has this PHC integrated data into structured EHR fields (i.e., not free text or
attachments)? (Answer in number format)

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* 22. From which external clinical and/or non-clinical sources did this PHC integrate data into structured EHR fields?

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* 23. Since 8/1/2022, did this PHC use advanced data strategies to present useful data to inform performance improvement and value-based care activities?

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* 24. What advanced data strategies did this PHC use?

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* 25. Since 8/1/2022, how many formal trainings that promote proficiency in the use of digital health tools did this PHC hold? (Answer in number format)

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* 26. Did this PHC provide routine support to providers and staff focused on promoting proficiency in the use of digital health tools?

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* 27. List the formal trainings and routine support provided at this PHC since 8/1/2022.

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* 28. Since 8/1/2022, how many health IT facilitated interventions to reduce operational barriers to health IT usability and adoption did this PHC implement? (Answer in number format)

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* 29. Which health IT interventions did this PHC implement?

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