Health Management Technology
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2. For auditing purposes, please enter the high school you last attended: (Provide last school attended if high school does not apply.)


3. Please select the category that best describes your title: (select only one)
General and Financial Management Information Management cont.
CEO, President, Executive Director, Administrator Other IT Personnel (please specify below)
CFO, Finance Director/Manager Network/MIS/Data Processing Director/Manager
CSO/Security Officer/Director Health Information Director/Manager
Planning Officer/Director Coding/DRG Director/Manager
Marketing Officer/Director Systems Administrator/Analyst/Network Specialist/Project Manager
COO, VP, Assistant Administrator Clinical Management
CCO, Compliance Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs
CPO/Purchasing/Materials Management Director/Manager Chief of Pathology/Pathologist
Quality Officer/Director Chief of Radiology/Radiologist
Other Administrative Title (please specify below) Other Clinical Administration (please specify below)
Information Management Chief of Laboratory Services/Lab Administrator
CIO, VP of Information Systems, Tech Officer Chief of Pharmacy/Pharmacist
Chief of Medical Records/Medical Records Manager Chief/VP of Nursing Services/Asst Director/Case Manager
Director/Manager of Medical Informatics Other Title (please specify)
Director/Manager of Telecommunications/Call Center Director/Manager


4. Please indicate type of Facility / Service / Firm: (select only one)
Hospital/Multi-Hospital System Managed Care Organization (HMO, PPO, Healthplans)
Integrated Delivery System/Health Network Insurance Company
University/Teaching Medical Center/Hospital Third Party Administrators (TPA)/Self-Insured Employer
Military/Government Medical Center/Hospital Pharmacy/Independent Lab
Clinical/Group Practice IT Consulting/Systems Integration
Physician Organization (IPA/PHO) Consulting Firm
Ambulatory Care Center VAR/Vendor of Systems
Long-Term/Sub Acute Care Facility/Nursing Home/Rehab Other (Please Specify)
Home Health Care Agency


5. Number of physicians in your organization: (select only one)
More than 300 10 - 19
100 - 299 4 - 9
50 - 99 1 - 3
20 - 49 Not applicable


6. Number of beds in your organization: (select only one)
over 1000 100 - 199
500 - 999 50 - 99
400 - 499 1 - 49
300 - 399 not applicable
200 - 299


7. Annual budget for information technology products and services: (select only one)
$10 million + $1 - $1.999 million
$7 - $9.999 million $500,000 - $999,999
$5 - $6.999 million $100,000 - $499,999
$3 - $4.999 million under $100,000
$2 - $2.999 million


8. For payers, the number of lives covered by your organization: (select only one)
10 million or more 250,000 - 500,000
5 - 10 million 100,000 - 250,000
2 - 5 million 50,000 - 100,000
1 - 2 million under 50,000
500,000 to 1 million not applicable


9. Indicate the type of product & services you recommended, specified or approved for purchase: (select all that apply)
Hardware Software cont.
Disaster Recovery/Preparedness EMR/EHR
Mobile Workstations/POC Systems EDIS/OR/Perioperative Systems
Monitors/Displays Financial/Billing Systems
Printers/Copiers/Scanners Hospital/Healthcare Info Systems
Tablets/PDAs/Handhelds/Laptops Managed Care Systems
Services Materials Management/eProcurement
ASP/Internet/Intranet Services Medication Management/Drug Info Systems
Call Centers/Telecommunications Physician Practice Management
Software Radiology Systems/PACs/RIS/Diagnostic Imaging
Bar Coding/RFID/Tracking Systems Scheduling Systems
Claims - Coding, Processing Security/Authentication/Biometrics
Clinical Information Systems Voice Recognition/Transcription
Data Storage/Mining Wireless Applications
Decision Support: Clinical/Financial Workflow Automation
Document Management/Imaging Other (please specify)
Electronic Data Interchange (EDI)
None of the above


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