Table 1. Questions sent to the survey participants.
| Study question | Questionnaire questions |
|---|---|
| Part I: descriptive data | |
| – | What is the ownership of your health system? (for profit, not for profit, public) |
| – | Number of inpatient beds? |
| – | Number of outpatient visits? |
| – | Years developing homegrown systems? |
| – | To what commercial EHR did you transition? |
| – | In what year did inpatient settings transition to the commercial EHR? |
| – | In what year did outpatient settings transition to the commercial EHR? |
| – | Part II: open-ended questions |
| – | 1. Please briefly describe the history of the development of the homegrown EHR system(s) used prior to the commercial EHR adoption. In what type of setting was/were it used (inpatient versus outpatient) and what were the most important functions provided by the system(s)? |
| Study question 1 | 2. Please briefly explain the rational for replacing the homegrown system(s) with a commercial EHR. Was there something missing in the legacy system(s)? Did the MU program play a role in the decision? If so, what was MU's role? |
| Study question 1 | 3. Did your organization maintain the homegrown system(s) for a given period after completing the transition to the commercial EHR? |
| – | If yes (to question 3): |
| Study question 2 | a. What was the rationale for maintaining the system(s)? Was there any reluctance to stop using it or did the system continue to add value to your organization? |
| Study question 2 | b. For how long the system(s) was/were maintained? Were all new data generated in the commercial EHR added to the homegrown system(s), only some data, or was/were the homegrown system(s) used only for historical purposes? |
| Study question 2 | c. How is(are) the system(s) used today or how was it used while being maintained? Was it fully operational or was it on a read-only mode? Please can you provide a few examples of how the system is/was used while it was maintained? |
| Study question 2 | d. Is there a formal process/procedure for EHR downtime (i.e., EHR not available/accessible) at your organization? If yes, please can you briefly describe what is/are the procedure(s)? |
| Study question 3 | e. Can you estimate the monthly/annual cost of maintaining the homegrown system(s) at your organization? Can you estimate the % of IT or informatics personnel allocated to maintain the system(s)? |
| Study question 3 | f. Did your organization have a terminology or knowledge management database prior to the commercial EHR adoption? If so, how did the transition to a commercial EHR impact the management of such databases? Are they still in use today? For what purposes? |
| – | If no (question 3): |
| Study question 2 | g. Is there a formal process/procedure for EHR downtime (i.e., EHR not available/accessible) at your organization? If yes, please can you briefly describe what is/are the procedure(s)? |
| Study question 4 | 4. Does your organization continue to develop local applications to be connected to the commercial EHR? If so, what is the rational for developing such applications locally and not through customizations of the commercial EHR? Do local applications use data exchange standards to interface with the vended EHR such as HL7 FHIR or use vendor's proprietary APIs? |
| Part III: snowball sampling questions | |
| – | 1. Do you know any other employee from informatics or clinical departments at your institution who is/were directly affected by the homegrown systems here discussed and would recommend for this survey? |
| – | 2. Do you recommend any other healthcare system with a known history of homegrown systems' development to be included in this study? |
Abbreviations: APIs, application programming interfaces; FHIR, fast healthcare interoperability resources; EHR, electronic health record; HL7, health level 7; IT, information technology; MU, Meaningful Use.