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iDynaForm pilot study sign-up

Thank you for your interest in the iDynaForm pilot study.

This survey will collect demographic information about you and your practice and will act as your online application to join the pilot study.

Thank you in advance for your participation. For more information about the iDynaForm, please click here.
1. 1. Does your practice have allied health professionals who assist in patient care?
2. 1. a. Are they interested in using the iDynaForm?
2. 2. Has your practice used staff as Project Champions to help introduce and test new EMR-based tools or programs?A Project Champion will help lead the implementation of the tool and serve as the primary point of contact for the project team.
3. 2. a. Would that person be willing to act as a Project Champion again?
3. 2. a. Would your team be willing to identify a staff member to act as a Project Champion?
3. 3. Please assess your practice's level of EMR use & proficiency across each EMR functional area.  These criteria and functional areas are adapted from the OntarioMD EMR Maturity Model.
Hover your mouse over the underlined text or click for additional information about the criteria.
Space Cell Level 0
Level 1
Data entry(E.g. electronic documentation, notes, forms)
Level 2
Early data use(E.g. forms, calculators, quick entry tools)
Level 3
Look ahead/predict(E.g. point-of-care reminders, alerts, regular searches)
Diagnosis and treatment support (e.g. point-of-care tools, lab results, prescriptions)
Information management (e.g. encounter documentation)
Practice management (e.g. appointment scheduling, billing)
4. 4. Are you interested in receiving a demonstration of this tool?
5. 5. Please provide your contact information:
This question requires a valid email address.

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