Illinois Health Information Technology Regional Extension Center
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Qualification Survey
Primary care physicians in an ambulatory care setting may be eligible for subsidized technical assistance for implementing electronic health record (EHR) and other health information technology (HIT) activities through the new, federally-funded Health Information Technology Regional Extension Center (HITREC) program. The federal government is making funds available to provide technical assistance for EHR and other HIT activities to help providers become eligible for Center for Medicare & Medicaid (CMS) meaningful use incentives.
The Illinois Health Information Technology Regional Extension Center (IL-HITREC) provides services to priority primary care physicians to adopt and meaningfully use electronic health record systems in Illinois, outside of the City of Chicago. The cost of these services is subsidized through an award from the Office of the National Coordinator, Department of Health and Human Services (Grant 90RC0023/01). Fee based services are also available to providers who are not designated by the Office of the National Coordinator to receive subsidized services.

Services provided to participating providers include:
  • Vendor Selection & Group Purchasing
  • EHR Implementation and Project Management
  • Practice and Workflow Redesign
  • Functional Interoperability and Health Information Exchange
  • Privacy and Security Best Practices
  • Attaining Meaningful Use as defined by ONC

IL-HITREC is administered by Northern Illinois University with satellite offices located in the southern region (Southern Illinois Healthcare Foundation), central region (Quality Quest for Health of Illinois), northwest region (Northern Illinois University), and the northeast region (Metropolitan Chicago Healthcare Council). IL-HITREC also collaborates with the Chicago Health Information Technology Regional Extension Center administered by Northwestern University which serves physicians in the City of Chicago.

We encourage you to participate by completing the following Qualification survey if you are interested in utilizing IL-HITREC services.
Practice Name
Practice Tax ID (FEIN) Organizational NPI
Address County
Primary Contact Email
Telephone Fax
1. Number of primary care providers in this practice:
Family Practice Nurse Practitioner with prescribing privileges
General Practice OB-GYN
Geriatrics Pediatrics
Internal Medicine Physician Assistant with prescribing privileges
Other Nurse Midwife with prescribing privileges
List specialties

2. Are you affiliated with a:
(check all that apply)
Small Group Practice (10 or less providers)
Critical Access Hospital
Rural Hospital (< 50 beds)
Community Health Center (FQHC)
Rural Health Clinic
a setting serving predominately uninsured, underinsured, or underserved populations

3. What is your primary practice hospital?  

4. EHR Status
Our practice currently uses an electronic health record system.
System and Version
Our practice plans to implement an EHR on (date).
System and Version
Our practice does not currently use an EHR.

5. What percent of your patients are on Medicaid? %



6. What percent of your patients are on Medicare? %

Completed By:
Name
Phone
Email


Thank you for taking time to complete the Qualification survey.                          


ILHITREC P.O. Box 755, Sycamore, IL 60178 Ph: 815-753-1136 Fax: 815-753-2460


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