HITEQ created this template, available at the bottom of this page, to assist HCCNs, PCAs, or other organizations in conducting health IT assessments of multiple health centers. The questions within this instrument were adopted from proposed UDS health IT capabilities questions and the HITEQ Center's Meaningful Use readiness assessment survey. This instrument may include some questions that are more comprehensive than some organizations need, but a secondary goal is to ease future responses to UDS and other health IT-related surveys.

• The 1st tab (Introduction) is an introduction and general instructions for this instrument. 
• The 2nd tab (A. Basic Info) captures basic information that describes each health center. 
• The 3rd tab (B. UDS Health IT) consolidates questions needed to respond to Appendix D of UDS reporting
• The 4th tab (C. Security) captures information that describes the cybersecurity activities of each health center.
• The 5th tab (D. Reporting) focuses on functionalities and abilities to create reports for both internal and external use. 
• The 6th tab (E. HIE) enumerates interoperability-related functionalities and environment. 
• The 7th tab (F. Patient Access) captures several areas related to patient access to financial and clinical information, including Patient Portal.
• The 8th tab (G. CMS EHR Incentive Program) consolidates questions needed to plan for, assess, and respond to CMS EHR Incentive Program.

How to use this tool:

1. You may choose to start by viewing the videos in the links section below, which cover all but the last tab. Note these have not been updated for 2025, but are still helpful.
2. This tool is formatted with questions (and descriptions of expected responses) in Column A.
   1. Each sheet is pre-formatted for up to 5 health centers (Column B to F), and organizations surveying more than 5 health centers can simply cut and paste additional columns as needed.
3. A potential usage scenario is for the organization (HCCN, PCA, etc.) to instruct each health center to complete the survey using column B. The organization can then collect completed surveys and simply cut and paste responses from each health center into a different column.
4. The user is expected to respond to all the cell with the LIGHT ORANGE background, illustrated by the background of this row. For your convenience, all other cells are blocked from writing. Should you need to unlock the spreadsheet for edits, the password is "HITEQ".
5. Some cells are limited to appropriate answer types for your convenience (e.g., >=0, date ranges, Y/N,… etc.)

Download the tool below!