Form #1 Form #1 MONAHRQ Host User Group Questionnaire

Form Approved
OMB No. 0935-0179
Exp. Date 7/31/2014

MONAHRQ Host User Group Questionnaire

Purpose:

We are seeking your input in forming the MONAHRQ Host User Group to ensure that it meets your needs.

1. How are you currently using MONAHRQ? (Please select all that apply.)

1. To build a public reporting site

2. As a private reporting site

3. To run internal analytics

4. Other (Please specify)

e. I am not currently using MONAHRQ software but may be interested in using it in the future

(If you selected (e), please specify why you are not using MONAHRQ at this time.)

2. What topics would you like to discuss on future MONAHRQ Host User Group conference calls or webinars? (Please select all that apply.)

1. Provide input on current and future functions and usability

2. Learn about other users’ experiences

3. Explore ideas to encourage stakeholders to visit and use your MONAHRQ-generated public reporting website

4. Get information to make the business case for using MONAHRQ

5. Other (Please specify)

3. If you use MONAHRQ, please share a success or challenge you have encountered in the process.

3. What would you like to be able to do using MONAHRQ?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0179) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

3. Do you find feature X useful? (Question will be refined based on specific version of MONAHRQ)

   1. Yes (Please comment about how you use it)

2. No (Please comment about why not)

3. What do you think about new functionality X? (Question will be refined based on

specific version of MONAHRQ)

3. W hat technical support issues, if any, do you want to explore?

3. Do you have any other comments or suggestions for us?

3. Would you be willing / interested in speaking with AHRQ about additional suggestions? If so, please provide your contact information below.

F ull Name:

Required Field

Email Address: Required Field

Organization: Required Field

Phone:

3. If there is someone in your organization who should also receive updates about the MONAHRQ Host User Group, please provide their contact information.

F ull name:

Email Address:

C onfirm

Email Address:

Organization:

Phone:

3