Needs Assessment Questionnaire
Respondent Number:
Name (Optional):_______________________________________Age:______Sex:_______
Position: ______________________________Unit/Department: _____________________
Please answer the questions below:
1. Do you utilize computer technologies to manage information in your job?
Yes
No, go to question #3
2. What specific computer technology/ies do you use to manage information?
Software:
spreadsheet
word processor
Computerized Patient Order Entry (CPOE)
Electronic Medical Record (database)
Others, please specify
Hardware:
desktop computer
laptop
tablet
mobile phone
printer
speaker
Others, please specify
Telecommunications:
Internet connection
Website
Local area network
Intranet
Extranet
Online referral system
Others, please specify
3. How do you perform data processing?
Collection:
Handed-in as a paper document
Document is captured through scanner
Data is encoded through computer keyboard
Data is encoded through mobile devices
Accessed from sources through a computer network
Others, please specify
Dissemination:
Shared as it is (paper document)
Shared as a summary document (hardcopy)
Shared as a file using external storage devices
Shared as a processed data through a computer network
Others, please specify
4. Have you encountered some errors or malfunctions on the use of technologies in your
job?
Yes
No
If Yes, what were the nature of the error/s?
Corrupted files
Virus
Inconsistent records
Others, please specify
________________________________________________________________
5. How many of your employees are capable of using ICT equipment. Please give the
percentage:
________________________________________________________________
6. Do you think it is important to have basic skills on the use of computer technologies?
Yes
No
7. If you could make changes/enhancements to your current information system, what
would they be?
Updated computer operating system
Electronic Health record(*complied patient history, including clinical or lab results,
as well as medications and allergies)
Computerized Patient Order Entry ( for ordering diagnosis tests and medications)
Clinical Decision Support (for automatic alerts of medication allergies and
treatment risks, and other clinical risks)
Data analytics (for automated census)
Automated clearance and billing
Automated scheduling of clinical tasks
Others, please specify
Signature of Respondent Date