We appreciate you taking the time to complete our short survey.

General qualification guidelines to attend include:

  • C-level and above executives from insurer and provider healthcare organizations
  • Must have an active role in the vendor evaluation process
  • Should have a minimum IT budget of $1 million
  • Over 100 licensed beds (providers)
  • Over 200,000 insured lives (insurers)

The above are general guidelines. Please fill out the form below to qualify. Qualified executives will receive a complimentary summit package that includes: round trip airfare, deluxe hotel accommodations, event access, meals and more.

You will be contacted shortly in regards to your application.

Are you a Payer (Insurance Organization) or a Provider (Hospital Organization)?

Payer    Provider  

PAYER

All fields required

First Name
Last Name
Company
Title
Address 1
Address 2
City
State
Postal/Zip Code
Country
Phone
E-mail
Website
How did you learn about Healthcare Summit?
If Other, please enter below
Please fill in Priority Code, if applicable
Did you receive this invitation from a Technology Provider as a referral?
Yes    No  
If Yes, please provide the Technology Provider name
Do you feel you are maximizing the use of your healthcare IT budget
and receiving the appropriate ROI?
Yes    No  
How would you best describe your organization?
Acute Care Facility Group Purchasing Organization
Multi Hospital System Integrated Delivery Network
Physician Group Healthcare Payer
Federal Government State Government
Other
Which topics as they relate to IT, do you feel are a focus for your organization?
(check all that apply)
Information Management Evidence Based Medicine
Data Retention CRM (Customer Relationship Management)
Business Process Management Ambulatory Care
Business Intelligence Revenue Cycle Management
Care Management Clinical Systems
RHIOs US NHIN
Other
What is your organization\'s annual IT budget?
Less than $500,000 $500,000 - $1 million
$1 million - $2 million $2 million - $5 million
$5 million - $10 million $10 million - $25 million
$25 million - $50 million $50 million - $100 million
$100 million - $500 million $500 million- $1 billion
More than $1 billion
What level of involvement do you have in the decision making process when it comes to IT purchases?
Recommender Influencer
Final Decision Maker None
How many people are employed in your entire organization?
1 - 99 100 - 499
500 - 999 1,000 - 2,499
2,500 - 4,999 5,000 - 9,999
More than 10,000  
How many insured lives does your organization service?
Under 200,000 200,000 - 500,000
500,000 - 1,000,000 Over 1,000,000
NA  
What is your organization\'s total annual revenue?
Less than $5 million $5 million - $50 million
$50 million - $100 million $100 million - $250 million
$250 million - $500 million More than $500 million

* . Please help us in better matching you with your peers and vendors by answering what solutions you have interest in investing in within the next 12-18month period:
High Medium Low
Application Integration
Ambulatory Care
BI & Analytics
Business Process Management
Care Management
Clinical Systems
Cloud
Collaboration
Compliance/Risk Management
CRM
Data Center
Data Protection
Data Retention
EMR/EHR
ERP
Evidence Based Medicine
Hardware
IT Infrastructure
IT Management
IT Services
Mobility
MPS
Networking
SaaS/Managed Services/On-demand
Security
SharePoint
Social Media
Storage
Unified Communications
Virtualization
   Desktop
   Server

 
Would you be interested in attending a full-day seminar on Leadership within the Healthcare IT Summit?
Yes    No  


PROVIDER

All fields required

First Name
Last Name
Company
Title
Address 1
Address 2
City
State
Postal/Zip Code
Country
Phone
E-mail
Website
How did you learn about Healthcare Summit?
If Other, please enter below
Please fill in Priority Code, if applicable
Did you receive this invitation from a Technology Provider as a referral?
Yes    No  
If Yes, please provide the Technology Provider name
Do you feel you are maximizing the use of your healthcare IT budget
and receiving the appropriate ROI?
Yes    No  
How would you best describe your organization?
Acute Care Facility Group Purchasing Organization
Multi Hospital System Integrated Delivery Network
Physician Group Healthcare Payer
Federal Government State Government
Other
Which topics as they relate to IT, do you feel are a focus for your organization?
(check all that apply)
Information Management Evidence Based Medicine
Data Retention CRM (Customer Relationship Management)
Business Process Management Ambulatory Care
Business Intelligence Revenue Cycle Management
Care Management Clinical Systems
RHIOs US NHIN
Other
What is your organization\'s annual IT budget?
Less than $500,000 $500,000 - $1 million
$1 million - $2 million $2 million - $5 million
$5 million - $10 million $10 million - $25 million
$25 million - $50 million $50 million - $100 million
$100 million - $500 million $500 million- $1 billion
More than $1 billion
What level of involvement do you have in the decision making process when it comes to IT purchases?
Recommender Influencer
Final Decision Maker None
How many people are employed in your entire organization?
1 - 99 100 - 499
500 - 999 1,000 - 2,499
2,500 - 4,999 5,000 - 9,999
More than 10,000  
What is the total number of licensed beds which your facility staffs?
Less than 100 100 - 149
150 - 199 200 - 249
250 - 499 500 - 999
More than 1,000 NA
What is your organization\'s total annual revenue?
Less than $5 million $5 million - $50 million
$50 million - $100 million $100 million - $250 million
$250 million - $500 million More than $500 million

* . Please help us in better matching you with your peers and vendors by answering what solutions you have interest in investing in within the next 12-18month period:
High Medium Low
Application Integration
Ambulatory Care
BI & Analytics
Business Process Management
Care Management
Clinical Systems
Cloud
Collaboration
Compliance/Risk Management
CRM
Data Protection
Data Retention
Data Center
EMR/EHR
ERP
Evidence Based Medicine
Hardware
IT Infrastructure
IT Management
IT Services
Mobility
MPS
Networking
SaaS/Managed Services/On-demand
Security
SharePoint
Social Media
Storage
Unified Communications
Virtualization
   Desktop
   Server

 
Would you be interested in attending a full-day seminar on Leadership within the Healthcare IT Summit?
Yes    No