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

You will be contacted shortly in regards to your application.

All fields required
Are you a Payer or Provider?
Payer    Provider  
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 IT Services Market Landscape
Revenue Cycle Management Global Technology Initiatives
Care Management Clinical Systems
RHIOs US NHIN
Other
Do you currently have integrated solutions that enable you to effectively support and manage healthcare business and IT requirements?
Yes    No  
Do you purchase through a solution provider (VAR)? Yes   No
If yes, who?
Do you plan to implement additional healthcare IT solutions within your organization in the next 12 - 24 months that supports your initiatives?
Yes    No  
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 percentage of your annual IT budget is spent on the following six categories?
Hardware
Infrastructure
Software
Healthcare IT Solutions
IT Services
IT Staff
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
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
BI
Business & Technology Issues
Collaboration
Compliance/Risk Management
Computing Infrastructure
CRM
Enterprise Content Management
ERP
IT Management
Linux/Open Source in production environment
Mobile Workforce
Networking
Outsourcing
Project & Portfolio Management
SaaS/Managed Services/On-demand
Security
Storage
Unified Communications
Multifunctional Print Products
Business Process Management
Virtualization
   Desktop
   Server


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