To confirm your participation and register for the iHT2 Health IT Summit in New York City taking place September 19-20, 2012 please complete the online registration form below. Once we have processed your registration you will receive an email confirming your attendance. Please note that none of your information will be shared with any 3rd parties. Please also note that your complimentary pass does not include lunches for both days of the Summit. To purchase the lunches ($59) and ticket to the networking cocktail reception please click on the lunch link in your confirmation email you receive upon completing this registration.

***As a result of the limited supply and high demand for this program, iHT2 will be taking all registrants credit card information in the secure form. The card WILL NOT BE CHARGED; however, any registrant that cannot make the Summit must contact Matthew Raynor at 561-748-6281 by COB on September 17th or your credit card will be charged the conference pass fee of $195. Any questions please do not hesitate to call.
 
 
 
Are you a provider, payer, physician, government employee, or education employee?
 
Provider
 
Payer
 
Physician
 
Government Employee
 
Education Employee
 
Other
 
 
 
 
How did you learn about the Health IT Summit in New York City?
 
Brochure
 
Email
 
Web Site
 
Press Release
 
Printed Invitation
 
Referral
 
Other
 
 
 
 
PROMO CODE:
   
 
 
 
Did you receive this invitation from a Technology Provider as a referral?
 
Yes
 
No
 
 
 
If Yes, please provide the Technology Provider's 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
 
Multi Hospital System
 
Physician Group
 
Federal Government
 
Group Purchasing Organization
 
Integrated Delivery Network
 
Healthcare Payer
 
State Government
 
Other
 
 
 
 
Which topics as they relate to IT, do you feel are a focus for your organization?
 
Information Management
 
Data Retention
 
Business Process Management
 
Business Intelligence
 
Revenue Cycle Management
 
Care Management
 
Health Information Exchanges
 
Evidence Based Medicine
 
CRM (Customer Relationship Management)
 
Ambulatory Care
 
IT Services Market Landscape
 
CPOE
 
Clinical Systems
 
US NHIN
 
Accountable Care Organizations
 
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 level of involvement do you have in the decision making process when it comes to IT purchases?
 
Recommender
 
Final Decision Maker
 
Influencer
 
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
 
 
 
What topics are you interested in learning about? (Select all that apply)
 
Accountable Care Organizations
 
Innovation in Health Care
 
Breach Avoidance
 
Transition to ICD-10
 
Mobile Health
 
Health Information Exchange
 
Meaningful Use
 
Data and Analytics
 
Cloud Computing
 
Other (please specify)
 

 
 
 
What are your goals and objectives for attending this program? (Select all that apply)?
 
Networking with Other Health IT Executives
 
Learning about the Latest Industry Trends
 
Learn Best Practices
 
Learn New Skills – How to’s
 
Hear from Industry Experts
 
Get New Ideas
 
Discuss Common Problems
 
Meet with Like Minded People
 
Meet with Vendors and Solution Providers
 
Other (please specify)
 

 
 
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 12-18 month 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
High Medium Low
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
 
 
 
Do you currently have an EMR?
 
Yes
 
No
 
 
 
If yes, please specify what software (and if you have more than one please specify)
   
 
 
 
Has your organization attested for Stage 1 Meaningful Use?
 
Yes
 
No
 
 
 
First Name
   
Last Name
   
Job Title
   
Company
   
Address
   
City
   
State
   
Zip
   
Phone
   
Email Address
   
Association Membership Number
   
 
 
 
Please enter your credit card information below. Your card will not be charged provided you check-in on the first day of the Summit or follow the cancellation policy by canceling on or before September 17th. If you prefer to give your credit card information over the phone please contact Matthew Raynor at 561-748-6281. *This is a secure form.
 
 
 
Credit Card Type
   
Credit Card Number (please no dashes)
   
Security Code (located on the back)
   
Credit Card Expiration Date
   
 
 
 
Registration Type
 
Complimentary Registration - $0
 
 
 
As an iHT2 registrant you’re entitled to a free subscription to Health IT SmartBrief: a concise, comprehensive e-mail news briefing of the day’s top healthcare IT stories, delivered three times per week
 
Yes please subscribe me
 
No thank you
 
Already a subscriber
 
 
 
Please process my registration for the iHT2 Health IT Summit in New York City. I agree by clicking below that I am confirming my attendance.
 
100%
Survey Software Powered by QuestionPro Survey Software