[Federal Register Volume 73, Number 32 (Friday, February 15, 2008)]
[Notices]
[Pages 8872-8874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 08-659]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Feasibility of secure messaging for pediatric patients with 
chronic disease: Pilot implementation in pediatric respiratory 
medicine.'' In accordance with the Paperwork Reduction Act of 1995, 44 
U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on this 
proposed information collection.

DATES: Comments on this notice must be received by April 15, 2008.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
[email protected].
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].

SUPPLEMENTARY INFORMATION: 

Proposed Project

Feasibility of Secure Messaging for Pediatric Patients With Chronic 
Disease: Pilot Implementation in Pediatric Respiratory Medicine

    AHRQ proposes to evaluate how the implementation of a secure email 
messaging (e-messaging) system between clinicians and adolescent 
patients affects: (1) Time spent by providers communicating with 
patients, (2) Emergency Department utilization for medication refills, 
and (3) qualitative satisfaction with care of the patients. The study 
will be conducted in the Yale University School of Medicine Pediatric 
Respiratory Medicine Clinic.
    Several studies have evaluated the use of e-mail between providers 
and patients and found that it is typically satisfactory to both, has 
not been abused by patients, and has not been used inappropriately for 
urgent items. Studies have not evaluated the use of e-mailing or secure 
messaging by children or adolescents with chronic diseases as well as 
their families. The setting of chronic disease provides a natural forum 
for discussion about the use of such technologies since these families 
may need more frequent contact with their care-providers, need more 
frequent medication refills, and may have close relationships with 
their providers that encourage a communication genre such as secure 
messaging.
    In particular, because many adolescents are comfortable with text 
messaging and email, the investigators hypothesize that adolescent 
patients themselves may feel empowered to contact their providers using 
this medium. This potential shift to having adolescents communicate 
with the providers presents two main hypotheses of interest. (1) 
Adolescents may be more prone to send a message that may be of an 
urgent nature because of the sense that messaging is``instant'' as well 
as a possible feeling of more privacy. This issue presents the concern 
that adolescents in particular could send a secure message about 
information that is potentially urgent in nature such as a severe 
asthma exacerbation or suicidal ideation. Such messages will need 
immediate attention. (2) Adolescents may be more apt to disclose 
questions about their care that they would not have otherwise brought 
up with the provider. By giving adolescents a medium where they feel 
comfortable communicating, clinicians may be able to better meet the 
medical and psychosocial needs of adolescents and their families.

[[Page 8873]]

Method of Collection

    The project will include 300 patient/family participants and 138 
provider participants. Data will be collected from (1) e-messaging 
content, to understand what children, adolescents and their parents 
will send in secure messages to their provider; (2) a survey, to 
determine the demographic characteristics of the patients and their 
family; and (3) qualitative interviews with patients and their families 
and clinic staff, to assess their attitudes and satisfaction with e-
messaging.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours. Each of the 
300 patient/family participants will complete a demographic survey and 
use the e-messaging system, sending an average of one e-message per 
month. Thirty of the patient/family participants will be randomly 
selected to participate in a qualitative interview. Each of the 138 
provider participants will use the e-messaging system, responding to 
about twenty-six e-messages per year, and keep a pre- and post-
intervention log of patient/provider communications. Ten provider 
participants will be randomly selected to participate in a qualitative 
interview. The total burden for all participants is estimated to be 
2,148 hours.
    Exhibit 2 shows the estimated annualized cost burden for the 
participants' time to participate in this study. The total cost burden 
for all participants is estimated to be $72,664.

                                  Exhibit 1.--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
             Interview participants                  Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Patient/Family Participants:
    Demographic Survey..........................             300               1               1             300
    E-messaging.................................             300              12           15/60             900
    Qualitative Interview.......................              30               1           30/60              15
Provider Participants:
    E-messaging.................................             138              26           15/60             900
    Qualitative Interviews......................              10               1           30/60               5
    Pre-intervention Provider Log...............             138               1            6/60              14
    Post-intervention Provider Log..............             138               1            6/60              14
                                                 ---------------------------------------------------------------
        Total...................................             438              na              na           2,148
----------------------------------------------------------------------------------------------------------------


                                  Exhibit 2.--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
             Interview participants                 respondents        hours        wage rate*        burden
----------------------------------------------------------------------------------------------------------------
Patient/Family Participants:
    Demographic Survey..........................             300             300          $26.20          $7,860
    E-messaging.................................             300             900           26.20          23,580
    Qualitative Survey..........................              30              15           26.20             393
Provider Participants:
    E-messaging.................................             138             900           43.78          39,402
    Qualitative Interviews......................              10               5           43.78             219
    Pre-intervention Provider Log...............             138            13.8           43.78             605
    Post-intervention Provider Log..............             138            13.8           43.78             605
                                                 ---------------------------------------------------------------
        Total...................................             438              na              na          72,664
----------------------------------------------------------------------------------------------------------------
* For Patient/Family Participants: Based upon the mean of the average wages for all occupations, National
  Compensation Survey, ``U.S. Department of Labor, Bureau of Labor Statistics.''
* For Provider Participants: Based upon the mean of the average wages for physicians ($65.54/hr) and nurses
  ($43.85/hr) in the New York, New Jersey, Connecticut and Pennsylvania region, National Compensation Survey,
  ``U.S. Department of Labor, Bureau of Labor Statistics.'' For Pulmonary Fellows: Based upon internal Yale
  University School of Medicine data.


[[Page 8874]]

Estimated Annual Costs to the Federal Government

    The total cost to the Federal Government for this project is 
$399,970 over a two year period. The average annual cost is $199,985. 
The following is a breakdown of the average annual costs:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
Direct Costs:
    Personnel..........................................       $159,488.5
    Consultancies......................................          5,475
    Data support.......................................          5,336.5
Indirect Costs:
    Indirect costs.....................................         29,685
                                                        ----------------
        Total..........................................        199,985
------------------------------------------------------------------------

Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ health care research and health care information dissemination 
functions, including whether the information will have practical 
utility; (b) the accuracy of AHRQ's estimate of burden (including hours 
and costs) of the proposed collection(s) of information; (c) ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and (d) ways to minimize the burden of the collection of 
information upon the respondents, including the use of automated 
collection techniques or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection.
    All comments will become a matter of public record.

    Dated: February 6, 2008.
Carolyn M. Clancy,
Director.
[FR Doc.08-659 Filed 2-14-08; 8:45 am]
BILLING CODE 4160-90-M