[Federal Register Volume 73, Number 237 (Tuesday, December 9, 2008)]
[Notices]
[Pages 74721-74723]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-28901]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Health Care Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Health Care Research and Quality, HHS.

ACTION: Notice.

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

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request the Office of 
Management and Budget (OMB) to allow the proposed information 
collection project: ``Overcoming Barriers to Expanded Health 
Information Exchange (HIE) Participation in Indiana.'' 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.
    This proposed information collection was previously published in 
the Federal Register on June 10th, 2008 and allowed 60 days for public 
comment. No comments were received. The purpose of this notice is to 
allow an additional 30 days for public comment.

DATES: Comments on this notice must be received by January 8, 2009.

ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk 
Officer by fax at (202) 395-6974 (Attention: AHRQ's desk officer) or by 
e-mail at [email protected] (attention: AHRQ's desk 
officer).
    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

    ``Overcoming Barriers to Expanded Health Information Exchange (HIE) 
Participation in Indiana.''
    AHRQ, through its contractor, the Regenstrief Institute at Indiana 
University, proposes to assess the barriers to participation in health 
information exchange (HIE) in Indiana. The Regenstrief Institute will 
use its experience to date working with a variety of organizations to 
establish specific barriers to engagement in HIE cited by stakeholders, 
define the barriers and evaluate them.
    The Regenstrief Institute will develop and implement a 
questionnaire and survey process to identify barriers that may exist 
throughout the State of Indiana to participation in the Indiana Network 
of Patient Care (INPC). The INPC is a local health information 
infrastructure that includes information from five major hospital 
systems (fifteen separate hospitals), the county and State public 
health departments, and Indiana Medicaid and RxHub. The INPC began 
operation seven years ago and is one of the first examples of a local 
health information infrastructure.
    This research will elicit and aggregate feedback from large and 
small physician groups, as well as hospitals, throughout the State of 
Indiana. The goal is to identify the gaps in understanding, barriers 
and disconnects that may exist with providers' adoption of, and 
membership in, the INPC. The relationship between the stakeholders 
involved in the Indiana HIE is governed by a contract between the 
participants. The Regenstrief Institute, acting on behalf of the 
participants, created and operates the exchange, including serving as 
the custodian of the data.
    The Regenstrief Institute will survey three key stakeholder groups 
in the State of Indiana: Small hospitals, small physician practices 
(less than 5 providers) and large physician practices (greater than 20 
providers) to identify barriers for each of these groups to participate 
in a HIE in general, and specifically the INPC. It is difficult to 
predict the barriers that will be identified, but based on their 
experience to date, anecdotal evidence suggests that

[[Page 74722]]

the cost of interfaces and the management attention needed to 
participate will be the two major barriers. The findings will be used 
to create approaches to engage specific entities to participate in 
their statewide HIE.
    This project is being conducted pursuant to AHRQ's statutory 
mandates to conduct and support research, evaluations and initiatives 
to advance information systems for health care improvement (42 U.S.C. 
299b-3) and to promote innovations in evidence-based health care 
practices and technologies by conducting and supporting research on the 
development, diffusion, and use of health care technology (42 U.S.C. 
299b-5(a)(1)). This project is also being conducted pursuant to a 
modification to an earlier AHRQ request for proposals entitled ``State 
and Regional Demonstrations in Health Information Technology'' (issued 
under contract 290-04-0015).

Method of Collection

    To ease the burden on the participating health care providers a 
Web-based questionnaire will be used. An initial screener interview 
will be conducted by telephone to describe the purpose of the survey 
and the survey process and to request the hospital's or physician 
practice's participation in the survey. After a hospital or practice 
agrees to participate, a communication packet will be sent by e-mail to 
the contact person identified during the telephone screening. The 
communication packet includes: (a) An HIE description and definition; 
(b) description of the INPC, its mission, overall direction, and other 
relevant background information; and (c) purpose for the contact, 
estimated time required to complete the Web-based questionnaire and a 
link to the questionnaire.
    Responses to the survey are expected from about 20 hospitals and 40 
physician practices of each size. Two to three individuals from each 
hospital will be asked to respond to the questionnaire. For physician 
practices, one person from each practice will be asked to respond: A 
practice manager, director of technology, or person occupying a similar 
role.
    Following the completion of the Web-based questionnaire, 
respondents will be re-contacted by telephone for a follow-up 
interview. The purpose of the follow-up interview is to determine the 
steps necessary to overcome the barriers to HIE identified in the Web-
based questionnaire. A structured interview guide has been developed 
with standard questions for the telephone follow-up.
    The data will be aggregated, analyzed and a final report will be 
prepared that focuses on the following major topic areas:
    a. General perceptions on electronic sharing of health information;
    b. The extent to which electronic health information sharing exists 
in the contact's current environment;
    c. Barriers to the adoption and implementation of electronic health 
information sharing and, specifically, INPC; and
    d. Recommendations for addressing and resolving issues preventing 
the adoption of HIE (general as well as entity-specific 
recommendations).
    This information will assist AHRQ's mission to advance ``the 
creation of effective linkages between various sources of health 
information, including the development of information networks.'' 42 
U.S.C. 299b-3(a)(3). A seventy-five percent (75%) response rate is 
anticipated.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this research. A screener interview 
will be completed once by each of the 20 hospitals and 80 physician 
practices and is expected to require about 5 minutes to complete. The 
Web-based questionnaire will be completed by an average of 3 persons 
from each of the 20 hospitals and by one person from each of the 80 
physician practices and will take about 10 minutes to complete. The 
telephone follow-up interview will be conducted with each person that 
completed the Web-based questionnaire and is expected to last about 15 
minutes. The total burden hours for the participating health care 
providers is estimated to be 66 hours.
    Exhibit 2 shows the estimated annualized cost burden to the 
responding health care providers based on their time to participate in 
this research. The total cost burden is estimated to be $3,074.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Screener........................................             100               1            5/60               8
Web-based Questionnaire.........................             100             1.4           10/60              23
Telephone Follow-up Interview...................             100             1.4           15/60              35
                                                 ---------------------------------------------------------------
    Total.......................................             300              na              na              66
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                    Form name                        Number of     Total burden     hourly wage     Total cost
                                                    respondents        hours          rate *          burden
----------------------------------------------------------------------------------------------------------------
Screener........................................             100               8          $46.58            $373
Web-based Questionnaire.........................             100              23           46.58           1,071
Telephone Follow-up Interview...................             100              35           46.58           1,630
                                                 ---------------------------------------------------------------
    Total.......................................             300              66              na           3,074
----------------------------------------------------------------------------------------------------------------
* Based upon the average of the ``Wage estimates, mean hourly'' for the following occupation codes and titles:
  11-101/Chief executives; 13-0000/Business and financial operations occupations; 15-1071/Network and computer
  systems administrators; 29-1062/Family and general practitioners; 11-9111/Medical and health services
  managers, from the ``May 2007 State Occupational Employment and Wage Estimates, Indiana; Occupational
  Employment Statistics, U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/oes/current/oes_in.htm.''


[[Page 74723]]

Estimated Annual Costs to the Federal Government

    This project will last for one year and is estimated to cost the 
government $120,000. The scope of work includes the development of the 
survey instruments and data collection ($90,000), and data analysis 
($10,000) to establish specific barriers to HIE participation cited by 
stakeholders and to define and evaluate them ($20,000).

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 
functions 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 on 
the information to be collected; and (d) ways to minimize the burden of 
the collection of information on 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: December 1, 2008.
Carolyn M. Clancy,
Director.
 [FR Doc. E8-28901 Filed 12-8-08; 8:45 am]
BILLING CODE 4160-90-M