[Federal Register Volume 76, Number 11 (Tuesday, January 18, 2011)]
[Pages 2911-2913]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-410]



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: ``Barriers to Meaningful Use in Medicaid.'' In accordance with 
the Paperwork Reduction Act, 44 U.S.C. 3501-3520, AHRQ invites the 
public to comment on this proposed information collection.

DATES: Comments on this notice must be received by March 21, 2011.

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.

Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].


Proposed Project

Barriers to Meaningful Use in Medicaid

    The Health Information Technology for Economic and Clinical Health 
(HITECH) Act, Title XIII of Division A and Title IV of Division B of 
the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111-
5), provides for financial incentives for Medicaid providers to adopt 
and meaningfully use certified electronic health record (EHR) 
technologies. To ensure that eligible professionals (EPs) are able to 
qualify for and access these incentives, AHRQ proposes a two-year 
project with the objective of understanding the barriers that Medicaid 
health providers encounter along the way to achieving the meaningful 
use of EHRs. This proposed information collection will allow AHRQ to 
synthesize knowledge regarding the barriers that BPs encounter when 
attempting to achieve meaningful use and translate that knowledge to 
develop technical assistance and support implementation and use of 
    Further, health care providers who serve Medicaid beneficiaries are 
serving many of AHRQ's priority populations: Inner city; rural; low 
income; minority; women; children; elderly; and those with special 
health care needs. The project is designed to solicit actionable 
recommendations on what activities can best help Medicaid providers 
take advantage of incentive payments, achieve meaningful use, and 
ultimately use health IT to improve health care for the Medicaid 
population. The information gathered under this project will also be 
used to inform the development of the Stage 2 and 3 Meaningful Use 
    In order to gather, analyze, and synthesize information on the 
barriers to the meaningful use criteria experienced by Medicaid 
providers this research has the following goals:
    (1) Identify the barriers to eligibility for the incentive 
payments; barriers to adoption, implementation, or upgrading of ERR 
systems; and barriers to achieving meaningful use.
    (2) Develop actionable recommendations to overcoming the barriers 
identified in 1 above, including, but not limited to, 
technical assistance that could be made available to Medicaid 
    (3) Provide data to inform the meaningful use objectives being 
developed by the Center for Medicare & Medicaid Services (CMS) for 
Stages 2 and 3 of the EHR Incentive Program.
    This study is being conducted by AHRQ through its contractor, RTI 
International, pursuant to AHRQ's statutory authority to conduct and 
support research to advance both training for health care practitioners 
in the use of information systems and the use of computer-based health 
records. 42 U.S.C. 299b-3(a)(2) and (6).

[[Page 2912]]

Method of Collection

    To achieve the goals of this project the following data collections 
will be implemented:
    (1) A screening questionnaire will be used to identify eligible 
participants, as part of the sampling procedure for the focus groups. 
Appended to the screening questionnaire is a series of questions for 
individuals who have agreed to participate in the focus groups, in 
order to collect descriptive and demographic information prior to the 
focus group session, and as part of the analysis plan.
    (2) Nine focus groups will include 6-11 EPs per group, containing a 
mix of pediatricians, other physicians, dentists, nurse practitioners, 
and certified nurse midwives. Focus groups with community health center 
(CHC) and rural health center (RHC)-based providers will also include 
physician assistants and administrators. Four of the focus groups will 
include providers in private practice (excluding dentists), an 
additional four will include providers working in CHCs or RHCs, and the 
final group will be comprised of private practice dentists. Private 
practice dentists are being considered separately due to the fact that 
their practice patterns are likely to vary substantially from those of 
primary care physicians and non-physician providers. The purpose of 
these focus groups is to gather information about adoption issues 
(factors in the decision to adopt an EHR), implementation issues 
(organizational or environmental factors that facilitate EHR 
implementation and training), upgrade issues (challenges to 
transitioning to certified EHRs), and challenges to achieving 
meaningful use of ERRS as defined for Stage 1 in the final rule for the 
Medicare and Medicaid ERR Incentive Program (75 FR 44314) (particular 
functions that are problematic, the source of the challenge). Responses 
will also address topics related to participants' knowledge of the ERR 
incentive program and other factors that may facilitate EHR use. The 
focus group moderator will use a moderator's guide to guide discussion. 
Show cards will provide key reminders of content for discussion.
    The information will be used to develop actionable recommendations 
to overcoming barriers to meaningful use of EHRs for Medicaid 
providers, including but not limited to technical assistance that could 
be made available to Medicaid providers. Furthermore, the data gathered 
through this research will inform the meaningful use objectives being 
developed by CMS for Stages 2 and 3 of the EHR Incentive Program. Three 
types of information will be collected: List of potential focus group 
participants, descriptive and demographic information about focus group 
participants, and the information gathered at each focus group related 
to the barriers to meaningful use. The information will be synthesized 
to provide information to the Federal government to inform the future 
meaningful use regulations and understand any disparities potentially 
resulting from the implementation of the incentive programs.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this research. The screening 
questionnaire will be completed by 300 clinicians and will take 12 
minutes to complete on average. Focus groups will be conducted with not 
more than 89 clinicians and will last about 2 hours. The total annual 
burden hours are estimated to be 238 hours.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondents' time to participate in this research. The total 
annual cost burden is estimated to be $15,902.

                                  Exhibit 1--Estimated Annualized Burden Hours
                                                                     Number of
                 Data collection                     Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
Screening Questionnaire.........................             300               1           12/60              60
Focus Groups....................................              89               1               2             178
    Total.......................................             389              na              na             238

                                   Exhibit 2--Estimated Annualized Cost Burden
                                                     Number of     Total burden   Average hourly    Total cost
                 Data collection                    respondents        hours        wage rate *       burden
Screening Questionnaire.........................             300              60           66.82          $4,009
Focus Groups....................................              89             178           66.82          11,893
    Total.......................................             389             238              na          15,902
* Hourly wage rate is the weighted average of hourly rates of the types of professionals who will be
  participating in the focus groups. The weighted average includes the following occupational codes and wage
  rates: 29-1065 (Pediatricians, General), $78.67; 29-1069 (Physicians and Surgeons, All Other), $97.35; 29-1021
  (Dentists, General), $76.61; 29-1111 (Registered Nurses), $32.35; 11-9111 (Medical and Health Services
  Managers), $40.85; 29-1071 (Physician Assistants), $41.86. Source: ``National Compensation Survey:
  Occupational wages in the United States 2009,'' U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the estimated total and annualized cost to the 
government for conducting this research. The total cost is estimated to 
be $424,493.

[[Page 2913]]

             Exhibit 3--Estimated Total and Annualized Cost
             Cost component                 Total cost         cost
Project Development.....................         $79,313         $39,657
Data Collection Activities..............          99,464          49,732
Data Processing and Analysis............          49,732          24,866
Publication of Results..................          38,415          19,208
Project Management......................          37,601          18,801
Overhead................................         119,968          59,984
    Total...............................         424,493         212,247

Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQs 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 healthcare research and healthcare 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: January 4, 2011.
Carolyn M. Clancy,
[FR Doc. 2011-410 Filed 1-14-11; 8:45 am]