[Federal Register Volume 76, Number 107 (Friday, June 3, 2011)]
[Pages 32207-32209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-13740]



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. 3501-3521,

[[Page 32208]]

AHRQ invites the public to comment on this proposed information 
    This proposed information collection was previously published in 
the Federal Register on March 11th, 2011 and allowed 60 days for public 
comment. One comment was 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 July 5, 2011.

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 
    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 2-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 EPs 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 EHR 
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).

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) A total of 13 focus groups will be conducted with eligible 
Medicaid providers. Eight focus groups will include a mix of 
pediatricians, other physicians, dentists, nurse practitioners, 
physician assistants, and certified nurse midwives who have adopted an 
EHR. Four of the focus groups will include providers who have not 
adopted an EHR, 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 EHRs as defined in Federal regulations for 
Stage 1 (particular functions that are problematic, the source of the 
challenge). Responses will also address topics related to participants' 
knowledge of the EHR incentive program and other factors that may 
facilitate EHR use. The focus group moderator will use the moderator's 
guide to guide discussion. The 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, except for the 
focus groups with non-users, which will last about 90 minutes. The 
total annual burden hours are estimated to be 228 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 $16,795.

Exhibit 1. Estimated Annualized Burden Hours

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                                                                     Number of
                 Data collection                     Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
Screening Questionnaire.........................             300               1           12/60              60
In-Person Focus Groups EHR Users only...........              40               1               2              80
Virtual Focus Groups EHR Users only.............              29               1               2              58
Virtual Focus Groups EHR Non-users only.........              20               1             1.5              30
    Total.......................................             389              na              na             228

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           73.66          $4,420
In-Person Focus Groups EHR Users only...........              40              80           73.66           5,893
Virtual Focus Groups EHR Users only.............              29              58           73.66           4,272
Virtual Focus Groups EHR Non-users only.........              20              30           73.66           2,210
    Total.......................................             389             228              na         $16,795
*Hourly wage rate is the weighted average of hourly rates of the types of professionals who will complete the
  screening questionnaire and participate 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 others), $97.35; 29-1021 (Dentists, General), $76.61; 29-1111 (Registered Nurses, includes Certified Nurse
  Midwives), $32.35; 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.

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 Paperwork Reduction Act, 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 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: May 20, 2011.
Carolyn M. Clancy,
[FR Doc. 2011-13740 Filed 6-2-11; 8:45 am]