[Federal Register: April 24, 2009 (Volume 74, Number 78)]
[Notices]
[Page 18722-18724]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr24ap09-65]
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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.
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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: ``Building an Implementation Toolset for E-Prescribing.'' In
accordance with the Paperwork Reduction Act of 1995, Public Law 104-13
(44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public
[[Page 18723]]
to comment on this proposed information collection.
DATES: Comments on this notice must be received by June 23, 2009.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by e-mail at
doris.lefkowitz@ahrq.hhs.gov.
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
doris.lefkowitz@ahrg.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
``Building an Implementation Toolset for E-Prescribing''
AHRQ proposes to develop and test an electronic prescribing (e-
prescribing) toolset to provide information and tools of sufficient
detail to act as a ``how-to guide'' for implementing e-prescribing
across various organizational settings.
The current system of prescribing and dispensing medications in the
United States poses widespread safety and efficiency problems. E-
prescribing systems have the potential to avert some of the more than 2
million adverse drug events (ADEs) annually, of which 130,000 are life
threatening. E-prescribing also has enormous potential to create
savings in health care costs, both through reducing ADEs and through
more efficient work processes of prescribers and pharmacists. One
recent study estimated the potential savings at $27 billion per year in
the United States. [Johnston D, Pan E, Middleton B, Walker J, Bates DW.
The value of computerized provider order entry in ambulatory settings.
2003 [cited 2003/12/10]. Available from: http://www.citl.org/research/
ACPOE_Executive_Preview.pdf.]
The Medicare Prescription Drug Improvement and Modernization Act
(MMA) of 2003, Public Law 108-173, provided that Medicare Part D
sponsors are required to establish electronic prescription drug
programs to provide for electronic transmittal of certain information
to the prescribing provider and dispensing pharmacy and the dispenser.
There is no requirement that prescribers or dispensers implement e-
prescribing, but those who do electronically transmit prescription and
certain other prescription-related information for Medicare Part D
covered drugs prescribed for Medicare Part D eligible individuals,
either directly or through an intermediary, are required to comply with
any applicable final standards that are in effect.
However, adoption of e-prescribing technology remains limited. On
the surface, e-prescribing involves getting a prescription from point A
to point B. In reality, the complexity of e-prescribing reflects all
aspects of the process from appropriate prescribing, through
dispensing, to correct patient use.
Much current work has been on the adoption of technical standards
that establish a common language, contain technical specifications, and
provide other specific criteria designed to be used consistently as
rules or definitions. While standards are a necessary foundation for e-
prescribing systems, they are insufficient in themselves to insure a
successful implementation. Of equal importance to successful e-
prescribing implementations are appropriate workflows and sustainable
commitment from the various organizations that must participate in such
a system.
This Accelerating Change and Transformation in Organizations and
Networks (ACTION) project will produce a toolset to help a diverse
range of provider organizations, from small independent offices to
large medical groups to ``safety net'' clinics, to adopt e-prescribing
systems and use them effectively in ways that advance the
organization's goals. By enabling the greater adoption of e-prescribing
systems that are effective in improving safety, quality and reducing
prescription drug costs, the project will advance each of the
priorities embodied in AHRQ's mission, which is to improve the quality,
safety, efficiency, and effectiveness of health care for all Americans.
This work is being conducted by the RAND Corporation under AHRQ
ACTION contract HHSA290200600017, Task Order 4, period of
performance--8/1/08-1/31/10. It is being conducted pursuant to AHRQ's
statutory authority to conduct research and evaluations (1) on health
care and systems for the delivery of such care, including activities
with respect to health care technologies, facilities and equipment, 42
U.S.C. 299a(a)(5), and (2) to advance training for health care
practitioners and researchers in the use of information systems. 42
U.S.C. 299b-3(a)(2).
Method of Collection
In order to evaluate the draft toolset's usability and usefulness,
we will pilot test the toolset by studying its effects among 6
practices that are attempting to implement e-prescribing for the first
time. Field researchers will visit each practice before and after the
e-prescribing implementation effort to conduct semi-structured
interviews and observations of work processes. Finally, selected
members of the practices will be surveyed via a web-based instrument
regarding the effort's success and the degree to which elements of the
toolset were helpful.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this project. Pre-test and post-
test interviews will be conducted with 3 physicians, 3 nurses or
clinical support staff and 3 other staff from each of the 6 test sites.
Eight physicians from each of the 6 test sites will complete the
physician survey and 12 other staff from each site will complete the
other staff survey. The total burden hours are estimated to be 168
hours.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondent's time to participate in this project. The total
cost burden is estimated to be $7,423.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
sites site response hours
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Pre-test Interviews:
Physician interviews........................ 6 3 1 18
Nurse or clinical support interviews........ 6 3 1 18
Other staff interviews...................... 6 3 1 18
Post-test interviews:
Physician interviews........................ 6 3 1 18
Nurse or clinical support interviews........ 6 3 1 18
[[Page 18724]]
Other staff interviews...................... 6 3 1 18
Web-based survey:
Physician survey............................ 6 8 30/60 24
Other staff survey.......................... 6 12 30/60 36
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Total................................... 48 (\1\) (\1\) 168
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\1\ Not applicable.
Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form name sites hours wage rate * burden
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Pre-test Interviews:
Physician interviews........................ 6 18 $78.24 $1,408
Nurse or clinical support interviews........ 6 18 30.42 548
Other staff interviews...................... 6 18 14.97 269
Post-test interviews:
Physician interviews........................ 6 18 78.24 1,408
Nurse or clinical support interviews........ 6 18 30.42 548
Other staff interviews...................... 6 18 14.97 269
Web-based survey:
Physician survey............................ 6 24 78.24 1,878
Other staff survey.......................... 6 36 30.42 1,095
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Total................................... 48 168 (\1\) 7,423
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* Based upon the mean of the national average hourly wages for physicians and surgeons, registered nurses, and
medical secretaries, National Compensation Survey: Occupational wages in the United States July 2007, U.S.
Department of Labor, Bureau of Labor Statistics.
\1\ Not applicable.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annual costs of this
project. Since data collection will not exceed one year, the total and
annual costs are the same. The total cost is estimated to be $119,976.
Exhibit 3--Estimated Total and Annual Cost
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Annualized
Cost component Total cost cost
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Instrument Development........................ $12,533 $12,533
Data Collection Activities.................... 33,422 33,422
Data Processing and Analysis.................. 16,711 16,711
Report Preparation/Publication................ 16,711 16,711
Project Management............................ 4,178 4,178
Overhead...................................... 36,421 36,421
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Total..................................... 119,976 119,976
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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 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: April 15, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-9247 Filed 4-23-09; 8:45 am]
BILLING CODE 4160-90-M